All right, so we'll talk about some bone loss here. I always thought the humeral side counted as bone loss as well, but I guess it's different. So questions or comments from the first session? Just to kind of get that off. Everyone was good with that? Great. So I'm going to start with case four here, because that's how we do it. So we have this great faculty up here who's going to really probably take me to task here, but we'll go ahead and do this. So first case, 27-year-old male, histories of shoulder dislocations for years. Had an arthroscopic bank heart in 2019 that failed. Had an open lateral J in August of 2021 and did well initially, but while working on a car was really pushing and pulling some things and felt a pop in his shoulder, and then he suffered a few dislocations following that. So on his examination, he has a well-heeled vertical incision, and that's his range of motion there. Good rotator cuff strength. Really no deficits at all. Axillary nerve was good. These are his radiographs. Brian, what do you think? Just a really sad state of affairs, you know? Like whenever they shear off, you kind of always hope they're in the midsection, not at the tip, because you're already thinking about what you're going to have to do to get that out. So ultimately, root cause analysis, it looks like you have a pretty atrophic piece of bone there. So you've got some floating screw heads. You've got the washers there to triangulate. There's a ton, I see, on the hill sacks, but we'll get some advanced imaging to show that. So Bogdan, anything else you would glean from that? Hello? No, I think Brian pretty much stated everything that I was looking at, and I also would like to see a CT scan. Okay. I just wanted to point out, so that view on the lower right, that's a Bernoulliot view. Does anyone get that standard in their office for instabilities? Yeah, so that's a little different type of view that you get. We get it kind of standard on all of our instabilities just because... Bill, I have a hard enough time getting a Grasci view. How are you coaching people up on getting this, maybe? Well, we have our own techs, and we... Private practice, okay, gotcha. So it becomes institutional. They train each other as they do it, as they kind of move through. And if you Google it, there's a photo of how to do it, and they just put their hand behind their head like this, and they put the plate down here. And so we print it out, and we put it in the radiology suite, and so we tell the techs, anyone that says they've had a shoulder pop out, get that x-ray. It's like a standing striker view is really what it is. Yeah. It's just, yeah, kind of try to flip the stack over. Unless they've dislocated yesterday, then we don't try and get... I've only had one dislocate in the office doing this, only just once. So we did get a CT scan, and it showed what you think it'd show. So it was anterior glenoid bone loss with a non-united coracoid. You're not going to show us? No, I'm not going to show you. Yeah. No, I'm not going to. Well, I mean, the issue is that, first of all, I don't have it. You didn't get one, did you? You just went straight to the DTA. Straight to the DTA. Yeah. No. So, Mike, give me your thoughts. What are you thinking with this? What would be your... So standard CT, there's nothing fancy in this. The standard CT scan, you know... I think this case is going to suck. And I'm going to be kind of excited when I book it, but the day that it comes, I'm going to be dreading it. Because going back on an open shoulder after a Latergé is hard, because you don't have a coracoid, and the subscap is all scarred in. You lose all your normal landmarks, right? Like, you don't have the lighthouse that we're used to. So I agree with exactly what Brian said. You know, there's an atrophic piece of bone. Those screw heads are broken off. I think you're going to need to make this up with a large chunk of bone, which for me would probably be DTA. You could do Iliac crest, but I think with DTA, you can maintain some of that cartilage. And the tricky part is going to be if you're going to try and take those screws out or go around them. So they're cannulated screws, so you could get a wire in it and have trefines available to try and trefine through it, which is what I'd probably do, because they're going to be... One of those screws is going to be right where you want to put a new screw. So I think I would plan to... And then subscap management too, you know? If you feel confident, do it through a subscap split. If you don't feel confident, do a tenotomy. Take the whole subscap down, you know? And the coracoid is not going to be in your way, conjoined tendon is not going to be in your way. You could do a full subscap tenotomy, take your time, take out that bone, prepare the bony bed, cut your DTA, get those screws out with the cannulation system and some trefines and then put in two new big screws. That would be my plan. Any other concerns about taking out those screws, Brian? You know, what I was going to say is maybe you could split the goal posts and do a suture button fixation. That's another potential thought or idea, because, you know, that hardware removal of this sort always gives me cold sweats, you know? And the trefines can shear the screws off, you know? These are titanium, so you know they're incredibly friable and likely to strip, and so you may go through all that effort. So I would