Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 ...
-
Upload
camron-goodman -
Category
Documents
-
view
217 -
download
3
Transcript of Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 ...
![Page 1: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/1.jpg)
ANTERIOR GLENOHUMERAL INSTABILITY
Jason Phillips
![Page 2: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/2.jpg)
Normal Anatomy:
Labrum increases depth of glenoid
IGHL 10 static check to A/P and inf @ 45-900
SGHL and MGHL play stabilizing roles in lower ranges of abductionInferior Glenohumeral
Ligament Complex
Hunt et al. JAAOS 2007
![Page 3: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/3.jpg)
Normal Anatomy: IGHL complex
forms “Hammock” Anterior band
resists anterior translation in Abd/ER
Glenoid “bare spot” is central
![Page 4: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/4.jpg)
History:
Arm in Abducted/ER positon Was an ER reduction required? Age? Contact athlete/Military? Position? Ultimate goals? End/Beginning of Season?
![Page 5: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/5.jpg)
Physical Exam:
Apprehension-Relocation (Instability) AbER reproduces
symptoms Posterior force
relieves Load & Shift (Laxity)
Grade I – Up face Grade II – To Rim w/
immediate reduction Grade III – Over Rim
Bahk et al. AJSM 2007
![Page 6: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/6.jpg)
Laxity or Excessive
TranslationDoes Not
Equal Instability
![Page 7: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/7.jpg)
EUA is Critical:
Compare translation of BOTH shoulders for any increase in anterior translation
![Page 8: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/8.jpg)
How should we treat the primary event?
Risks for recurrent instability Position of immobiliztion Length of immobilization Meeting patients goals and expectations
![Page 9: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/9.jpg)
Risks for Recurrent Instability
Rowe 1980 1
<20yo = 94% recurrent instability 21-30yo = 79% 31-40yo = 50% >40yo = 14%
Arciero 1989 2
Ave age 18yo (17-22) 3wks of immobilization (position not specified) 92% recurrence if treated nonoperatively
1. Rowe CR. Acute and recurrent anterior dislocations of the shoulder. Ortho Clin North Am 1980;11:253-70.2. Wheeler JH, et al. Arthroscopic vs. Nonoperative treatment of acute shoulder dislocations in young athletes.
Arthroscopy 1989;5:213-217.
![Page 10: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/10.jpg)
Risks for Recurrent Instability
Arciero et al. Arthroscopic bankart vs nonoperative treatment for acute, initial anterior shoulder dislocations. AJSM 1994;22:589-594.
![Page 11: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/11.jpg)
Risks for Recurrent Instability
Group 1 = immobilized IR for 3-4 weeksGroup 2 = immobilized IR until patient felt comfortableGroup 3 = immobilization less than 3 weeks
Hovelius L, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. JBJS Am
2008;90:-45-952.
![Page 12: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/12.jpg)
Risks for Recurrent Instability
Hovelius L, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. JBJS Am
2008;90:-45-952.
![Page 13: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/13.jpg)
Risks for Recurrent Instability
Hovelius L, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. JBJS Am
2008;90:-45-952.
![Page 14: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/14.jpg)
Keys1. Primary
dislocation2. 4wks
immobilized IR
Robinson CM, et al. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. JBJS AM 2006;88:2326-2336.
![Page 15: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/15.jpg)
Bushnell BD, et al. Bony instability of the Shoulder. Arthroscopy 2008;24:1061-1073.
![Page 16: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/16.jpg)
Balg F, Boileau P. The instability severity index score: A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89:1470-1477.
![Page 17: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/17.jpg)
Balg F, Boileau P. The instability severity index score: A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89:1470-1477.
![Page 18: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/18.jpg)
Balg F, Boileau P. The instability severity index score: A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89:1470-1477.
![Page 19: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/19.jpg)
Balg F, Boileau P. The instability severity index score: A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89:1470-1477.
![Page 20: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/20.jpg)
Glenoid Bone Loss: Biomechanical Evidence
Osseous defect at least 21% of glenoid length may cause instabilityItoi E et al. JBJS(A) 2000 Jan
Anteroinferior glenoid defect diminished stability by almost 50%Bone grafting increased stability by 150% to 230%Montgomery WH et al. JBJS (A) 2005 Sept.
![Page 21: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/21.jpg)
Risk Factors for Failure
194 consecutive arthroscopic Bankart repairs; 101 contact athletes
Recurrence in Contact Athletes: Without significant bony defects: 6.5%With significant bony defects: 89%
Engaging Hill-Sachs Glenoid bone loss 25%
Burkhart SS, DeBeer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic bankart repairs: significance of the inverted-pear glenoid and the humeral engaging hill-sachs lesion. Arthroscopy 2000;16:677-694.
![Page 22: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/22.jpg)
Bushnell BD, et al. Bony instability of the Shoulder. Arthroscopy 2008;24:1061-1073.
