Courtesy: Dr Jacob Varghese, Head, Division of Joint Reconstruction, Lakeshore Hospital, Kochi
- A 24 year old army captain with history of recurrent dislocation.
- Positive apprehension was demonstrated for anterior instability.
- No ligamentous laxity.
- Xrays showed indistinct anterior inferior border of glenoid. Therefore CT scan was done in addition to MRI.
- This confirmed a large anterior inferior glenoid fragment with a Hill Sachs lesions.
- What are the treatment options?
Dr Jacob and colleagues decided to increase the glenoid ARC as descibed by de beers and others.
It is an extraarticular enlargement of the arc with a corocoid transfer
sir,
there is roughly 25% loss of glenoid surface anteriorly. this will need augmentation. i will probably do a rotataed coracoid transfer with biceps attached to act as anterior buttress.
humeral lesion not quantified, if it is engaging in the glenoid rim after coracoid transfer, it will require soft tissue (remplissage) or bony (?allograft) procedure.
saurabh chaudhary
salem,TN
I do agree with the modified latarjet turning the corocoid medial surface where the p. minor is attached parallel to the anterior inferior defect extraarticularly. The suture anchors on the edgeof host glenoid posterior to the corocoid graft attached the remnant of labrum and capsule to keep the corocoid extraarticualr.( Other s dont care is it is intraarticular.
The concept of engaging hillsachs is controversial. All Hillsac’s have to be engaging if parallel to cause the defect, i am told and beleive. It the glenoid defect was smaller. we could consider a remplissage or the latetest tweak Dr. biju pankapilly. J kany”s L paper in Journal of orthopedics on bipolar fixation in shoulder instabilty where in they anchor the infraspinatus to the bare area with no resultant loss of external rotation which is a problem of the standard remplissage.
respected sir,
my name is Dr. Dhaval A. Patel.
i have completed MS Orthopaedics.
i would like to join fellowship programme under you.
i am interested in Arthroscopy and Arthroplasty.
kindly consider me for the same.
thanks..
with regards..
dr. Dhaval A. Patel