Abstract
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The Trillat procedure, initially described by Albert Trillat, is historically one of the first techniques for addressing recurrent anterior shoulder instability, incorporating fascinating biomechanical mechanisms.
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After lowering, medializing, and fixing the coracoid process to the glenoid neck, the subcoracoid space is reduced, the subscapularis lowered, and its line of pull changed, accentuating the function of the subscapularis as a humeral head depressor centering the glenohumeral joint. Furthermore, the conjoint tendon creates a ‘seatbelt’ effect, preventing anteroinferior humeral head dislocation.
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Even though contemporary preferences lean towards arthroscopic Bankart repair with optional remplissage, bone augmentation, and the Latarjet procedure, enduring surgical indications remain valid for the Trillat procedure, which offers joint preservation and superior outcomes in two distinct scenarios: (i) older patients with massive irreparable cuff tears and anterior recurrent instability with an intact subscapularis tendon regardless of the extent of glenoid bone loss; (ii) younger patients with instability associated shoulder joint capsule hyperlaxity without concomitant injuries (glenoid bone loss, large Hill–Sachs lesion).
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Complications associated with the Trillat procedure include recurrent anterior instability, potential overtightening of the coracoid, leading to pain and a significant reduction in range of motion, risk of subcoracoid impingement, and restriction of external rotation by up to 10°, a limitation that is generally well-tolerated.
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The Trillat procedure may be an effective alternative technique for specific indications and should remain part of the surgical armamentarium for addressing anterior shoulder instability.
Introduction
The incapacitating characteristics of recurrent anterior shoulder instability have spurred the development of numerous surgical techniques aimed at addressing the condition over the past two centuries. One procedure that has historically played a pivotal role, however, seems to have faded from the spotlight – the Trillat procedure (1). Among the spectrum of surgical techniques, the ‘forgotten’ Trillat procedure has emerged as a unique and intriguing approach to addressing recurrent anterior shoulder instability. Originally introduced by Albert Trillat, this procedure has traversed a trajectory from prominence to relative obscurity, yet its historical significance and potential contemporary applications warrant renewed attention. Electronic databases, including PubMed, MEDLINE, Embase, and Google Scholar, were meticulously queried using a combination of relevant keywords and controlled vocabulary terms. The search strategy encompassed terms such as ‘Trillat procedure’, ‘anterior shoulder instability’, ‘surgical management’, ‘shoulder dislocation’, and ‘joint stabilization’. The search was not limited by publication date nor restricted to a specific language. In this narrative review, we delve into the historical context, the underlying biomechanical principles, and the clinical outcomes associated with the Trillat procedure. By revisiting this overlooked technique, we aim to shed light on its intrinsic merits, explore its advantages in specific patient populations, and offer insights into its potential resurgence within the armamentarium for managing anterior shoulder instability.
Albert Trillat: the pioneering French surgeon
Albert Trillat (Fig. 1) was born on 9 September 1910, in Lyon, France. He pursued his medical education at the University of Lyon, where he developed a passion for orthopedics. His groundbreaking research earned him a position as a professor of orthopedic surgery at the University of Lyon. He served as the head of the department of orthopedics at Lyon’s Edouard Herriot Hospital, where he trained numerous orthopedic surgeons and influenced the development of orthopedic surgery in France and beyond. Professor Trillat was a prolific author, publishing extensively on various topics in orthopedics. His textbook, ‘Recurrent Shoulder Dislocations (Luxation récidivante de l’épaule)’ was regarded as the ‘bible’ for managing shoulder instability for many years (2).
The Trillat procedure
History and rationale of the procedure
From 1950 to 1953, Trillat operated on seventeen patients with recurrent anterior shoulder instability using the procedure that bears his name, which was influenced by the one initially described by Noesske, a German surgeon who resided in Dresden, in 1924 (3). While Noesske employed a wedge osteotomy of the coracoid process, lowering and medially repositioning it without fixation, Albert Trillat enhanced the fixation of the coracoid process by using a coraco-scapular nail passing above the subscapularis tendon. On 11 March 1954, Trillat presented his series of seventeen cases to the Société Lyonnaise de Chirurgie, and his paper was published in the Lyon Chirurgical journal in November 1954 (1).
The primary objective of the Trillat procedure is to reduce the space between the tip of the coracoid process and the anterior part of the glenoid, thereby preventing the humeral head from slipping during anterior dislocation (Figs 2 and 3). By fixing the coracoid process to the glenoid neck above the subscapularis, the conjoint tendon acts as a ‘seatbelt’ ensuring that the subscapularis remains in contact with the anterior glenoid rim and effectively closing the Bankart or Broca–Hartmann detachment (Figs 2 and 3).