have a suture button-based construct available on backup or a bone block or both. Would you try and split the goal posts with another screw? I was thinking more a suture button, adjustable suture button. You'd do that, yeah. It'd be a little more forgiving on the drilling across. Do you worry at all with suture buttons with the failure rates of, you know, graft resorption with the buttons for allograft that Cliven Wong's shown? Frozen, though. Not fresh. Not been proven. And then if you look at distal clavicle, distal clavicle shows higher rate of union. Granted, there are some conflicts, but the French data suggests there's a pretty high rate of union. Comments from the audience so far? Any other thoughts as we move through this? My concern with those screw threads are exactly that. I mean, what I get concerned about is the guy who has to do the total shoulder on this that has just lined up metal, you know, that's underneath everything. But on the other hand, I'm really worried about glenoid neck bone loss, trying to use those trefines and trying to get that in there and just then you have nothing to fix to anything. Takes a big hole. Yeah. Yeah. So DTA, was there any other – you said iliac crest. Any other graft options you would think of? I mean, you really kind of don't have a whole lot here. You're not going to go to the contralateral shoulder and use that coracoid. You're not going to – you know, there's not a whole lot else to do here, right? Any other thoughts for grafting? I haven't yet done this, but I mean, there's – a scapular spine has been described. You know, distal clavicle has been described as well, and I think that that's a good graft option with low morbidity. But I think that you – it does look like a pretty significant amount of glenoid bone loss, so I do think DTA is probably more reliable here. So that's what I did. I went to – I did a DTA, but I did it arthroscopically. So I did Ivan Wan's technique in a revision setting. So – You're a madman. So the nerves are always there, whether you're doing it in the scope or not, right? To be honest, this is probably how I would have done it as well. I think arthroscopically, you can just kind of peel everything back and not worry so much. I was really trying to see if I could actually re-fix that coracoid piece, and that bone is just terrible. There is just nothing there to fix. It just fell apart every time I grabbed it. So that's the subscap split. That's what it looks like from internal. But you've got to find the upper – I've got to find the superior edge of subscap. So you can see the bone graft still sitting there, but that's where they put the graft in initially, and there's upper edge of subscap. So the concern with this, of course, is I've lost the lighthouse, right? So we know we've got to stay kind of high and lateral to stay away from the plexus. So I just have to – you have to define your anatomy. So it's amazing the amount of scar going from inside out, and this is – as Mike was saying before, you try to do this outside in, it's even worse, because you can't – you're not seeing the anatomy as you're coming in. But getting all of that stuff out of the interval just really scars in there afterward. You can see how thick that is. And you really want to make sure that we have the upper edge of the subscap and the subscap itself well-defined. So I'm going to clean off all of this back tissue scar as well that's on the subscapularis, because that's really the only point of reference I have as to where the neurovascular structures are. So we're going to clean off all of this scar here. And then I want to also be able to just make sure, again, that I know exactly where that – because you'd normally be looking for a conjoined tendon in the front there, but there's all this – all this tissue just kind of forms – the shoulder's pretty amazing at all this stuff that will reform after you kind of do these. So we're just going to get all of this tissue off the top edge of the subscap. And then I can feel comfortable that I have a well-defined anatomy that I can see where things are. And you kind of have an idea where the coracoid would be, and you know if you stay a little bit high and use Ivan Wong's technique, you should be able to get the graft in to where you need it to go. So again, this is now switching the scope to the anterior superior portal. So you can see the amount of bone loss that they were dealing with before. You know, they needed a lateral J before, so you know that's not going to grow back at all. But here's where the screws are. And Mike, this is – I mean, actually, I like the comments, because when I went to put this graft in, I actually put the guide wire for those cannulated screws right through the other screw. And so they're right where you need to go, but they're just not easy to get. You can't even see the edges of the – you can't even see them there. They're buried within that neck there. You could probably get a little better view if you had them open there. But through the scope, there's just really no shot at that. So we come in with our switching stick from the back. We're going to push down the upper edge of subscap. And you really had to loosen that up enough to get the right angle to be able to get the bone graft in, just like you do normally. But even more so, after an open procedure, it can really get scarred in there, so it's hard to get it low enough. So I usually