A 45-year-old presents with recurrent anterior shoulder dislocation. Radiograph reveals a Hill-Sachs lesion occupying 25% of the humeral head and a glenoid bone loss of 30% (inverted pear glenoid). The Instability Severity Index Score (ISIS) is 8. The most appropriate surgical treatment is:
- A Arthroscopic Bankart repair
- B Open Latarjet coracoid transfer procedure ✓
- C Bone block augmentation with iliac crest graft (Eden-Hybinette)
- D Remplissage (posterior capsulodesis into Hill-Sachs defect) alone
Explanation
Glenoid bone loss >25% (inverted pear glenoid) is a predictor of failure of soft tissue Bankart repair — a recurrence rate approaching 70% at 2 years. The Latarjet procedure transfers the coracoid with conjoined tendon to the anterior glenoid rim, achieving three effects: (1) bony augmentation of the glenoid arc, (2) sling effect of the conjoined tendon blocking subluxation in abduction-external rotation, and (3) subscapularis reinforcement via the capsule. Arthroscopic Bankart (A) alone is contraindicated with significant bone loss. Remplissage (D) treats the humeral head defect (Hill-Sachs) but not the glenoid bone loss.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.