Management of Failed Latarjet and Off-tract Hill-Sachs Lesion: Arthroscopy-assisted Remplissage and Open Eden-Hybinette Procedure

Summary

Here, we describe a modified technique for arthroscopy-assisted Remplissage and open Eden-Hybinette procedure for patients with failed Latarjet and off-tract Hill-Sachs lesions.

Abstract

This case report describes a 49-year-old former semi-professional judo player with recurrent right shoulder instability following his first dislocation in 2006. He underwent two unsuccessful arthroscopic Bankart repairs due to improper anchor positioning. In March 2020, an open Latarjet procedure was performed to address his ongoing instability, but he suffered another dislocation in January 2023 after a fall. Physical examination revealed a full range of motion, normal rotator cuff strength, and a positive apprehension test. X-rays showed a broken coracoid bone block, screw displacement, and a significant Hill-Sachs lesion. CT confirmed resorption of the previous coracoid graft and an off-track Hill-Sachs lesion. The patient underwent revision surgery, combining an arthroscopic-assisted Remplissage with an Eden-Hybinette procedure. One year postoperatively, the patient reported improved outcomes. Managing recurrent shoulder instability after failed surgeries is challenging. While the Latarjet procedure has a 10% recurrence rate, revision options such as distal tibial allograft and Eden-Hybinette procedures offer promising results. This case emphasizes the importance of combined surgical approaches and individualized treatment plans, particularly for patients with significant humeral bone loss, to enhance stability and reduce recurrent instability.

Introduction

Recurrent shoulder instability is a demanding condition, especially in patients with previous surgical interventions^1,2,3. Soft tissue procedures such as Bankart repair, capsulorrhaphy, Remplissage, and bony procedures such as Eden-Hybinette⁴, Trillat⁵, Bristow⁶, and Latarjet procedure^7,8,9,10 were developed. However, there are still reports for failed Latarjet procedure necessi....

Protocol

This study was approved by the Ethics Committee of our institution and informed consent was obtained from the patient.

1. Put the patient in a beach chair position with an arm holder under general anesthesia and interscalene nerve block.
2. Create posterior, posterolateral, anterior, and anterolateral portals with a No. 11 blade (Figure 3A).
3. Perform a thorough arthroscopic exam with a 4-mm, 30-degree-angled arthroscope to define the location of the Hill-Sachs lesion from the anterior portal.
4. Clean the subacromial bursae with a 5.5 mm shaver blades. Shuttle the arthroscope through the anterolateral por....

Results

One year postoperatively, the patient's reported outcomes showed significant improvements. The Oxford Shoulder Instability Score improved from 26 to 54, the QuickDASH score decreased from 63.6 to 11.4, and the WOSI score dropped from 78.4 to 15.1. One-year postoperative X-rays showed full incorporation of the bone graft without evidence of osteolysis (Figure 5A). A computer tomography scan was performed 12 months postoperatively to evaluate the bone union between the graft and host bone (

Discussion

Decision-making following a failed Latarjet procedure
Numerous studies have confirmed the efficacy of the Latarjet procedure in treating recurrent anterior shoulder instability¹⁶. Despite the generally high success rates, there remains a possibility of recurrent instability following the procedure^17,18,19. Previous research has reported recurrence and reoperation rates around 10%

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
4 mm, 30°-angled arthroscope	Stryker Endoscopy, Michigan, USA		For arthroscopic visualization
4.5 mm cannulated screws	Synthes, Switzerland		For graft fixation
5.5 mm shaver blades, Dyonics	Smith & Nephew, Andover, MA		For arthroscopic debridement
Y-Knot RC all-suture anchor	ConMed Linvatec, Largo, FL		Triple-loaded all suture anchors. Increase the repair area of Remplissage procedure