Arthroscopic shoulder instability surgery should not be used in cases that involve bony defects

LAHAINA, Hawaii — Although arthroscopic techniques offer many benefits in shoulder surgery, there are some patients with instability in whom the procedure should be avoided, according to the shoulder section chair of the Orthopedics Today Hawaii 2008 meeting.

William N. Levine

Some of the contraindications are: volunteerism, or the ability to throw one's shoulder out of socket; humeral avulsions of the glenohumeral ligaments (HAGL); and bone defects, William N. Levine, MD, said.

"In general, patients who voluntarily dislocate their shoulders are troublesome," Levine said. "They get to the point where they have involuntary volunteerism, and that is a difficult problem to face."

The HAGL lesions are difficult to handle arthroscopically and better treated with an open procedure, he said.

"Bone defects on the humeral side, the so-called engaging Hill-Sachs lesions, and significant glenoid bone defects that may cause problems with the bony constraints, are also contraindications for arthroscopic instability repair," Levine, a member of Orthopedic Today Editorial Board, said. "In these cases, you may want to think about doing something else, such as a Latarjet procedure or some form of coracoid transfer."

Also in these cases, Levine said, "It really is not a question of open vs. arthroscopic; we have to change our mindset to thinking about this as soft tissue vs. bone repair."

For more information:
Levine WN. When to avoid arthroscopic instability repair. Presented at Orthopedics Today Hawaii 2008. Jan. 13-16, 2008. Lahaina, Maui, Hawaii.