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Valencia Mora M, Novo Rivas U, Calvo C, Martínez-Catalán N, Luengo-Alonso G, Morcillo Barrenechea D, Foruria de Diego AM, Calvo E. Does preoperative glenoid bony defect determine final coracoid graft positioning in arthroscopic Latarjet? JSES Int 2023. [DOI: 10.1016/j.jseint.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
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Arthroscopic Trillat technique for chronic post-traumatic anterior shoulder instability: outcomes at 2 years of follow-up. J Shoulder Elbow Surg 2022; 31:e270-e278. [PMID: 35017078 DOI: 10.1016/j.jse.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to assess the outcomes of a new arthroscopic Trillat technique at a 2-year follow-up. Our current hypothesis was that this technique could be used for the effective treatment of chronic post-traumatic unidirectional anterior shoulder instability, and that the recurrence and complication rates, external rotation, and functional outcomes would be as good as those of the reference technique. METHODS Between April 2012 and August 2016, all patients older than 16 years who underwent the arthroscopic Trillat technique for unidirectional chronic post-traumatic anterior shoulder instability at the Dijon University Hospital (France), after the failure of well-conducted medical and rehabilitation treatment with at least 24 months of follow-up, were included. Criteria for noninclusion were association with posterior and/or inferior instabilities, voluntary instabilities, and glenoid bone loss greater than 20%. Patients attended follow-up with their surgeon before the intervention, in the immediate postoperative period, at 6 weeks, 3 and 6 months, and then by an independent observer for the last evaluation. Patients were then examined clinically with scores such as Constant, Rowe and Walch-Duplay scores, and subjective shoulder value, for shoulder range of motion, and radiographically (anteroposterior and Lamy's lateral x-rays of the operated shoulder). RESULTS Forty-nine patients and 52 shoulders were included, with a mean follow-up of 40 months (range, 24-71 months). The recurrence rate of instability was 3.8% (2 of 52). No conversion to arthrotomy was necessary. No intraoperative complications, postoperative neurological lesions, or sepsis were observed. The mean Constant score was 92.1 (77.5-100) points, Walch-Duplay 82.9 (40-100), Rowe 81.73 (5-100), and subjective shoulder value 86.1 (50-100) at the last follow-up. The arm at side external rotation limitation averaged 8.4° (-25° to 40°) and the external rotation with 90° arm abduction limitation 0.34° (-5° to 15°). Forty-one patients (79%) resumed their sports activity at the same level. Fifty patients (96%) were satisfied to very satisfied. One patient developed nonunion of the coracoid process and subsequently underwent a Latarjet procedure with a good outcome. CONCLUSIONS The arthroscopic Trillat procedure offers good outcomes as a first-line treatment for chronic anterior post-traumatic glenohumeral instability. It should be excluded in cases of glenoid loss greater than 20%.
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Ali J, Altintas B, Pulatkan A, Boykin RE, Aksoy DO, Bilsel K. Open Versus Arthroscopic Latarjet Procedure for the Treatment of Chronic Anterior Glenohumeral Instability With Glenoid Bone Loss. Arthroscopy 2020; 36:940-949. [PMID: 31870727 DOI: 10.1016/j.arthro.2019.09.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the clinical, functional, and radiographic outcomes of open versus arthroscopic Latarjet procedures. METHODS Between December 2009 to January 2015, all patients older than 18 years of age who were treated with a Latarjet procedure for chronic osseous anterior instability by a single surgeon were included in this retrospective cohort study. Range of motion, strength, Rowe, Western Ontario Shoulder Instability Index (WOSI) scores, and pain level according to the Visual Analog Scale (VAS) were evaluated. In addition, postoperative computed tomography scans were used to evaluate the position of the transferred coracoid, screw orientation, and degree of graft resorption. RESULTS Forty-eight patients with a mean age of 29.5 years (range 19-59 years) who underwent open (n = 15; group OL) and arthroscopic (n = 33; group