Purpose
The purpose of the present study is to report the mid- and long-term clinical and
radiologic outcomes of the arthroscopic Trillat for the treatment of recurrent anterior
instability in patients with chronic massive irreparable rotator cuff tears (MIRCTs)
and maintained active shoulder motion where reverse shoulder arthroplasty (RSA) is
not indicated.
Methods
Twenty-one consecutive patients (mean age 61 years) were identified and retrospectively
reviewed. All patients had recurrent anterior dislocations and conserved active forward
elevation and active external rotation. 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 and computed tomography scan at 6 months,
along with Subjective Shoulder Value, visual analog scale, 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 < .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 < .001). Among the 13 patients practicing sports before surgery, 10 (77%) went back
to sports. At last follow-up, only 1 patient was revised to RSA.
Conclusions
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.
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Article info
Publication history
Published online: November 08, 2022
Accepted:
October 26,
2022
Received:
December 14,
2021
Footnotes
See commentary on page 946
The authors report the following potential conflicts of interest or sources of funding: P.B. received support from Smith & Nephew to develop specific instruments and implants used to perform the arthroscopic Trillat procedure described here. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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