put a little mark on the bone there as to where I kind of want to bring the graft in. And this is just dilating through the pec major to be able to bring the graft in. You guys can criticize anytime you want, because just – if you need more time to criticize, you can start now. And then we'll bring the graft in, so we can line that up. We're all waiting for the collision course of screws that I know you're not going to – It's been edited out. These are edited videos. Like I said, I did have a problem putting the drill down initially. One of the guide wires went right through the cannulated screw, so I had to adjust it a little bit. Do you know if those are the same generation screws that were used for the first one? Different companies. Yeah, this is the Latter-day Experience screws. These are beefier screws than what was in before, yeah. So that's what I did there, and then that's what it looked like post-op. So I don't envy the total shoulder guy coming up with that. All right, give me some critiques. Bogdan, critique that. What do you think? Well, I mean, I think you did a really good job working around complicated hardware. I think the graph may be a touch higher, but I think you also have your ceiling effect probably still functional from the Latter-day with the graph still kind of stuck through the conjoint there. So I don't think I worry so much about graph positioning here. On the axillary, it's perfectly – the subchondral bone is perfectly flush with the subchondral bone of the native glenoid, which is how you want it. And then there isn't a lot of screw divergence there. It's sort of aiming the right spot. There is the hillsacks, which I didn't really get a good appreciation of either on the intraoperative view or would have liked to have seen on the CT scan, because sometimes I do address that as well in addition to the bone, especially because it's the third go. I might have considered something there, but – Yeah, nice, nice. So Brian, so maybe some hints on doing this open for your experience, and then would you do a remplissage on this if you saw a larger – because he does have a bit of a hillsacks there. Yeah. I mean, this is where I would employ the glenoid tract concept, because I think that's helpful for identifying when the Latter-day is not enough or when your DTA is not enough. I was going to ask you a question, if you don't mind, real quick. How did you size this out, because it looks like you had a megagraft here, and then that begets conversations about reabsorption. Are you trying to restore that to 100 percent, 110 percent? Give us some guidance on that. So using the glenoid tract concept, I just was going to make up the difference on the front side. Yeah. That's what my thought was. I did a standard 15-millimeter-wide graft, and I don't think he had that much bone loss in the front, but he needed enough to have the reabsorption, so there will be some absorption, I assume. You've got a pontoon boat there. I love it. Yeah. Do you try and measure that preoperatively on your CT scan so you have some idea of the dimensions? I try to. There's not a great way to do it. Some of the planning programs, really, on the total shoulders, they'll have an AI thing in there where you can reconstruct the native glenoid. I've used that before. It's kind of off-label, but I've used that before to give me an idea of what's missing on the front. So to take a CT scan for a bone loss case and actually put it onto the planner for the total shoulders so I can get an idea of what the loss is on the front, so just to get an idea beforehand, because I have a hard time doing it. Does anyone else have a good idea of doing that? Yeah. So I've started 3D printing these cases. I bought a 3D printer a couple of years ago and learned how to use it. So 3D printing them, then you can just measure it off of the model, and it's pretty cool to do that. Do you have to look at the accuracy of your 3D printer? I mean, do you have concerns about that not being that accurate? I'm living in blissful ignorance on the accuracy of the printer, but yeah. But it's really cool. Yeah, it seemed to have worked so far. It seems to me you could use just the contralateral side, too, to re-approximate what the pre-morphin anatomy is. The other reference I'd put out there is Emilio Calvo has just released his revision Latter-day Experience, or failed Latter-day Experience, and they've predominantly used Iliac Crest as their workhorse. So I'd encourage you to take a look at his algorithm. It's quite good. Hey, Bill, can I make one other comment on the open? Sure, please. So I have a very limited—I think I've done three of these revisions open, non-arthroscopic, and I've gotten more comfortable with open because you don't really have to get into where the conjoint tendon is. If you work your way lateral, like you're doing a shoulder arthroblasty, and then just expose the subscap and do a subscap tenotomy and dissect that off of the capsule, kind of like you're doing an open bank heart repair, then all of that stuff just kind of goes medially with the subscap flap. And it's not like it's easy. I'm not saying it's easy, but it's not like you have to dissect out the brachial plexus to get into that area and do the revision. Yeah, for sure. Mike, so yeah. I totally agree, and I think whether you choose to do a subscap tenotomy or a peel, whatever you're more comfortable with, you're peeling everything