Advertisement

The Arthroscopic Trillat Procedure is a Valuable and Durable Treatment Option for Recurrent Anterior Instability Associated with Massive Irreparable Cuff Tears

Published:November 08, 2022DOI:https://doi.org/10.1016/j.arthro.2022.10.045

      Abstract

      Purpose

      The purpose of the present study is to report the mid- and long-term clinical and radiological outcomes of the arthroscopic Trillat for the treatment of recurrent anterior instability in patients with chronic massive irreparable rotator cuff tears (MIRCT) and maintained active shoulder motion. where RSA is not indicated.

      Methods

      Twenty-one consecutive patients (mean age 61 years) identified and retrospectively reviewed. All patients had recurrent anterior dislocations and conserved active forward elevation (AFE) and active external rotation (ARE). The MIRCTs included a retracted (stage 3) supraspinatus tear in 14%, a supra- and infraspinatus tear in 76.5%, and a 3-tendon tear in 14%. A closed wedge osteotomy of the coracoid was performed, and the coracoid was fixed above the subscapularis with a cannulated screw (10 cases) or suture-buttons (11 cases). We followed patients with x-rays, CT scan at 6 months, Subjective Shoulder Value, VAS, Walch, Constant, and Rowe scores. The mean clinical and radiographic follow up was 58 months (24-145 months).

      Results

      Overall, 96% (20/21) of the patients had a stable and functional shoulder and were satisfied with the procedure; no patient lost active shoulder motion. The Subjective Shoulder Value increased from 44% (10-75) to 94% (80-100), p<0.001. The Constant and Rowe scores improved from 60 (25-81) to 81 (66-96) and from 54 (35 to 65) to 92 (70-100), respectively (p<0.001).Among the 13 patients practicing sports before surgery, 10 (77 %) went back to sports. At last follow-up, only one patient was revised to RSA.

      Conclusion

      The arthroscopic Trillat procedure is a valuable and durable option for the treatment of recurrent anterior dislocations in older patients with chronic MIRCTs and conserved active shoulder motion.
      Level of Evidence. Level IV, therapeutic case series.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gombera M.M.
        • Gomberawalla M.M.
        • Sekiya J.K.
        Rotator cuff tear and glenohumeral instability : a systematic review.
        Clin Orthop Relat Res. 2014; 472: 2448-2456https://doi.org/10.1007/s11999-013-3290-2
        • Gumina S.
        • Postacchini F.
        Anterior dislocation of the shoulder in elderly patients.
        J Bone Joint Surg Br. 1997; 79: 540-543https://doi.org/10.1302/0301-620x.79b4.7497
        • Neviaser R.J.
        • Neviaser T.J.
        • Neviaser J.S.
        Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient.
        J Bone Joint Surg Am. 1988; 70: 1308-1311
        • Porcellini G.
        • Paladini P.
        • Campi F.
        • Paganelli M.
        Shoulder instability and related rotator cuff tears: arthroscopic findings and treatment in patients aged 40 to 60 years.
        Arthroscopy. 2006; 22: 270-276https://doi.org/10.1016/j.arthro.2005.12.015
        • Rapariz J.M.
        • Martin-Martin S.
        • Pareja-Bezares A.
        • Ortega-Klein J.
        Shoulder dislocation in patients older than 60 years of age.
        Int J Shoulder Surg. 2010; 4: 88-92https://doi.org/10.4103/0973-6042.79792
        • Walch G.
        • Dejour H.
        • Trillat A.G.
        [Recurrent anterior luxation of the shoulder occurring after the age of 40].
        Rev Chir Orthop Réparatrice Appar Mot. 1987; 73: 609-616
        • Bankart A.S.
        Recurrent or habitual dislocation of the shoulder-joint.
        Br Med J. 1923; 2: 1132-1133https://doi.org/10.1136/bmj.2.3285.1132
        • Moseley H.F.
        The basic lesions of recurrent anterior dislocation.
        Surg Clin North Am. 1963; 43: 1631-1634https://doi.org/10.1016/s0039-6109(16)37153-5
        • Craig E.V.
        The posterior mechanism of acute anterior shoulder dislocations.
        Clin Orthop Relat Res. 1984; 190: 212-216
      1. McLaughlin H. Injuries of the shoulder and arm. In: McLaughlin H, Harrisson L, eds. Trauma. WB Saunders; 1959:233-296.