Rationale of the Trillat procedure: the conjoint tendon is repositioned medially closer to the glenohumeral joint, while the nail lowers the subscapularis. This results in a ‘seatbelt’ effect, preventing anteroinferior dislocation of the humeral head, pushing it backwards in the vulnerable at-risk position (i.e. throwing position or abduction-external rotation (ABER)). Reproduced with permission from Boileau et al. (9).
Citation: EFORT Open Reviews 9, 9; 10.1530/EOR-23-0208
The Trillat procedure involves performing a close-wedge osteotomy of the coracoid process, tilting it inferiorly, posteriorly, and medially. The coracoid is then secured to the glenoid neck using a nail (later replaced with a screw) positioned above the subscapularis. Additionally, the capsule and labrum are repositioned and fixed in place with the nail Reproduced with permission from Boileau et al. (9).
Citation: EFORT Open Reviews 9, 9; 10.1530/EOR-23-0208
The original technique
As per the original technique described by Trillat (1), an osteoclasia is performed at the base of the coracoid process (Fig. 3). The entire coracoid process is then repositioned inferiorly and medially and then fixed using a nail or screw, which passes through the tip of the coracoid into the glenoid neck (Fig. 3). A small gap, approximately the size of the index finger's pulp, is intentionally left between the coracoid and glenoid to prevent compression of the subscapularis muscle and to preserve external rotation (Fig. 3).
Modifications reported in the literature
While preserving the foundational principles established by Albert Trillat, the surgical technique has been documented to encompass the open method as originally described (2, 4), the arthroscopically assisted (5), and the comprehensive all-arthroscopic approaches (6, 7, 8, 9). The methodological versatility highlights the commitment to preserving Trillat's core concepts while embracing the potential enhancements that different approaches bring to the table.
The arthroscopic Trillat procedure
Boileau was the first to propose conducting the Trillat procedure entirely under arthroscopy and documented the initial outcomes (10, 11). This technique can be executed with the arthroscope placed in the standard posterior portal within the glenohumeral joint, with visualization through the rotator interval. Alternatively, the procedure can be performed with the arthroscope in the subdeltoid bursa via a lateral or anterolateral portal.
Boileau and colleagues also advanced the fixation method of the coracoid process: initially, they employed cannulated screws for this purpose (Fig. 4A) during their early attempts (11). Later, they transitioned to using suture anchors and cortical buttons (Fig. 4B and C) (8, 9), employing the same drilling guides developed for the arthroscopic Latarjet procedure (Fig. 5) (12). Only four portals are required to fix the coracoid using suture buttons: posterior, superolateral (north-west), anterolateral (west), and anteromedial (north). If the coracoid process is to be fixed using a screw, however, an additional transpectoral (east) portal becomes necessary (9).
The evolution of the coracoid fixation in an all-arthroscopic Trillat procedure by Boileau and colleagues: (A) fixation with a cannulated screw, (B) suture anchor with cortical button, (C) cortical button Reproduced with permission from Boileau et al. (9).
Citation: EFORT Open Reviews 9, 9; 10.1530/EOR-23-0208
The arthroscopic Trillat procedure with the use of suture buttons involves several key steps: (A) following the drilling of the coracoid and the glenoid, a suture is utilized to thread double buttons, with one button positioned against the posterior neck of the scapula and the other placed over the coracoid process; (B) a wedge osteotomy is performed at the base of the coracoid process, and a suture tensioner is employed after securing a sliding-locking knot (Nice knot) to tilt the coracoid process inferiorly, medially, and posteriorly Reproduced with permission from Boileau et al. (8).