off medial. And then your view of the glenoid is amazing, you know, because you can view that whole thing to get out the old hardware if you choose to, and it's easy to bovie down the medial glenoid next. You can create a nice big pocket. I have not done that arthroscopically. That was beautiful. I think one other point, if you ever do a DTA with the coracoid intact, you might have to take down the conjoint tendon to get it at the right angle because the conjoint tendon is fighting you so much. You can't get it parallel with the glenoid. So if you're doing one as like a primary case, be prepared to cut the conjoint tendon to get your approach exposure and then repair it back at the end. So I mean, to Rob's point, when you look at the anatomy of some of these things, the coracoid, the tip of the coracoid is sometimes in line with or sometimes lateral to the plane of the glenoid. You can see that on a 3D print for sure, and you'll know when that coracoid sits lateral on the CT that you're going to have to work to get that host to your switching stick through, lateral to conjoint, and then back down so you can drop your graft in the right area to what you're saying there. So in ROR, they make those really big switching sticks. You can't really fit your scope over them, but those work really well to come in from the back to be able to push the head lateral so that you can come over the top of the subscap and then stay lateral to conjoint and drop back in again. For those tough ones where the coracoid's really overhanging, you can do something really cool and cut the coracoid at the base and use that as a graft. Okay, that's a good segue into the next one here. All right, next case. Sorry, any other comments with that? Any questions from the audience? Would anyone do anything different? I'm just curious on all the faculty, like how many of you have switched to bottoms instead of screws or any kind of, any? Everybody's using screws? I've done it both ways. What do you prefer? I've gone back to screws. Why? He likes screwing. I still use cannulated. I still use cannulated. Cannulated with the exception of the knuckleheads, those are solid. Cannulated as well. It's partial union when you sell buttons. It's non-union when you sell screws. I think he's even admitted that he gets some fibrous unions, but he says they're still stable. Yeah, I mean, you know, I think there's a little bit longer healing associated with the buttons as well than with the screws. There's a microphone on your thing that we just can't hear you very well up here. There's a green light that comes on. Okay. I think Ivan has talked about the glenoid wants to be the width it wants to be. And so with these large graphs, sometimes there'll be some absorption and the screws will stick out. I've had to take a couple of mine out. I'm just curious if you've had that experience as well. I think most people feel better with the rigid fixation of screws, but that's the trade-off with the button. For sure. And I think he'll also say that if the graft is remodeling before you get union with buttons, you can get some toggle so your graft might slip a little medial. Whereas with the screws, it's going to hold it there until it fully incorporates. For better or for worse. For better or for worse. So I think, like Theo, I've done both. I've gone back to doing screws. I think I would do buttons for an autograft. So if you were going to do an arthroscopic distal clavicle bone block where you just need six weeks for it to heal, I think that'd be great for buttons. But for any type of allograft, I think I'd still prefer screws. All right. We've got nine minutes. We'll run through one quick case here. So another case, 19-year-old male traveling hockey player. So lives away from home to get into these fancy schools for the pro hockey things. Right hand dominant. He has left shoulder instability. Had initial dislocation back in March of 2022. Was self-reduced. Had physical therapy. And then in June of 2022, taking a slap shot, dislocated and was reduced by the trainer. Underwent a spank heart repair in 2022. And then in October of that same year, dislocated again playing hockey. And he's had some persistent pain since that time. So physical examination, again, healthy appearing, nerves intact, full range of motion. He has apprehension and pain with glenohumeral glide testing. So here are the images again. Mike, anything outstanding on those images at all? No, not really. There's not much of a HillSax defect there. It looks like a shallow HillSax defect. And there's probably a little anterior glenoid bone loss. And then just to our points earlier, that's how you take a Berner-Joe view. This glenoid is not the glenoid. I'm not showing that because that's what was really there. But that's how you shoot a Berner-Joe view. So here are the imaging. So these are just kind of the biggest cuts I have. So I don't see a whole lot of glenoid bone loss. He does have a HillSax. And then there's the 3D CT. So, Mike, glenoid bone loss was calculated around 13%. It was an on-track lesion. So, Bogdan, what do you think about that? Yeah, I mean, this is very much the patient population that I deal with. You know, we get a lot of hockey players with these. I mean, I think at 13%, especially given the revision setting, whether there's significant bone loss or not, I'm going to a bony procedure on this patient for sure. And I think, like has been