Martini, Liborio Ingala

Abstract Over the past years, several arthroscopic fixation procedures have been adopted for fractures of the greater tuberosity. Although they offer advantages over open approaches, especially for avulsion‐type fixation, split‐type fractures are usually treated with open reduction and internal fixation. However, suture constructs can result in a more reliable fixation system for multifragment or osteoporotic split‐type fractures. Currently, the use of arthroscopic techniques in these more complex fractures is questionable due to inherent limitations of anatomic reduction and stability concerns. The authors report a technically simple and reproducible arthroscopic procedure based on anatomic, morphologic, and biomechanical concepts, which offers advantages over traditional open approaches or double‐row arthroscopic techniques in the treatment of most split‐type greater tuberosity fractures. Technique Video video See video under supplementary data.

» Anterior glenohumeral instability (AGI) is a challenging condition that requires close attention to osseous and soft-tissue abnormalities. The morphometric variance of the periarticular scapular anatomy may be involved in the pathogenesis of recurrent traumatic anterior instability. » The Trillat procedure repositions the coracoid medially and downward by a partial wedge osteotomy, mimicking the sling effect of the Latarjet procedure by moving the conjoint tendon closer to the joint line in throwing position. The Trillat procedure decreases the coracohumeral distance without affecting the integrity of the subscapularis muscle and tendon. » Joint preservation methods, such as the Trillat procedure, may be explored in older patients to treat AGI with simultaneous irreparable rotator cuff tears (RCTs) with a static centered head and a functional subscapularis. » Shoulder hyperlaxity and instability can be challenging to treat with isolated soft-tissue procedures. In cases without glenoid bone loss, free bone block techniques are ineffective because of the subsequent potential graft resorption, apprehension, or recurrence. The Trillat surgery, in conjunction with an anteroinferior capsuloplasty, seems to be helpful in preventing recurrent instability and in reducing shoulder apprehension. » Recently, several variations of the original technique have been described. In the future, anatomical, biomechanical, and clinical studies need to be conducted to further evaluate the morphometric characterization of the procedure, enhance the technical features, improve indications, and avoid coracoid impingement and other potential complications with the Trillat procedure.