anterior instability

Complications

Subscapularis failure

Rotator cuff failure

Instability

Infection

Periprosthetic fracture

Aseptic loosening

Neurological injury

Parada et al. J Should Elbow Surg 2021

- 2224 aTSA complication rate 11%, revision rate 5.6%

Indications

Engaging Hill Sachs

Causes for failure

1.  Patient factors

A.  Recurrent Trauma

- contact athletes higher risk

B.  MDI / Ligamentous Laxity / Voluntary dislocaters

C.  Poor rehabilitation

- poor motivation

- too rapid

- patients rarely get stiff, better to go very slow

2.  Surgeon Factors

A.  Unrecognised bony defect

Putti-Platt

Concept

Plication subscapularis & capsule

Problems

Loss ER 

Secondary OA if ER < 0°

Contraindication

MDI

- will force head out posteriorly

Technique

Divide SSC 2.5cm from insertion 

- may divide capsule in same plane

Aim

Repair of the anterior capsule & avulsed labrum to anterior glenoid 

- anatomic repair

Usually combined with a capsular shift

Contraindications

Bony bankart > 25% glenoid

Technique

Position

- beach chair position

- arm free

- Mayfield head ring / Spyder and Tmax

Epidemiology

Traumatic initial cause in 95%

M:F 2:1

Age of initial dislocation inversely related to recurrence rate

- patients younger than 20 have a redislocation rate of 90%

- between 20 - 40 years, redislocation rate of 60%

- patients > 40 years have a 10% rate of dislocation but a higher rate of cuff tears (up to 40% in patients > 60yrs)

Anatomy & Stability

1. Passive Stabilisers