        • Goldberg J.A.
        • Chan K.Y.
        • Best J.P.
        • Bruce W.J.M.
        • Walsh W.
        • Parry W.
        Surgical management of large rotator cuff tears combined with instability in elite rugby football players.
        Br J Sports Med. 2003; 37 (; discussion 181): 179-181https://doi.org/10.1136/bjsm.37.2.179
        • Voos J.E.
        • Pearle A.D.
        • Mattern C.J.
        • Cordasco F.A.
        • Allen A.A.
        • Warren R.F.
        Outcomes of combined arthroscopic rotator cuff and labral repair.
        Am J Sports Med. 2007; 35: 1174-1179https://doi.org/10.1177/0363546507300062
        • Araghi A.
        • Prasarn M.
        • St Clair S.
        • Zuckerman J.D.
        Recurrent anterior glenohumeral instability with onset after forty years of age: the role of the anterior mechanism.
        Bull Hosp Jt Dis. 2005; 62: 99-101
        • Jouve F.
        • Graveleau N.
        • Nove-Josserand L.
        • Walch G.
        [Recurrent anterior instability of the shoulder associated with full thickness rotator cuff tear: results of surgical treatment].
        Rev Chir Orthop Réparatrice Appar Mot. 2008; 94: 659-669https://doi.org/10.1016/j.rco.2008.03.032
        • Boileau P.
        • Gonzalez J.F.
        • Chuinard C.
        • Bicknell R.
        • Walch G.
        Reverse total shoulder arthroplasty after failed rotator cuff surgery.
        J Shoulder Elbow Surg. 2009; 18: 600-606https://doi.org/10.1016/j.jse.2009.03.011
        • Boileau P.
        • McClelland W.B.
        • Rumian A.P.
        Massive irreparable rotator cuff tears: how to rebalance the cuff-deficient shoulder.
        Instr Course Lect. 2014; 63: 71-83
        • Clavert P.
        • Kling A.
        • Sirveaux F.
        • et al.
        Reverse shoulder arthroplasty for instability arthropathy.
        Int Orthop. 2019; 43: 1653-1658https://doi.org/10.1007/s00264-018-4123-4
        • Eden R.T.
        Zur Operation der habituellen Schulterluxation unter Mitteilung eines neues Verfahrens bei Abriss am inneren Pfannenwande.
        Dtsch Z Chir. 1918; 269: 44-53
        • Provencher M.T.
        • Frank R.M.
        • Golijanin P.
        • et al.
        Distal Tibia Allograft Glenoid Reconstruction in Recurrent Anterior Shoulder Instability: Clinical and Radiographic Outcomes.
        Arthroscopy. 2017; 33: 891-897https://doi.org/10.1016/j.arthro.2016.09.029
        • Gerber C.
        • Terrier F.
        • Ganz R.
        The Trillat procedure for recurrent anterior instability of the shoulder.
        J Bone Joint Surg Br. 1988; 70: 130-134
        • Trillat A.
        • Dejour H.
        • Roullet J.
        Luxation récidivante de l’épaule et lésions du bourrelet glénoïdien.
        Rev Chir OrthopRéparatrice Appar Mot. 1965; 51: 525-544
      2. Trillat A, Leclerc-Chalvet F. [Recurrent dislocation of the shoulder]. Masson; 1973.

        • Walch G.
        • Neyret P.
        • Charret P.
        • Pietrapoli H.
        • Dejour H.
        The Trillat procedure for anterior recurrent shoulder dislocations-Long-term results of 250 cases with a mean follow-up of 11.3 years.
        Lyon Chirurgical. 1989; : 25-31
        • Goutallier D.
        • Postel J.M.
        • Bernageau J.
        • Lavau L.
        • Voisin M.C.
        Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan.
        Clinical Orthop Relat Res. 1994; 304: 78-83
        • Nove-Josserand L.
        • Walch G.
        • Adeleine P.
        • Courpron P.
        [Effect of age on the natural history of the shoulder: a clinical and radiological study in the elderly].
        Rev Chir Orthop et Réparatrice ApparMot. 2005; 91: 508-514
        • Zur Noesske.
        habituellen schulterluxation.
        Zentralblatt für Chirurgie. 1924; 51: 2402-2404
        • Boileau P.
        • Saliken D.
        • Gendre P.
        • et al.
        Arthroscopic Latarjet: Suture-Button Fixation Is a Safe and Reliable Alternative to Screw Fixation.
        Arthroscopy. 2019; 35: 1050-1061https://doi.org/10.1016/j.arthro.2018.11.012
        • Bonnevialle N.
        • Thélu C.E.
        • Bouju Y.
        • et al.
        Arthroscopic Latarjet procedure with double-button fixation: short-term complications and learning curve analysis.
        J Shoulder Elbow Surg. 2018; 27: e189-e195https://doi.org/10.1016/j.jse.2017.12.007
        • Dines J.S.
        • Dodson C.C.
        • McGarry M.H.
        • Oh J.H.
        • Altchek D.W.
        • Lee T.Q.
        Contribution of osseous and muscular stabilizing effects with the Latarjet procedure for anterior instability without glenoid bone loss.
        J Shoulder Elbow Surg. 2013; 22: 1689-1694https://doi.org/10.1016/j.jse.2013.02.014
        • Giles J.W.
        • Boons H.W.
        • Elkinson I.
        • et al.
        Does the dynamic sling effect of the Latarjet procedure improve shoulder stability? A biomechanical evaluation.
        J Shoulder Elbow Surg. 2013; 22: 821-827https://doi.org/10.1016/j.jse.2012.08.002
        • Latarjet M.
        [Treatment of recurrent dislocations of the shoulder.] A propos du traitement des luxations récidivantes de l’épaule.
        Lyon Chir. 1954; 49: 994-997
        • Yamamoto N.
        • Muraki T.
        • An K.N.
        • et al.
        The Stabilizing Mechanism of the Latarjet Procedure: A Cadaveric Study.
        J Bone Joint Surg Am. 2013; 95: 1390-1397https://doi.org/10.2106/JBJS.L.00777
        • Boileau P.
        • Gendre P.
        • Baba M.
        • et al.
        A guided surgical approach and novel fixation method for arthroscopic Latarjet.
        J Shoulder Elbow Surg. 2016; 25: 78-89https://doi.org/10.1016/j.jse.2015.06.001
      3. Boileau P, Schwartz DG, Hardy MB, Walch G. Arthroscopic Trillat: a new option for the the cufff deficient or hyperlax unstable shoulder. In: Shoulder Concepts 2012-Arthroscopy, Arthroplasty & Fractures. Sauramps Médical; 2012:193-204.