AL) Latarjet procedures were included in the study. The mean follow-up was 30.5 months (range 24-50 months). At final follow-up there were significant differences in the mean internal rotation loss (mean of 9° vs 14°, P = .044) favoring open surgery and WOSI (P = .017) scores favoring arthroscopic. No significant differences were detected in mean forward flexion loss (P = .918), external rotation loss (P = .883), Rowe (P = .429), and Visual Analog Scale (P = .208) scores. Mean superoinferior position of the coracoid bone graft was found between the 1:55 and 4:49 o'clock positions (2:05-4:55 for group OL; 1:51-4:47 for group AL) in en-face views. The grafts were placed laterally in 13% (group OL) and 9% (group AL) of patients. The mean α angles of the screws were 11° and 19.2°, respectively (P = .004). The mean graft resorption rates were 21% and 34% (P = .087), respectively. CONCLUSION Good functional results were obtained after both open and arthroscopic Latarjet procedures for the treatment of chronic osseous anterior shoulder instability. Comparative analysis showed small but statistically significant differences in internal rotation loss favoring open and in WOSI favoring arthroscopic techniques. All measured radiographic parameters were similar with the exception of a significant difference in alpha angle with improved screw position in open surgery. OL and AL techniques provide similar clinical and radiographic outcomes. LEVEL OF EVIDENCE III; Retrospective cohort study with comparison group.
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Affiliation(s)
- Jotyar Ali
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Anil Pulatkan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | | | | | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey.
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The Effect of Screw Design and Cortical Augmentation on Insertional Torque and Compression in Coracoid-Glenoid Fixation in a Sawbones Model. Arthroscopy 2020; 36:689-695. [PMID: 31901392 DOI: 10.1016/j.arthro.2019.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare screw insertional torque and coracoid-glenoid compression from 4 fixation techniques with different screw design parameters and cortical augmentation for the Latarjet procedure. METHODS Simulated Latarjet procedures were performed with 4 fixation techniques using laminated polyurethane blocks with dimensions similar to the coracoid-glenoid construct. The groups included DePuy Synthes Mitek 3.5-mm partially threaded screws with top hats, Arthrex 3.75-mm fully threaded screws with a 2-hole plate, Arthrex 3.75-mm fully threaded screws, and Smith & Nephew 4.0-mm partially threaded screws. Screws were inserted using a digital torque-measuring screwdriver to determine maximum insertional torque. Pressure-sensitive film was used to measure the maximum contact pressure and the effective pressure distribution (EPD) between the coracoid and glenoid; the EPD represents the percentage of the film's surface area that experienced pressure greater than 10 MPa. One-way analysis of variance and post hoc tests were used for statistical analysis. RESULTS Significant differences were found between the 4 fixation groups for each variable measured. The 2 cortically augmented systems produced significantly higher maximum insertional torque than the non-cortically augmented systems (P < .001 for both). The 3.75-mm screws with a 2-hole plate yielded significantly higher contact pressures than the 4.0-mm screws (P = .028). This group also had a high EPD, with a mean value more than double the values of the non-cortically augmented systems (P = .037 and P < .001). CONCLUSIONS Cortically augmented fixation methods showed higher maximum insertional torque, maximum contact pressure, and EPD between the surfaces of the coracoid and glenoid in this Sawbones model. CLINICAL RELEVANCE Various implants are available for the Latarjet procedure, but their biomechanical characteristics have not yet been fully elucidated. Graft fracture and nonunion represent 2 modes of failure that may be related to insertional torque and coracoid-glenoid compression. This study compared screw insertional torque and compression achieved using 4 fixation techniques with different screw design parameters and cortical augmentation in a Sawbones model.
