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Recurrent Shoulder Instability s/p Bankart Repair in 21M

HPI

A 21-y/o RHD male c/o recurrent left shoulder instability. He reports ~20 instability events (all self-reduced) prior to arthroscopic Prior Bankart repair + remplissage. Now 9 months s/p stabilization, he reports recurrent instability that began ~5 months post-op. Now reports instability while sleeping. He has taken a medical leave from college due to symptoms. He plays golf, soccer, and basketball.

PMH

PE

ROM (all limited by apprehension) FF: 165 ER: 40 (A) 60 (P) IR: L4 5/5 rotator cuff strength Markedly positive apprehension and relocation tests + anterior load and shift No posterior apprehension or laxity

Poll
1 of 9
1. How would you treat this patient?
Nonoperative - PT until the cows come home.
3%
35/1114
Arthroscopic Revision arthroscopic stabilization
5%
65/1114
Open Revision arthroscopic stabilization
4%
52/1114
Latarjet reconstruction (coracoid transfer)
83%
931/1114
Putti-Platt procedure
1%
20/1114
Magnuson-Stack procedure
0%
2/1114
Eden-Hybinette procedure
0%
9/1114
2. If performing a Latarjet reconstruction (coracoid transfer), would you do it open or arthroscopic?
Open Latarjet
89%
910/1020
Arthroscopic Latarjet
10%
110/1020
3. If performing an Open Latarjet, would you perform a scope first in this case?
Yes, I always scope before an open Latarjet
42%
415/985
Yes in this case, but I dont always scope first
15%
149/985
No in this case, but sometime I do scope first
22%
219/985
No, I never scope before the open Latarjet
20%
202/985
4. If doing a Latarjet reconstruction, what do you think is the ideal position for the coracoid graft?
12 - 3 O'clock
8%
82/936
1 - 4 O'clock
14%
137/936
2 - 5 O'clock
36%
340/936
3 - 6 O'clock
40%
377/936
5. If doing a Latarjet reconstruction, do you repair the capsule?
Yes
83%
780/936
No
16%
156/936
6. If you performed the operation seen in postop images, for how many weeks would you keep the patient immobilized in a sling (outside of supervised therapy)?
No sling, I would mobilize immediately
3%
24/792
Sling x 2 weeks
25%
201/792
Sling x 4 weeks
35%
285/792
Sling x 6 weeks
35%
282/792
7. If you performed the operation seen in postop images, when would you begin supervised therapy with passive or active motion?
Immediately
14%
116/777
2 weeks
31%
241/777
4 weeks
28%
218/777
6 weeks
24%
187/777
8 weeks
1%
15/777
8. What is your glenoid "bone loss" indication for a Latarjet reconstruction?
0-10% Glenoid Bone Loss
1%
12/903
> 10% Glenoid Bone Loss
8%
75/903
> 20% Glenoid Bone Loss
55%
502/903
> 30% Glenoid Bone Loss
22%
204/903
> 40% Glenoid Bone Loss
3%
30/903
Depends on other variables
8%
80/903
9. If you routinely do open or arthroscopic shoulder stabilization procedures in your practice, would you perform the Latarjet in this patient or refer it out to a Latarjet specialist?
I would refer it out to a specialist in Latarjet procedures
36%
274/747
I would do it, I do < 5 Latarjet procedures per year
27%
206/747
I would do it, I do 6 - 10 Latarjet procedures per year
13%
98/747
I would do it, I do 11 to 20 Latarjet procedures per year
5%
38/747
I would do it, I do > 20 Latarjet procedures per year
5%
39/747
I don't routinely do open or arthroscopic shoulder stabilization procedures
12%
92/747
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