Citation: EFORT Open Reviews 9, 9; 10.1530/EOR-23-0208
Valenti et al. (13) indicated the need for a 6th accessory portal for screw fixation (13). From a technical standpoint, suture button fixation presents several benefits compared to screw fixation, including the need for fewer arthroscopic portals, the ability to prevent excessive tension on the subscapularis muscle, and a reduced likelihood of coracoid process fractures (7). While some authors incorporate dissection of the lateral aspect of the conjoint tendon as a part of the preparation for the wedge osteotomy (13), Boileau advocates for preserving the insertion of the pectoralis minor, which offers the advantage of reducing the risk to the brachial plexus (9). Several benefits are associated with the all-arthroscopic Trillat procedure. It allows for the simultaneous execution of a Bankart repair (13), capsular shift (5), or cuff repair using the same portals. Moreover, as previously noted, the Trillat procedure does not carry the risk to the subscapularis tendon associated with the Latarjet procedure. Also, the arthroscopic technique allows for intraarticular exploration without arthrotomy (14), potentially reducing the risk of stiffness in external rotation compared to the open technique (15, 16). Regarding technical aspects, Boileau and co-authors shared their experiences with both procedures, demonstrating that the Trillat procedure is relatively less intricate compared to the Latarjet procedure (8, 9). Lastly, performing the Trillat procedure using an all-arthroscopic approach encompasses the traditional advantages of arthroscopic surgery, including reduced bleeding, diminished postoperative pain, and improved cosmetic outcomes (7, 11).
Indications and contraindications of the Trillat procedure
Originally, Trillat introduced the procedure named after him to address the entire spectrum of recurrent anterior shoulder instability, which may explain the high postoperative recurrent instability rates reported in the initial stages of clinical implementation (15). Over the past two decades, however, the indications of the Trillat procedure have undergone refinements involving critical analysis of patient profiles, diagnostic advancements, and treatment outcomes, ultimately guiding the selection of appropriate candidates for the Trillat procedure. The current indications and contraindications of the Trillat procedure as documented in the recent literature (4, 5, 8, 9), are listed in Table 1 and will be discussed in the following subsections.
Indications and contraindications of the Trillat procedure.
| Indications | Contraindications |
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*ISIS, Instability Severity Index Score.
Indications of the Trillat procedure
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Group 1: older patients with recurrent anterior shoulder instability and chronic massive irreparable cuff tears.
This group of patients is characterized by recurrent anterior shoulder instability while maintaining an active forward elevation and experiencing no pain in the context of chronic massive posterosuperior irreparable cuff tears. Although rare, treatment options remain limited in these cases. Restoration of the horizontal muscle balance via a cuff repair is not an option due to the fatty infiltration and reduced tendon substance. A Bankart repair can be performed, but the labrum is primarily intact in these cases as reported many years ago by Edward Craig (17). Joint replacement is also not indicated in this case, as the active range of motion is retained, and there is no pain. The Latarjet procedure is contraindicated within this specific patient cohort due to its association with potential complications (18). The Trillat procedure produces the same sling effect (Fig. 2) as the Latarjet procedure without the drawback of detaching the coracoid graft and passing it through the subscapularis muscle.
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Group 2: young patients with recurrent anterior shoulder instability and joint capsule hyperlaxity.
This group comprises young and active individuals, often athletes, with high expectations. So, the goal is to stabilize the shoulder and allow for postoperative return to high-risk sports (collision/overhead sports). The main pathological characteristic of the patients in this group is joint capsule hyperlaxity without concomitant injuries (Labrum lesion, glenoid erosion). Hyperlaxity is a well-known risk factor of recurrent anterior instability with a low return to high-risk sports following soft tissue stabilization procedures (Bankart repair, capsular shift) (19, 20, 21).
Combining capsular shift and the Latarjet procedure, as proposed by Walch et al.(22), can be employed to restore the stability of hyperlax shoulders and improve the chance of returning to high-risk sports. However, this approach would pose more technical challenges (detaching the intact labrum and abrading the anterior glenoid rim) compared to the Trillat procedure, which offers a similar stabilizing sling effect with several benefits when compared to the Latarjet procedure (no need for detaching the coracoid process or splitting the subscapularis muscle, and the entire procedure is performed arthroscopically in the extraarticular subcoracoid space without arthrotomy).
Contraindications of the Trillat procedure
Patients with isolated loss of external rotation without recurrent anterior shoulder instability may benefit from tendon transfer procedures (e.g. latissimus dorsi) and are not suitable candidates for the Trillat procedure. Older individuals presenting with limited active forward elevation and external rotation are candidates for reverse shoulder arthroplasty with tendon transfer. Subscapularis tendon insufficiency/tear is a contraindication for the Trillat procedure, as an intact subscapularis is integral for creating the procedure's stabilizing sling effect in the at-risk position (Fig. 2). The presence of significant glenoid bone loss (> 10% of the anterior glenoid rim) or a large Hill–Sachs lesion (Calandra type 3) (23) constitute contraindications for the Trillat procedure and would instead be effectively addressed through a Latarjet procedure in Group 2. According to Domos, Lunini, and Walch (18), however, the Latarjet procedure is contraindicated in Group 1 patients older than 50 due to the severe complications observed, including (A) static anterior instability with progressive osteonecrosis of the humeral head as it interacts with the bone block, and (B) irreducible static inferior subluxation of the humeral head; possibly caused by the pull on the less flexible portion of the subscapularis by the conjoint tendon. In light of this, and regardless of the extent of bone loss in this specific group of patients, Walch et al. (15) recommend primarily addressing the instability via the Trillat procedure, which, based on their research, restored the stability in 86% of the patients (15).