stated previously, very low threshold to do a remplissage. I actually had a player. I put together the case I can show you after. But a player, 16, I did an arthroscopic latergy on him, went well six months out, went back to playing, and he re-dislocated after a check. The grout was fully healed, well-positioned, and his HillSax was technically on track by about 10%, and he's still re-dislocated. He went back and did a remplissage on him. So I think remplissage I would consider in addition to a bony procedure here. Yeah, the glenoid track only helps when there's no one helping you dislocate your shoulder like in hockey. When you've got another guy helping you do it. So I don't disagree. But let's go back to the initial procedure, though. So he had this done in June, and he was back playing hockey in October. So probably not recommended to begin with. So being as this is a failure now, maybe of just him being a knucklehead, as Brian would say. I mean, would you consider going back in and doing a revision Bankart with a remplissage this time? Is that a thought at all or no? I think if you were going to consider that, I would do an open Bankart. And so you could stick the scope in and do a remplissage and then open him up in the front with a subscap split, and you could do an open Bankart and add a remplissage. In a collision athlete like this, it still makes me nervous, and I would probably feel better about doing a Latter-Jay with a bony procedure and adding the sling. Any thoughts, Larry? Any thoughts? Would you do anything different there? Yeah, it's a complicated problem, right? And I think I would tend to agree with Mike. In a really active, high-energy, high-activity, high-contact guy who's failed like this, I'd probably do a Latter-Jay. Buddy and I published an article a number of 12, 15 years ago on remplissage, and we had two groups. One was we did the remplissage in the index patients, and one we did the remplissage in the revision arthroscopic Bankarts, and we had a 36% failure rate when we did it in the revision setting. So I think it speaks to doing the remplissage at the index operation almost always. I agree with what's been said, and it doesn't probably work quite as well in a revision setting, although when I do a revision Bankart, I always do the remplissage. Okay. Yes, sir. I think if you look at that casting, it's OK. Yeah, I mean, it's a year and a half out now is the thing. So it's, you know. All right, and other thoughts? We did a Yellow Journal article on the failed bank cart repair. And it was funny, when we assembled the section on revision arthroscopic labor repair, there was like three studies. And they were all abysmal. So I feel like you've got to know your audience. And as a young junior hockey guy, this is a Latter-day all the way. Yeah, I think the success rate, the failure rate with revision bank cart after a failed bank cart is still 20% failure rate. You know, it's like probably a little worse than a primary. Not better. So Brian, give us your top three tips on open Latter-day in this setting. What are your tips to this? Maybe a little bit of dogma first. I scope all of them. Because every once in a while, I'll be surprised by loose body, bucket handle slap, something that I may not fully appreciate. So for me, I feel like that backs up Steve Burkhardt's data on that. Next is patient positioning is key. So posting the medial border of the scapula. I usually get them on a standard OR bed, no head positioner. And make sure that it delivers and really broadens the chest. Third is, or second is then your retractors. We've got this little triot retractor, at least that's what we call it. It's like a three-pronged retractor that's bent. And it really allows us to deliver the glenoid even when the coracoid's intact. So I think that's key. And then, you know, the third is try to strive as much as you can for collinearity with the articular surface. I think that can't be understated. Use TXA on all those cases? When I remember, truthfully. Can I make a point too? Oh yeah. One other thing, tip that I learned from someone that's spent time with Jill Walsh is the incision is more like a chest incision than an axillary incision. And so it's almost like you start the coracoid and you go straight down. And that really helps with getting parallel with the articular surface, especially in somebody that's got a big pec that you're not fighting it as much. So when I started, I was doing an axillary incision and now I make it even more medial and it's helped with the screw trajectory. I don't know if you guys have had a similar experience with that or where you make your skin incision. I find also for screw trajectory, it's helpful if you, at least when I don't do them open, but if I'm doing arthroscopic, basically for elevating the shoulder internal rotation, that detentions the subscap and the conjoint tendon, well, conjoint, you'll have taken it, but it detentions the subscap, so it allows you to kind of work your way more medial for your trajectory. So I did an arthroscopic Laterge in this. Sensing a theme, Bill. Was that? Sensing a theme. I hate incisions. So you can kind of see that the glenoid loss there, you can kind of see that the injury there in the front. So what we didn't have in the other case is the conjoint. So we want to define lateral side of conjoint. So we want to make sure that we get all this adventitial off the lateral side of