The Value of the Arthroscopic Trillat Procedure

The arthroscopic Trillat procedure, a type of bone block procedure, can be a valuable treatment of recurrent anterior dislocations in older patients with chronic massive irreparable rotator cuff tears and conserved active shoulder motion, according to a new retrospective French study of 21 patients.

The Trillat procedure has been associated with the potential for serious complications, but this latest research suggests that it is still a worthy treatment option.

The study, “The Arthroscopic Trillat Procedure is a Valuable and Durable Treatment Option for Recurrent Anterior Instability Associated with Massive Irreparable Rotator Cuff Tears,” was published online on November 8, 2022 in the journal Arthroscopy.

For their study, the researchers determined the mid- and long-term clinical and radiological outcomes of the arthroscopic Trillat for the treatment of recurrent anterior instability in patient with chronic massive irreparable rotator cuff tears and maintained active shoulder motion. In these patients, reverse shoulder arthroplasty was not indicated.

The researchers retrospectively reviewed data on 21 consecutive patients with a mean age of 61 years. All patients had recurrent anterior dislocations and conserved active forward elevation and active external rotation. The massive irreparable rotator cuff tears all included a retracted supraspinatus tear in 14%, a supra- and infraspinatus tear in 76.5%, and a 3-tendon tear in 14%.

The team collected data from X-rays, CT scans at 6 months, Subjective Shoulder Value, Visual Analogue Score, Walch, Constant and Rowe scores. The mean follow-up was 58 months.

At the end of follow-up, 96% of the patients had a stable and function shoulder. No patient lost any active shoulder motion, and they were all satisfied with the surgery.

The researchers reported that the Subjective Shoulder Value increased from 44% (10-75) to 94% (80-100); p < 0.001. In addition, the Constant and Rowe scores improved from 60 (25-81) to 81 (66-96) and from 54 (35 to 65) to 92 (70-100); p < 0.001. Only one patient was revised to reverse shoulder arthroplasty, and of the 13 athletes in the study, 10 of them were able to return to the game.

The study authors included Pascal Boileau, M.D., Ph.D., of ICR-Institut de Chirurgie Réparatrice-Locomoteur & Sports Institute for Sports and Reconstructive Surgery in Nice, France; Giles Clowez, M.D., of Centre Hospitalier Princesse Grace in Monaco; Soufyane Bouacida, M.D., of Centre de la Main de Toulon et La Ciotat in Toulon, France; Giles Walch, M.D., of Centre Médical Santy in Lyon, France; Daniel G. Schwartz, M.D., of The Polyclinic Madison Center in Seattle, Washington and Christophe Trojani, M.D., Ph.D., of ICR-Institut de Chirurgie Réparatrice-Locomoteur & Sports Institute for Sports and Reconstructive Surgery in Nice, France.