Complications of the Trillat procedure
The most commonly observed complication following the Trillat procedure is recurrent anterior instability (Table 2) (8, 9, 15, 16, 24). Kazum et al. (25) reported one case of asymptomatic fibrous non-union of the osteotomized coracoid process following the Trillat procedure. Gerber et al. (26) reported the iatrogenic subcoracoid impingement as one of the serious complications associated with the Trillat procedure leading to persistent pain and limited external rotation.
Overview of the clinical studies published on the Trillat procedure.
| Study | Number of cases | Operation | Follow-up time (years) | Complications |
|---|---|---|---|---|
| Boileau et al. (9) | 28 | All-arthroscopic Trillat in young patients with shoulder hyperlaxity | 4.6 | 10% rate of recurrent instability |
| Boileau et al. (8) | 21 | All-arthroscopic Trillat in old patients with posterosuperior cuff tears | 4.8 | 4% rate of recurrent instability |
| Chauvet et al. (14) | 49 | All-arthroscopic Trillat | 2 |
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| Gerber et al. (26) | 48 | Open Trillat | 5.75 | 4% rate of recurrent instability 15% subcoracoid impingement |
| Jouve et al. (52) | 19 | Open Trillat | 2 | 16% rate of recurrent instability |
| Kazum et al. (25) | 17 | Arthroscopic Trillat + capsuloplasty | 2 | 5.8% asymptomatic fibrous non-union of the coracoid process |
| Labattut et al. (5) | 18 | Arthroscopically assisted Trillat | 2 | 5.5% rate of recurrent instability |
| Landmann et al. (49) | 13 | Open Trillat | 2.5 | Mean loss of external rotation = 13° |
| Walch et al. (24) | 38 | Open Trillat | – | 15% rate of recurrent instability |
| Walch et al. (16) | 24 | Open Trillat | 10 | – |
| Walch et al. (15) | 250 | Open Trillat | 11.3 | 14% rate of recurrent instability |
Loss of external rotation following the Trillat procedure is a well-documented complication that was attributed to the tethering effect of the conjoint tendon on the lowered subscapularis following the Trillat procedure (9). Gerber et al. (26) reported a loss of external rotation greater than 30° in 46% of patients. In their study, Boileau et al. (9) reported a mean loss of external rotation of 19° compared to the contralateral side. Interestingly, Chauvet et al. (14) reported an 8° mean loss of external rotation with the arm at the side, which reduced to 0.4° with the arm abducted.
The rate of glenohumeral osteoarthritis increased from 40% preoperatively to 70% at the last postoperative follow-up (mean, 58 months) in the series by Boileau et al. (8). However, they reported that the radiographic findings did not correlate with functional outcomes (8). Chauvet et al. (14) reported a 3.8% rate of glenohumeral osteoarthritis in their series at a mean follow-up of 40 months.
Discussion
Throughout the history of medicine, there have been numerous surgical procedures that, over time, have been forgotten or replaced by newly developed techniques. These ‘forgotten’ procedures often served as crucial milestones in the evolution of surgical practices, paving the way for innovations. However, revisiting these procedures is common sense to gain a deeper understanding of their contributions and potential applications in contemporary practice. Analysis of the existing literature on anterior shoulder instability indicates that the employment of the Trillat procedure is, compared to other techniques, confined to certain institutions or even individual practitioners. Furthermore, the technique has, over the past decades, been left out of many review articles and comparison studies (27, 28, 29, 30, 31, 32). The Trillat procedure, now largely disregarded, stood as the sole contender against the Bankart repair in France from 1950 to 1970 (33). Nonetheless, Gilles Walch’s (15) documentation of a 14% instability recurrence rate among 250 patients operated on by Trillat himself, coupled with Didier Patte’s (34) innovative elucidation of the ‘triple-blocking’ impact of the Latarjet procedure, unquestionably played a role in promoting the latter technique’s popularity and leading to the discontinuation of the former. Yet, a comprehensive understanding of the stabilizing mechanism of the Trillat procedure and the characteristics of the compromised structures following an episode of anterior shoulder dislocation allows for a genuine recognition of the relevance of the Trillat procedure in managing recurrent anterior shoulder instability.