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Valencia M, Fernández-Bermejo G, Martín-Ríos MD, Fernández-Jara J, Morcillo-Barrenechea D, Coifman-Lucena I, Foruria AM, Calvo E. Subscapularis structural integrity and function after arthroscopic Latarjet procedure at a minimum 2-year follow-up. J Shoulder Elbow Surg 2020; 29:104-112. [PMID: 31409562 DOI: 10.1016/j.jse.2019.05.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subscapularis function after arthroscopic Bankart repair has been widely studied. However, data regarding subscapularis performance after arthroscopic Latarjet procedures are lacking. This study aimed to evaluate subscapularis clinical and radiologic performance after arthroscopic Latarjet procedures. METHODS We included 40 patients who underwent arthroscopic Latarjet procedure with a minimum 2-year follow-up. Clinical evaluation included Western Ontario Shoulder Instability Index and Rowe scores, specific subscapularis isokinetic study, and lift-off tests. Contralateral measurements were used for comparison. Computed tomographic evaluation included graft consolidation, muscle dimensions, and degree of fatty atrophy, calculated as the mean muscle attenuation (MMA). RESULTS There was a decrease of 8.3% of maximum internal rotation peak torque in the operated arm (P = .02). However, there was no significant difference in the agonist-antagonist ratio: 76.9% in the operated arm and 76% in the contralateral (P = .82). Lift-off strength test demonstrated a decrease in the first year but not at final follow-up (P = .38). There was a significant decrease in lift-off distance of 23% compared to the contralateral side (P < .001). Subscapularis MMA was diminished when compared to the infraspinatus/teres minor (P < .001) at the expense of its upper part (P = .03). Hyperlaxity and number of dislocation episodes were correlated to a lower MMA (P = .046 and P = .005). CONCLUSION Arthroscopic Latarjet procedures provide satisfactory clinical results. There seems to be a diminished subscapularis MMA depending on its superior half. Hyperlaxity and number of previous dislocations were correlated to a lower MMA. Although there was a decrease in the maximum internal rotation peak torque, we did not find any difference in the agonist-antagonist ratio or in the final lift-off strength between sides.
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Affiliation(s)
- María Valencia
- Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Gloria Fernández-Bermejo
- Physical Medicine and Rehabilitation Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - María D Martín-Ríos
- Department of Epidemiology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Javier Fernández-Jara
- Musculoskeletal Radiology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Diana Morcillo-Barrenechea
- Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ismael Coifman-Lucena
- Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Antonio M Foruria
- Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
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Kordasiewicz B, Kiciński M, Małachowski K, Boszczyk A, Chaberek S, Pomianowski S. Arthroscopic Latarjet Stabilization: Analysis of the Learning Curve in the First 90 Primary Cases: Early Clinical Results and Computed Tomography Evaluation. Arthroscopy 2019; 35:3221-3237. [PMID: 31785749 DOI: 10.1016/j.arthro.2019.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/24/2019] [Accepted: 07/03/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the learning curve of arthroscopic Latarjet, evaluating time of surgery, clinical outcomes, complications, revisions, and recurrence. METHODS Arthroscopic Latarjet procedures performed from 2011 to 2016 were reviewed. Satisfaction rate, subjective shoulder value, Walch-Duplay, Rowe scores, range of motion, and stability were evaluated on clinical examination. Graft position and fusion were analyzed using computed tomography. All patients were divided into 3 chronological groups. RESULTS Ninety patients (3 groups of 30) were available for clinical evaluation (96,8%). The mean follow-up was 23.7 months. Surgical time was significantly (P = .0028) longer in group I (mean 128 minutes, standard deviation [SD] 33.6) when compared with groups II (mean 102 minutes, SD 16.2) and III (mean 108 minutes, SD 21.8). A regression analysis and cumulative sum learning curve analysis showed the surgeon oscillated around mean operative time (112.7 minutes; SD 27.2) after 30 procedures. The number of intraoperative complications was significantly greater (P = .024) in Group I (5 cases; 17%) compared with zero in group II, and 3 (10%) in group III. All 3 cases (3.3%) of recurrence were reported in group I (P = .033). Significantly, 2 of 3 patients with recurrence had intraoperative graft complications (P = .0107). Overall patient satisfaction was evaluated as 92%, SSV 90%, Walch-Duplay and Rowe scores, respectively, 79 and 81 points. Nine revisions (10%) were reported. No significant differences were found between the results and revisions of the 3 chronological groups. CONCLUSIONS This study confirms that the arthroscopic Latarjet procedure provides good clinical and radiologic results at short-term follow-up. The surgical time, frequency of complications, and number of hardware problems significantly decreased after the first 30 cases. As such, surgeons should be aware of the elevated potential for complications and recurrence early in the learning curve-serious intraoperative complications are important risk factors for recurrence. LEVEL OF EVIDENCE III. Therapeutic study: case-control study.
