The Arthroscopic Trillat Procedure is a Valuable and Durable Treatment Option for Recurrent Anterior Instability Associated with Massive Irreparable Cuff Tears

Abstract

Purpose

The purpose of the present study is to report the mid- and long-term clinical and radiological outcomes of the arthroscopic Trillat for the treatment of recurrent anterior instability in patients with chronic massive irreparable rotator cuff tears (MIRCT) and maintained active shoulder motion. where RSA is not indicated.

Methods

Twenty-one consecutive patients (mean age 61 years) identified and retrospectively reviewed. All patients had recurrent anterior dislocations and conserved active forward elevation (AFE) and active external rotation (ARE). The MIRCTs included a retracted (stage 3) supraspinatus tear in 14%, a supra- and infraspinatus tear in 76.5%, and a 3-tendon tear in 14%. A closed wedge osteotomy of the coracoid was performed, and the coracoid was fixed above the subscapularis with a cannulated screw (10 cases) or suture-buttons (11 cases). We followed patients with x-rays, CT scan at 6 months, Subjective Shoulder Value, VAS, Walch, Constant, and Rowe scores. The mean clinical and radiographic follow up was 58 months (24-145 months).

Results

Overall, 96% (20/21) of the patients had a stable and functional shoulder and were satisfied with the procedure; no patient lost active shoulder motion. The Subjective Shoulder Value increased from 44% (10-75) to 94% (80-100), p<0.001. The Constant and Rowe scores improved from 60 (25-81) to 81 (66-96) and from 54 (35 to 65) to 92 (70-100), respectively (p<0.001).Among the 13 patients practicing sports before surgery, 10 (77 %) went back to sports. At last follow-up, only one patient was revised to RSA.

Conclusion

The arthroscopic Trillat procedure is a valuable and durable option for the treatment of recurrent anterior dislocations in older patients with chronic MIRCTs and conserved active shoulder motion. Level of Evidence. Level IV, therapeutic case series.