As outlined in the recent publications authored by Boileau and colleagues (8, 9), the ideal candidates for the Trillat procedure can be categorized into two distinct groups: i) older individuals experiencing recurrent anterior shoulder instability, maintaining their active range of motion, possessing an intact subscapularis tendon, and exhibiting massive irreparable cuff tears without signs of arthritis of the glenohumeral joint; ii) young and physically active patients with joint capsule hyperlaxity in the absence of concurrent injuries (large Hill–Sachs lesion, labral tear). Based on the scientific literature, a correlation appears to exist between injuries to the cuff tendons after an episode of anterior shoulder dislocation and the age of the patient groups involved. In individuals aged 40 years and older, traumatic anterior dislocation gives rise to rotator cuff tears within a spectrum of 34% to 100% (35, 36, 37, 38, 39). However, recurrent dislocation is witnessed in only up to 33% of the cases (36, 38, 39, 40, 41, 42).
According to Craig (17) and McLaughlin (43), a cuff repair would adequately address the instability in the absence of anterior capsuloligamentous lesions. In the study presented by Gumina and Postacchini (38), poor results were reported in the two cases that solely underwent a cuff repair, in contrast to the three patients who underwent a stabilization procedure combined with a cuff repair, which yielded better results (38). Porcellini et al. (44) detailed a mere 4% instability recurrence rate in a cohort of 50 patients with recurrent anterior shoulder instability associated with a full-thickness cuff tear: all patients underwent an arthroscopic repair of the anterior capsulolabral and cuff lesions. In 1987, Walch and colleagues (16) reported on the results of the Trillat procedure on 24 cases of recurrent anterior shoulder instability occurring after the age of 40, strongly suspecting posterior cuff tears, and demonstrated that the Trillat procedure without cuff repair yielded satisfactory outcomes in 85% of cases (16).
In a retrospective investigation carried out by Walch and colleagues (45), they found that in a group of 70 patients, 37% exhibited a dislocated long head of the biceps tendon in conjunction with massive irreparable cuff tears. Given the strong association between these two conditions, the authors indicated that performing a tenodesis of the long head of the biceps concurrently with the Trillat procedure in the context of recurrent anterior shoulder instability is imperative to prevent postoperative pain and potential limitations in the range of motion (45).
In situations where elderly patients maintain their active range of motion, where scans indicate massive irreparable cuff tears and an intact subscapularis tendon, the available options are limited. The likelihood of a successful cuff repair is low due to the notable reduction in tendon substance and the accompanying fatty infiltration of the cuff muscles. Neither a Bankart repair nor a capsular shift is appropriate as the labrum remains uninjured. Moreover, tightening the anterior structures in the presence of massive irreparable cuff tears could potentially destabilize the joint further by causing anterior displacement of the humeral head (17). Joint replacement via reverse shoulder arthroplasty is considered unethical since the active range of motion remains preserved. The Latarjet procedure is an unfavorable option, not only due to the risk it poses to the subscapularis tendon through splitting but also because it leads to the rapid development of progressive osteoarthritis (46, 47, 48). Even more, the serious complications observed in this demographic population following the Latarjet procedure have prompted its declaration as a contraindication (18).
According to some authors, the Trillat procedure is regarded as the benchmark in these cases (8). As previously mentioned, the highest recurrence rates after undergoing the TP were documented in the two studies conducted by Walch et al. (15, 24), with percentages of 14% and 15%, respectively (Table 2). Gerber et al. (26) observed highly favorable functional results following the Trillat procedure in 73% of cases, with 10% achieving good outcomes, despite a recurrence rate of instability at 4%. They highlighted the iatrogenic subcoracoid impingement (15%) as the most significant complication, leading to persistent pain and constrained range of motion (26). The mean loss of external rotation reported by Chauvet et al. (14) and Landmann et al. (49) was comparable to that reported following the Latarjet procedure (50, 51). Labattut et al. (5) recorded notably high levels of patient contentment (94.5%) in cases where an arthroscopically assisted Trillat procedure was performed. Notably, Kazum et al. (25) reported excellent functional outcomes with no recurrence of instability in a series of 19 consecutive shoulders treated using an arthroscopic Trillat procedure combined with an anterior capsuloplasty. Despite the relatively high recurrence rate in the group of 19 patients who underwent the Trillat procedure, Jouve et al. (52) reported a 96% subjective satisfaction rate with the overall results. Boileau et al. (8) documented a notable degree of satisfaction with the outcomes of the all-arthroscopic Trillat procedure, with 10 out of 13 individuals who engaged in sports successfully returning to their athletic activities. Regarding the postoperative development of glenohumeral arthritis following the Trillat procedure, Chauvet et al. (14) noted comparable outcomes with the Latarjet procedure (53). However, the risk of contact between the humeral head and the osteosynthesis screw seems to be absent in the Trillat procedure, whereas such contact in the Latarjet procedure may potentially lead to the rapid onset of osteoarthritis (46, 47, 48).