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Affiliation(s)
- Bartłomiej Kordasiewicz
- Trauma and Orthopaedics Department, SPSK im. A. Grucy, Otwock; Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Maciej Kiciński
- Trauma and Orthopaedics Department, SPSK im. A. Grucy, Otwock.
| | | | - Andrzej Boszczyk
- Trauma and Orthopaedics Department, SPSK im. A. Grucy, Otwock; Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Sławomir Chaberek
- Trauma and Orthopaedics Department, SPSK im. A. Grucy, Otwock; Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Stanisław Pomianowski
- Trauma and Orthopaedics Department, SPSK im. A. Grucy, Otwock; Centre of Postgraduate Medical Education, Warsaw, Poland
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Labral Repair Augmentation by Labroplasty and Simultaneous Trans-Subscapular Transposition of the Long Head of the Biceps. Arthrosc Tech 2019; 8:e507-e512. [PMID: 31194141 PMCID: PMC6552014 DOI: 10.1016/j.eats.2019.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/20/2019] [Indexed: 02/03/2023] Open
Abstract
Chronic traumatic anteroinferior instability is a common pathology of the shoulder joint. In case of glenoid bone defects, the Latarjet or bone block technique is the method of choice. The arthroscopic Bankart procedure and its modifications remain the preferred methods of treating patients without substantial bone damage of the glenoid and humeral head; however, there is a high recurrence of instability after the Bankart procedure, even for optimal indications. One of the main causes of recurrence is poor quality and weakness of the glenohumeral ligaments and labrum. We describe an alternative technique that provides triple mechanisms of stabilization like the Latarjet procedure. In our procedure, the long head of the biceps tendon is used for a sling effect, dynamic stabilization is achieved by trans-subscapular tenodesis with simultaneous plasty of the anterior segment of the labrum, and subsequent resuspension of the glenohumeral ligaments is performed using the same anchors. In patients without substantial bone loss, this procedure has numerous advantages over the arthroscopic Latarjet procedure. By creating triple mechanisms of stability like the Latarjet procedure (the bumper effect, reinforcement of ligaments, and sling effect), our procedure can significantly reinforce the Bankart procedure in cases of poor-quality glenohumeral ligaments.
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Kordasiewicz B, Małachowski K, Kiciński M, Chaberek S, Boszczyk A, Marczak D, Pomianowski S. Intraoperative graft-related complications are a risk factor for recurrence in arthroscopic Latarjet stabilisation. Knee Surg Sports Traumatol Arthrosc 2019; 27:3230-3239. [PMID: 30796488 PMCID: PMC6754355 DOI: 10.1007/s00167-019-05400-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 02/06/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The goal of this study was to evaluate clinical and radiological outcomes after arthroscopic Latarjet stabilisation in anterior shoulder instability. METHODS Ninety-three patients after primary arthroscopic Latarjet stabilisation were reviewed. Satisfaction, subjective shoulder value (SSV), Walch-Duplay and Rowe scores, and range of motion and stability were evaluated on clinical examination. Computed tomography (CT) was used to analyse graft position and fusion. RESULTS Ninety patients (96.8%) were available for clinical and 85 for CT evaluation. The mean follow-up was 23.7 months (13-50, SD 7.1) and age at surgery was 26.2 years (16-44, SD 5.6). Intraoperative complications were reported in eight patients (8.9%) and recurrence in three (3.3%). Significantly, two out of three patients with recurrence had intraoperative graft complications (p = 0.0107). Forty-one patients (45.6%) reported the feeling of "subjective return to sport anxiety". External rotation with arm at the side was 59° (10-90°, SD 20) with 15° (0-70°, SD 17) of loss of rotation. These two factors correlated with results the most. Patient satisfaction was evaluated as 92% (40-100, SD 14) and SSV 90% (30-100, SD12). Revision rate after primary surgery was 10%. CT showed graft healing in 81 (95.3%) patients. A graft position between 2 and 5 o'clock was found in 70 (83.4%) patients and flush to the anterior glenoid rim in 34 (40.5%). Osteolysis of the superior part of the graft was found in 55 (64.7%) patients. CT evaluation showed no correlation with clinical results. CONCLUSION Arthroscopic Latarjet stabilisation demonstrates satisfactory results in short-term follow-up; however, intraoperative graft-related complications are a risk factor for recurrence. "Subjective return to sport anxiety" and loss of external rotation with the arm at the side are factors worsening the results. Graft position imperfections and osteolysis of the superior part of the graft reported in CT evaluation do not influence the clinical results.
