Coinflips⎪Shoulder & Elbow⎪Recurrent Shoulder Dislocation s/p Latarjet in 20M
Apr 17, 2025
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Join experts John Tokish, an orthopedic surgeon from the Mayo Clinic with a military background; Desmond J. Bokor, a seasoned professor in orthopedics; and Joseph Abboud, a shoulder specialist from Rothman Orthopedics, as they navigate the complexities of recurrent shoulder dislocations post-Latarjet procedure. They delve into innovative surgical techniques, the importance of tailored rehabilitation strategies, and the unique challenges faced by young athletes. Lighthearted stories about Antarctic adventures add a fun twist to their clinical discussions!
Assessing mechanical factors and pre-existing conditions, like hyperlaxity, is crucial in treating recurrent shoulder dislocations.
Accurate evaluations of bone loss using CT scans are vital, especially when distinguishing between on-track and off-track lesions.
Tailoring surgical techniques, including considering remplissage for large Hill-Sachs lesions, is essential for optimal patient outcomes.
Deep dives
Understanding Shoulder Instability
The podcast discusses a case involving a 20-year-old male with recurrent shoulder dislocations. The expert panel highlights the importance of assessing both the mechanical factors and any pre-existing physical conditions, such as hyperlaxity indicated by a high Baten score, which adds complexity to treating shoulder instability. The case emphasizes that in young athletes, if dislocation occurs during sleep, it raises concern for possible bone loss or significant instability, necessitating careful planning for surgical intervention. Determining the right surgical approach often depends on understanding the patient's activity level and aspirations to return to sports.
Evaluating Bone Loss in Shoulder Surgery
The conversation explores the different methods of evaluating bone loss in shoulder surgeries, particularly in cases of recurrent dislocation. Experts debate between using imaging techniques like CT scans for accurate measurements against relying on visual assessments during surgery. The importance of distinguishing between on-track and off-track lesions is emphasized, as an off-track lesion can significantly impact the surgical outcome and recurrence rates. The panel suggests that a more aggressive approach may be warranted when significant bone loss is present, particularly in contact athletes.
Surgical Techniques and Approaches
The panel deliberates on various surgical techniques for addressing shoulder instability, debating the efficacy of arthroscopic versus open procedures. There is a consensus on the effectiveness of the Bankart repair, yet they note that its success can be compromised by factors such as significant bone loss or poor patient compliance. The experts also discuss the advantages of adding a remplissage procedure to reinforce the repairs, especially in cases with large Hill-Sachs lesions. Ultimately, they stress the importance of tailoring the surgical approach to the unique needs of each patient, balanced against their activity level and expected outcomes.
Post-Operative Considerations and Complications
The discussion shifts to post-operative outcomes and the potential for complications following shoulder surgeries. The panel members share their experiences with recurrence rates, stressing the necessity of adhering to a structured rehabilitation program for patients post-surgery to prevent stability issues. They reflect on one patient's post-operative struggles due to perceived non-compliance, highlighting that both the recovery process and patient education around rehabilitation are critical components of successful outcomes. The conversation underscores the need for continuous follow-up and assessment to address any issues that may arise early in the recovery phase.
Future of Orthopedic Procedures
The podcast concludes with a future-oriented discussion on innovations in orthopedic procedures, particularly regarding shoulder reconstruction techniques. The experts advocate for further research into various grafts and fixation devices, including potential uses for distal radius grafts and advancements in soft tissue techniques like remplissage. They stress the importance of developing procedures that not only improve patient safety but also enhance surgical outcomes. The conversation exemplifies the ever-evolving nature of orthopedic surgery, as specialists continually seek better solutions for complex shoulder stabilization.