On the other side, the second age group that presents an optimal candidate profile for the Trillat procedure comprises young, active individuals who exhibit joint capsule laxity without identifiable osseous lesions on either the glenoid or humeral sides; the presence of such lesions would contraindicate the Trillat procedure. Shoulder hyperlaxity, defined as an external rotation measurement exceeding 90°, indicates a lack of anterior capsule support (20, 21, 54, 55). This condition is widely recognized as a significant risk factor for unsuccessful outcomes following isolated soft tissue stabilization procedures such as the Bankart repair or capsular shift, which have shown a low success rate in allowing patients to resume sports activities (9, 19, 20, 54, 55). Performing a Hill–Sachs remplissage is not advisable in such cases due to the absence or minimal presence of humeral impaction fractures. While the option of conducting a Latarjet procedure (or other free bone block procedures) is feasible for hyperlax shoulders, it may not be the most rational approach as the anterior glenoid rim remains intact in most cases (22). Undertaking such a procedure would also necessitate intentionally creating a defect in the anterior glenoid rim in order to properly position and secure the bone block.
The application of the Trillat procedure to this specific group of patients was more recently highlighted by Boileau et al. (9). In their retrospective analysis, they enrolled 28 young patients (with an average age of 25 years) characterized by joint capsule hyperlaxity and recurrent anterior shoulder instability (9). The predominant arthroscopic finding was a ‘loose shoulder’ and anterior-inferior capsule redundancy without any concurrent bony or soft tissue impairments (9). Following the all-arthroscopic Trillat procedure, 90% of the cases experienced restored joint stability, with an impressive 79% of patients engaging in sports successfully returning to their pre-injury activity levels (9). We recognize that suggesting the Trillat procedure to athletes involved in throwing activities, like baseball pitchers, is not advisable as substantial limitations of external rotation among this group could have negative implications on their athletic capabilities and should be steered clear of (9).
Upon reviewing the results reported following different techniques of the Trillat procedure, the arthroscopic approach is associated with the lowest incidence of complications (Table 2). However, a comprehensive analysis via well-designed comparative studies is needed to draw more definite lines and substantiate these observations. In their retrospective cohort study, Walch and colleagues (52) emphasized the significance of assessing the outcomes of an entirely arthroscopic Trillat procedure, given the lack of data at that juncture. Recently, Boileau et al. reported favorable long-term results of the all-arthroscopic approach in older individuals with massive irreparable cuff tears and younger patients exhibiting joint capsule hyperlaxity (8, 9).
With that being stated, we hold the perspective that the inclusion of the Trillat procedure should be considered in the armamentarium of approaches for addressing anterior shoulder instability (Figs 6 and 7). Finally, striking a balance between preserving historical knowledge and embracing innovative ideas is a challenge that demands careful thought and discernment. However, we must remember and acknowledge the towering figures from the past who have laid the foundation upon which we build.
Algorithm demonstrating the Trillat procedure’s role in managing recurrent anterior shoulder instability in elderly patients with rotator cuff tears.
Citation: EFORT Open Reviews 9, 9; 10.1530/EOR-23-0208
Algorithm showing the Trillat procedure's role in managing recurrent anterior shoulder instability in young patients with an isolated joint capsule hyperlaxity.
Citation: EFORT Open Reviews 9, 9; 10.1530/EOR-23-0208
Conclusion
The Trillat procedure effectively reinstates shoulder stability, particularly in specific patient cohorts for whom alternative surgical interventions may not be the most pragmatic choice. On the technical aspect, care should be taken to avoid potential complications such as overtightening of the coracoid process, which is associated with the risk of subcoracoid impingement, progressive osteoarthritis, and limitations in the range of motion.
ICMJE Conflict of Interest Statement
The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the study reported.
Funding Statement
This work did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.
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