      4. Boileau P, Seeto BL, Bouacida S, Clowez G. Arthroscopic Trillat Procedure for Recurrent Anterior Shoulder Instability with Associated Irreparable Rotator Cuff Tear. In: Provencher MT, Cole BJ, Romeo AA, Boileau P, Verma N, eds. Disorders of the Rotator Cuff and Biceps Tendon: The Surgeon’s Guide to Comprehensive Management. Elsevier; 2019:325-327.

        • Constant C.R.
        • Gerber C.
        • Emery R.J.H.
        • Søjbjerg J.O.
        • Gohlke F.
        • Boileau P.
        A review of the Constant score: modifications and guidelines for its use.
        J Shoulder Elbow Surg. 2008; 17: 355-361https://doi.org/10.1016/j.jse.2007.06.022
      5. Rowe CR. Evaluation of the Shoulder. (Rowe CR, ed.). Churchill Livingstone; 1988:631-637.

        • Walch G.
        La luxation récidivante antérieure d’épaule.
        Rev Chir Orthop Traumatol. 1991; 77: 177-191
        • Gilbart M.K.
        • Gerber C.
        Comparison of the subjective shoulder value and the Constant score.
        J Shoulder Elbow Surg. 2007; 16: 717-721https://doi.org/10.1016/j.jse.2007.02.123
        • Hamada K.
        • Yamanaka K.
        • Uchiyama Y.
        • Mikasa T.
        • Mikasa M.
        A radiographic classification of massive rotator cuff tear arthritis.
        Clin Orthop Relat Res. 2011; 469: 2452-2460https://doi.org/10.1007/s11999-011-1896-9
        • Hamada K.
        • Fukuda H.
        • Mikasa M.
        • Kobayashi Y.
        Roentgenographic findings in massive rotator cuff tears. A long-term observation.
        Clinical Orthop Relat Res. 1990; : 92-96
        • Buscayret F.
        • Edwards T.B.
        • Szabo I.
        • Adeleine P.
        • Coudane H.
        • Walch G.
        Glenohumeral Arthrosis in Anterior Instability before and after Surgical Treatment: Incidence and Contributing Factors.
        Am J Sports Med. 2004; 32: 1165-1172https://doi.org/10.1177/0363546503262686
        • Swan J.
        • Boileau P.
        • Barth J.
        Arthroscopic Trillat Procedure: A Guided Technique.
        Arthrosc Tech. 2020; 9: e513-e519https://doi.org/10.1016/j.eats.2019.12.004
        • Gendre P.
        • Thelu C.E.
        • d textquoteright Ollonne T.
        • Trojani C.
        • Gonzalez J.F.
        • Boileau P.
        Coracoid bone block fixation with cortical buttons: An alternative to screw fixation?.
        Orthop Traumatol Surg Res. 2016; 102: 983-987
        • Kazum E.
        • Chechik O.
        • Pritsch T.
        • et al.
        Biomechanical evaluation of suture buttons versus cortical screws in the Latarjet-Bristow procedure: a fresh-frozen cadavers study.
        Arch Orthop Trauma Surg. 2019; 139: 1779-1783https://doi.org/10.1007/s00402-019-03269-6
        • Athwal G.S.
        • Meislin R.
        • Getz C.
        • Weinstein D.
        • Favorito P.
        Short-term Complications of the Arthroscopic Latarjet Procedure: A North American Experience.
        Arthroscopy. 2016; 32: 1965-1970https://doi.org/10.1016/j.arthro.2016.02.022
        • Butt U.
        • Charalambous C.P.
        Complications associated with open coracoid transfer procedures for shoulder instability.
        J Shoulder Elbow Surg. 2012; 21: 1110-1119https://doi.org/10.1016/j.jse.2012.02.008
        • Shah A.A.
        • Butler R.B.
        • Romanowski J.
        • Goel D.
        • Karadagli D.
        • Warner J.J.P.
        Short-term complications of the Latarjet procedure.
        J Bone Joint Surg Am. 2012; 94: 495-501https://doi.org/10.2106/JBJS.J.01830
        • Zuckerman J.D.
        • Matsen F.A.
        Complications about the glenohumeral joint related to the use of screws and staples.
        J Bone Joint Surg Am. 1984; 66: 175-180