Speaker: Arthroscopic bone blocks may be the future of shoulder instability treatment
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Key takeaways:
- Latarjet and remplissage are effective techniques for shoulder instability, but these often have high complication rates.
- Arthroscopic bone blocks may offer an alternative treatment.
WAILEA, Hawaii — Arthroscopic bone blocks may eventually surpass Latarjet and remplissage as the preeminent bone grafting technique for shoulder instability, according to data presented here.
“Bone loss in shoulder instability must be corrected,” John M. Tokish, MD, said in his presentation at Orthopedics Today Hawaii. “The Latarjet is effective for sure, but risks and the technique limit its widespread adoption. The ideal technique should be arthroscopic, anatomic and osteochondral.”
Although Tokish said Latarjet is a widely utilized bone grafting technique, he added that some of the outcome statistics may be misleading.
“Many of the studies do not talk about apprehension as an outcome score,” Tokish said. “And that is high in those patients, 15% to 30%.”
In addition, Tokish said the remplissage bone grafting technique has a higher recurrence rate both as a primary procedure and in revision surgery when compared with Latarjet.
Considering data suggest that Latarjet and remplissage may not be ideal bone grafting techniques in every patient, Tokish said new techniques must be developed to change the way surgeons deliver the bone graft.
“We should develop a technique that will allow us to use standard portals that surgeons know how to use,” Tokish said. “We need to deliver the graft through the interval, so you do not have to do a subscapularis split. That is the most technically challenging part of this operation. If you can do that, you can take nerve injury off the table.”
In the future, Tokish said he believes a change is on the horizon.
“Arthroscopic bone blocks, I believe, will replace the Latarjet and many of our other forms of treatment because it is safer, it is easier and it is just as reproducible,” Tokish said.
He added, “Newer all-suture fixation continues to improve. We have a new version of it coming out soon, and many people around the world are doing this. I think eventually it will replace screws altogether, so stay tuned.”
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Tokish JM. Arthroscopic bone grafting: Why the Latarjet is becoming obsolete. Presented at: Orthopedics Today Hawaii; Jan. 7-11, 2024; Wailea, Hawaii.
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