A 35-year-old man presents with recurrent anterior shoulder dislocations (4 episodes in 2 years). MRI arthrogram shows a Bankart lesion (anterior labral tear) and a Hill-Sachs lesion engaging with the glenoid rim in external rotation (engaging Hill-Sachs). The bone loss of the glenoid is estimated at 20% on CT. Which surgical procedure is most appropriate for this patient?
- A Arthroscopic Bankart repair (soft tissue labral re-attachment) alone
- B Open Putti-Platt repair (subscapularis shortening) to limit external rotation
- C Latarjet procedure (coracoid transfer to the anterior glenoid) to address glenoid bone loss and provide the 'triple locking mechanism' ✓
- D Total shoulder arthroplasty for recurrent instability
Explanation
When glenoid bone loss exceeds 15-20% (the 'critical' threshold) AND an engaging Hill-Sachs lesion is present, arthroscopic Bankart repair alone has unacceptably high failure/re-dislocation rates. The Latarjet procedure transfers the coracoid process (with attached conjoined tendon) to the anterior glenoid, providing: (1) bone graft expanding the glenoid arc, (2) the subscapular sling effect of the conjoined tendon preventing subluxation in ER-Abd, (3) capsulolabral reinforcement — the 'triple locking mechanism.' This is the procedure of choice for anterior instability with significant glenoid bone deficiency. Putti-Platt is largely abandoned due to ER loss and arthritis.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.