![Page 23: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/23.jpg)
Burkhart SS, DeBeer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic bankart repairs: significance of the inverted-pear glenoid and the humeral engaging hill-sachs lesion. Arthroscopy 2000;16:677-694.
![Page 24: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/24.jpg)
Bushnell BD, et al. Bony instability of the Shoulder. Arthroscopy 2008;24:1061-1073.
![Page 25: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/25.jpg)
Quantifying the Risk Factor
Cadaveric study : Quantify glenoid bone loss by arthroscopic means
“The bare spot of the glenoid…consistent reference point from which to determine glenoid bone loss…”
Burkhart SS, De Beer JF et al. Arthroscopy, 2002 May
![Page 26: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/26.jpg)
Itoi E, et al. The effect of glenoid defect on anterior inferior stability of the shoulder after bankart repair: a cadaveric study. JBJS Am 2000;82:35-46.
![Page 27: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/27.jpg)
Itoi E, et al. The effect of glenoid defect on anterior inferior stability of the shoulder after bankart repair: a cadaveric study. JBJS Am 2000;82:35-46.
![Page 28: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/28.jpg)
Itoi E, et al. The effect of glenoid defect on anterior inferior stability of the shoulder after bankart repair: a cadaveric study. JBJS Am 2000;82:35-46.
![Page 29: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/29.jpg)
Itoi E, et al. The effect of glenoid defect on anterior inferior stability of the shoulder after bankart repair: a cadaveric study. JBJS Am 2000;82:35-46.
![Page 30: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/30.jpg)
Itoi E, et al. The effect of glenoid defect on anterior inferior stability of the shoulder after bankart repair: a cadaveric study. JBJS Am 2000;82:35-46.
![Page 31: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/31.jpg)
Risks for Recurrent Instability
![Page 32: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/32.jpg)
![Page 33: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/33.jpg)
3B Effect1. Labral repair (Bumper effect)2. Increased bony contact via coracoid transfer (Bony effect)3. Sling effect of conjoined tendon and lowered subscap (Belt or sling
effect)
Boileau et al. Orthop Clin N Am 2010;41:381-392.
![Page 34: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/34.jpg)
Position/Length of Immobilization
Paterson WH, et al. Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. JBJS AM 2010;92:2924-2933.
![Page 35: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/35.jpg)
Position/Length of Immobilization
Paterson WH, et al. Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. JBJS AM 2010;92:2924-2933.
![Page 36: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/36.jpg)
Position/Length of Immobilization
Paterson WH, et al. Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. JBJS AM 2010;92:2924-2933.
![Page 37: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/37.jpg)
Position/Length of Immobilization
Paterson WH, et al. Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. JBJS AM 2010;92:2924-2933.
![Page 38: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/38.jpg)
Position/Length of Immobilization
Paterson WH, et al. Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. JBJS AM 2010;92:2924-2933.
![Page 39: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/39.jpg)
Position/Length of Immobilization
Paterson WH, et al. Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. JBJS AM 2010;92:2924-2933.
![Page 40: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/40.jpg)
Itoi, JBJS 2007 RCT, Level II, 2yr f/u 198pts sling vs 100ER x 3wks (ER group more
compliant (68% vs 80%) ER group w/ reduced recurrence (38% Rel.
Risk)
![Page 41: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/41.jpg)
Itoi, JBJS, 2007
Immobilize 100 ER Must initiate tx early Most effective if
<30yo
![Page 42: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/42.jpg)
Conservative Treatment:
Strengthen GH rotators and scapular stabilizers
Injury Prevention Graduated
Return GOAL –To keep
head centered
![Page 43: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/43.jpg)
Scapular Exercises: Push-up plus Bear hug Seated rows Shrugs Upright rows
Moseley et al., AJSM 1992.Decker MJ, Hawkins RJ, AJSM 1999.
![Page 44: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/44.jpg)
Arthroscopic Repair after Primary Event?
![Page 45: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/45.jpg)
Arthroscopic Repair after Primary Event?
![Page 46: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/46.jpg)
Results of Arthroscopic Repair: Contact Athletes
Sample Follow Up Recurrence
O’Neill JBJS 1999
41 52 months 5%
Mazzocca AJSM 2005
18 37 months 11%
RobinsonAOSSM 2006
28 51 months 7%
![Page 47: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/47.jpg)
Risks after Primary Repair
Porcellini G, et al. JBJS AM 2009;91:2537-2542.
![Page 48: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/48.jpg)
Risks after Primary Repair
![Page 49: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/49.jpg)
Results of Latarjet At 15yrs, 98%
excellent or good At 15yrs, only
4/118 redislocated (3%)
Hovelius L, et al. JSES 2004;13:509-516.
![Page 50: Jason Phillips. Labrum increases depth of glenoid IGHL 1 0 static check to A/P and inf @ 45- 90 0 SGHL and MGHL play stabilizing roles in lower.](https://reader036.fdocuments.us/reader036/viewer/2022062719/56649ef05503460f94c008bb/html5/thumbnails/50.jpg)
Tibial Plafond Allograft