the conjoint tendon. You can clear that up there because we want to have a clear path for our insertion instrumentation. You can see lateral side of coracoid there. So again, we use this large switching stick to come from the back. I do these, I think I feel safer doing the Laterge, doing my coracoid split before I take the coracoid, do the coracoid osteotomy. It allows me to keep that conjoined tendon to where it needs to go. So I keep my switching stick in place, and that defines the medial side of my split. So I'll just go from the switching stick, then lateral. With the electrocautery to create the split. So I have a little bit of control of where the axillary nerve would be by keeping that intact. When you take down, when you do that, if you do the osteotomy first, I think you run into problems of knowing where you are. So we just have to get the rest of this capsule. I'll clear it off in there. You can see as we come through the subscap here, we can get down to the glenoid. And then the way I like to do the medial split is to take this, this is called the channel, or you can put that right through our portal, directly under the neck, and then externally rotate the arm. I just do it bluntly. You just externally rotate there, and that thing dissects right into the muscle belly. And then we have to take off, that's taking off pec minor. You have to take that off. You just don't go too far medial to get in a musculocutaneous nerve. You can see now the coracoid's pretty well defined, and then we just have to put our fixation in. So guide wires. Bogdan, is this how you do it? Is this the system that you use for this? It's the same system. Very similar so far. Where are you viewing from here, and do you have a 30 or a 70? Just a 30 degree scope. I do, you do have to switch, so it's kind of a more of an anterior portal, because you want to watch, when you do use the subscap split, you want to be more on FOS, instead of trying to look around the corner. So I just change it so that the scope's about here, and my entry portal's about here for the graft. So we have to make our stress risers at the base of the coracoid. And then we'll just use a osteotome. You have to make sure you get these good, so you get a nice split there, so it doesn't fracture the graft. So we can take that off. Have you ever splintered into that proximal or posterior drill hole before? No, but thanks for that though. No, I haven't. I make sure that I'm well, you know, three or four millimeters posterior to it. I've started preparing the undersurface of the coracoid while the coracoid is still in place, because I find that once you osteotomize it, it starts to get a little bloody and harder to see. Yes, yes, so this is me working through that. Yeah, exactly, exactly. You can do that, but my only concern with that is, is what Brian's saying, is I get a little concerned about it splitting where I don't. I try to avoid the base, and you do it more kind of at the tip. Yeah, so you can make a nice flat area for their graft. Now, the nice thing with this is, if you want to pick one thing nice about the arthroscopic Latter Jay, is that a lot of the musculocutaneous nerve injuries occur on those guys with the very large pecs that you've got to pull that graft. You have to exteriorize the graft to get it down and get it, and that can pull on the plexus as you're pulling that out and you're doing that blunt dissection. In these, it's all right there. You don't have to exteriorize the graft at all. So once we get it realigned there, and you want to get a graft, just like with the open, you want to get it aligned with the subchondral bone, not necessarily with the chondral surface, because you'll be lateral. And both of you use a shoulder positioner, MayoStan, what would... Basically, for me, it's just, it's the arm just kind of sits like this the whole case. Yeah. I use the spider, just because I'm used to that. And then that's what it looks like once it's all down there, and then post-op x-rays. So we're right at the end here, but any quick critiques of that, Mike, Brian? Oh, that looks great. Nice case. You're still shooting for about three to five o'clock for your arthroscopic? Yeah. I mean, I think that's pretty good there. You know, like the other one was a little high, I agree, because I got constrained by those other screws being in there. I couldn't get around them. That's a great result. All right, so we can go ahead and finish this. We can move on to the next session. Any other comments while we're setting up? Will you put the anchors and make your graft extra particular, or do you just leave the graft around the top? So, for me anyway, and maybe Bogdan does it differently, when we're doing the Latter Jay, we're blowing out the whole front. There's nothing there to fix. You got to take out the labrum. You got to take middle genital ligament. All that has to go to get that graft in through the subscap split. There's nothing enough to fix up there, right? I mean, you don't have any- The one that I did go back on to do a remplissage, like we were showing in, I think in Rob's case, so much tissue had formed at the front that it was almost like I did exactly that. I made it extra articular to augment the remplissage at the back. But, yeah. All right, thank you.

shoulder dislocation

surgical intervention

Bankart repair

Latarjet procedure

shoulder instability

recurrent dislocations

surgical techniques