The Trillat procedure: the man and the technique revisited through the lens of arthroscopy

被引:1
作者
Shekhbihi, Abdelkader [1 ]
Bauer, Stefan [2 ,3 ]
Walch, Arnaud [4 ]
Reichert, Winfried [1 ]
Walch, Gilles [5 ]
Boileau, Pascal [6 ]
机构
[1] Lorrach Dist Hosp, Dept Trauma Surg, Lorrach, Baden Wurttembe, Germany
[2] Ensemble Hosp Cote, Morges, Switzerland
[3] Univ Western Australia, Sch Surg, Perth, Australia
[4] Hop Edouard Herriot, Chirurg Orthoped & Traumatol Membre Super, Lyon, France
[5] Hop pr Jean Mermoz, Ctr Orthoped Santy, Ramsay Gen Sante, Lyon, France
[6] Univ Inst Locomot & Sports, Dept Orthopaed & Sports Surg, Nice, France
关键词
hyperlaxity; massive cuff tears; shoulder instability; trillat procedure; RECURRENT ANTERIOR INSTABILITY; SHOULDER INSTABILITY; BANKART REPAIR; ROTATOR CUFF; LATARJET PROCEDURE; DISLOCATION; OUTCOMES; STABILITY; PROGNOSIS; OPERATION;
D O I
10.1530/EOR-23-0208
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
The Trillat procedure, initially described by Albert Trillat, is historically one of the first techniques for addressing recurrent anterior shoulder instability, incorporating fascinating biomechanical mechanisms. After lowering, medializing, and fixing the coracoid process to the glenoid neck, the subcoracoid space is reduced, the subscapularis lowered, and its line of pull changed, accentuating the function of the subscapularis as a humeral head depressor centering the glenohumeral joint. Furthermore, the conjoint tendon creates a 'seatbelt' effect, preventing anteroinferior humeral head dislocation. <br /> Even though contemporary preferences lean towards arthroscopic Bankart repair with optional remplissage, bone augmentation, and the Latarjet procedure, enduring surgical indications remain valid for the Trillat procedure, which offers joint preservation and superior outcomes in two distinct scenarios: (i) older patients with massive irreparable cuff tears and anterior recurrent instability with an intact subscapularis tendon regardless of the extent of glenoid bone loss; (ii) younger patients with instability associated shoulder joint capsule hyperlaxity without concomitant injuries (glenoid bone loss, large Hill-Sachs lesion). Complications associated with the Trillat procedure include recurrent anterior instability, potential overtightening of the coracoid, leading to pain and a significant reduction in range of motion, risk of subcoracoid impingement, and restriction of external rotation by up to 10 degrees, a limitation that is generally well-tolerated. The Trillat procedure may be an effective alternative technique for specific indications and should remain part of the surgical armamentarium for addressing anterior shoulder instability.
引用
收藏
页码:923 / 932
页数:10
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