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Affiliation(s)
| | - Konrad Małachowski
- Trauma and Orthopaedics Department, SPSK im. A. Grucy w Otwocku, ul. Konarskiego 13, 05-400, Otwock, Poland
| | - Maciej Kiciński
- Trauma and Orthopaedics Department, SPSK im. A. Grucy w Otwocku, ul. Konarskiego 13, 05-400, Otwock, Poland.
| | - Sławomir Chaberek
- Trauma and Orthopaedics Department, SPSK im. A. Grucy w Otwocku, ul. Konarskiego 13, 05-400, Otwock, Poland
| | - Andrzej Boszczyk
- Trauma and Orthopaedics Department, SPSK im. A. Grucy w Otwocku, ul. Konarskiego 13, 05-400, Otwock, Poland
- Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Dariusz Marczak
- Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Orthopaedics, Otwock, Poland
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Samim M, Small KM, Higgins LD. Coracoid graft union: a quantitative assessment by computed tomography in primary and revision Latarjet procedure. J Shoulder Elbow Surg 2018; 27:1475-1482. [PMID: 29477667 DOI: 10.1016/j.jse.2018.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 01/05/2018] [Accepted: 01/07/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The goal of the Latarjet procedure is restoration of shoulder stability enabled by accurate graft positioning and union. This study aimed to establish a reproducible method of quantitatively assessing coracoid graft osseous union percentage (OUP) using computed tomography (CT) scans and to determine the effect of other factors on the OUP. MATERIALS AND METHODS Postoperative CT scans of 41 consecutive patients treated with the open Latarjet procedure (37% primary, 63% revision) for anterior glenohumeral instability were analyzed for the OUP, position of the graft, and screw type and angle. Two musculoskeletal radiologists independently examined the images 2 times, and intraobserver and interobserver reliability was calculated using intraclass correlation coefficient (ICC). RESULTS Mean OUP was 66% (range, 0%-94%) using quantitate methods, with good intraobserver reliability (ICC = 0.795) and interobserver reliability (ICC = 0.797). Nonunion and significant graft resorption was found in 2 patients. No significant difference was found in the mean OUP in the primary (63%) vs. revision Latarjet procedure (67%). Grafts were flush in 39%, medial in 36%, and lateral in 8%. The medial and neutral graft position was associated with slightly higher OUP (72% and 69%) compared with lateral (65%). OUP was higher when the superior screw angle was less than 17° and the inferior screw angle was less than 24°. This difference did not reach statistical significance. Screw type was not associated with significant difference in OUP. CONCLUSION Quantitative assessment of osseous union of the graft using a reproducible method that we introduced showed similar OUP in the primary and revision Latarjet procedure.
