Good morning, I'd like to thank Dr. Kelly, Dr. McIntyre for their very kind invitation to present at this meeting and for their very lavish hospitality to date. So I have no disclosures relating to this talk. In Ireland, Cull Ireland is the land of saints and scholars, but we're also pretty famous for our collision sports, so we play a lot of rugby and we also play Irish sports, including Gaelic football and hurling, which generate a significant number of severe shoulder injuries. So in our country, landshade has become more popular, particularly dealing with bipolar bone loss, off-track lesions, our collision players, poor tissue and failed arthroscopic cases. And we've recently published a paper showing the superior results of open LATICHE over both arthroscopic and open Bankart in relation to recurrent dislocation and instability and also improvement in return to play and in row score. And Dr. Romeo's group have also shown an increase in the use of the LATICHE procedure, particularly in the northeast of the U.S. So proponents of the arthroscopic LATICHE would say that it's better in terms of grass placement, dealing with common pathology, easier conversion to open if the tissue is or to arthroscopic LATICHE if the tissue is poor, quicker rehab and better cosmesis. My task this morning is to convince you otherwise. So in terms of recurrent instability, we've performed a meta-analysis of 896 patients. So although not statistically significant, there has been a trend towards better row score, external rotation, total recurrent instability in the open group. However, the most concerning feature we discovered was that in the arthroscopic LATICHE, at least a third of patients will have persistent apprehension. When one looks at the complications, although not statistically significant, there is a trend for a higher requirement for revision procedures in the arthroscopic group and an increased number of neurological complications in the arthroscopic group. Graph placement has been looked at in a number of patients and generally there's more favorable graph positioning in the open technique in both the medial lateral and the superior and inferior planes and also the screw position and level of the subscapular split has been better in the open LATICHE. Operative time and costs are always important and the operative time of the arthroscopic LATICHE, not surprisingly, is longer. This comes closer to the open technique after a learning curve of 20 cases, but it remains significantly different. In Ireland, the cost of the LATICHE saw blade and the two screws necessary for the procedure come to $100. Other authors have looked at the increased cost of the arthroscopic technique and it's in the order of 2.3 times higher than a open technique. The arthroscopic LATICHE proponents often suggest that the cosmesis is better with the arthroscopic technique. One requires at least five and up to eight portals for some of these techniques and these often give very conspicuous and often unattractive scars compared to the open technique where one can perform the open technique through a low auxiliary approach as in this patient of mine, the female. The rather tattooed gentleman is in fact an MMA fighter and he was very keen to make sure that his other opponents wouldn't know that he'd had surgery. So in this case, we performed a delta pectoral approach on the patient, but also a delta pectoral approach on the bird, which nicely hid the scar. So in my personal experience, approximately 40% of our instability cases are LATICHEs. We've had thankfully a low re-dislocation rate, we've found to be safe and reliable. Thankfully I haven't had any significant neurovascular complications and the operative time has been on average, we looked at our last 100 cases have been 43 minutes with either myself or my talented fellow performing the case. So in my mind, I don't think we should change a winning formula, it's reliable, low recurrence rate, low complications, it's reproducible, the equipment is available in any OR, it's inexpensive comparatively and it allows efficient use of the OR time. So thank you for your attention.

LATICHE procedure

shoulder injuries

open LATICHE

arthroscopic LATICHE

recurrent dislocation