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Affiliation(s)
- Mohammad Samim
- Department of Radiology, NYU Langone Medical Center, New York, NY, USA
| | - Kirstin M Small
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
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Haeni D, Sanchez M, Johannes P, Victoria L, Henderson D, Munji J, Petkin K, Lafosse L. Arthroscopic double bone block augmentation is a salvage procedure for anterior and posterior shoulder instability secondary to glenoid bone loss. Knee Surg Sports Traumatol Arthrosc 2018; 26:2447-2453. [PMID: 29752500 DOI: 10.1007/s00167-018-4975-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE The aim of this study was to describe a one-step arthroscopic anterior and posterior bone block augmentation technique for bidirectional shoulder instability and to present preliminary results. METHODS Seven consecutive patients who underwent a concomitant anterior and posterior bone block procedure between 2007 and 2015 were retrospectively reviewed. Clinical scores, return to sport rate, and complications were assessed. Radiological outcome, with CT scan at 6 months and plain radiographs at final follow-up were reviewed. Patient reported functional outcomes were also assessed via phone or email interview. RESULTS Seven consecutive patients were included in the study with a median age at surgery of 27 years. Median clinical and radiological follow-up was 7 months (4-72 months). Walch-Duplay score and Rowe scores were improved. Four patients were able to return to sport. One patient experienced recurrent dislocation, and one subjective instability/subluxation without confirmed recurrence. CT scan showed union in all cases, with one case of anterior bone block osteolysis and one case of partial posterior bone block osteolysis. Radiographs showed no detectable progression of osteoarthritis using the Samilson and Prieto classification. At final follow-up the median WOSI score was 187 (100-1140). CONCLUSIONS An all-arthroscopic technique for the treatment of combined anterior and posterior glenoid bone loss as a cause of shoulder instability can provide fair to good clinical outcomes, with a low incidence of intra-operative complications. The rate of failure in our series remains higher than that seen in primary stabilization procedures. As such we consider this largely as a salvage procedure for cases in which alternative treatments have failed or are unlikely to succeed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- David Haeni
- Alps Surgery Institute, Annecy, France. .,Department of Orthopaedics and Traumatology, University Children Hospital Basel UKBB, Spitalstrasse 21, 4056, Basel, Switzerland.
| | | | | | - Lilling Victoria
- Department of Orthopedic Surgery, Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Ernstbrunner L, Gerber C. Editorial Commentary: Computed Tomography-based Analysis of the Arthroscopic Latarjet Procedure Suggests Graft Positioning Is More Variable than Expected. Arthroscopy 2018; 34:2041-2044. [PMID: 29976423 DOI: 10.1016/j.arthro.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 05/13/2018] [Accepted: 05/15/2018] [Indexed: 02/02/2023]
Abstract
The Latarjet operation is one of the most successful techniques for the treatment of recurrent anterior shoulder instability, which has recently been translated into the arthroscopic field. Several studies suggest that its arthroscopic variant is safe and reproducible and report promising short-term and mid-term results. Some authors claim that, in addition to less soft tissue damage, positioning of the coracoid graft is more accurate during arthroscopic control. There is currently no evidence of superiority of the arthroscopic or the open technique. As with the open procedure, the arthroscopic Latarjet operation requires a substantial learning curve; therefore the arthroscopic technique should be reserved for experienced arthroscopists treating a large number of shoulder instabilities.
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van der Linde JA, Wessel RN, Trantalis JN, van den Bekerom MPJ. Review of Latarjet (1954) on the treatment of recurrent shoulder dislocations. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This classic discusses the original publication ‘Treatment of recurrent dislocation of the shoulder’ on the Latarjet procedure. This surgical technique that has become one of the basics in shoulder-stabilising surgery, introduced by Latarjet in 1954 in the journal Lyon Chirurgical. Inspired by publications of colleagues in the field of shoulder surgery, Latarjet introduced a technique that transfers the coracoid process to the anterior glenoid rim in patients with anterior shoulder instability. Although being outrun in popularity by the Bankart repair for several decades, improved knowledge regarding long-term outcomes, surgical techniques and patient characteristics such as bone loss and participation in contact sports has led to renewed interest in the Latarjet procedure. This especially accounts for patients with significant glenohumeral bone loss or patients with a previously failed soft tissue repairs. Whereas the increase in popularity has led to many studies focussing on various aspects, the 15 basics of the initial procedure have virtually remained unchanged.
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Plath JE, Henderson DJH, Coquay J, Dück K, Haeni D, Lafosse L. Does the Arthroscopic Latarjet Procedure Effectively Correct "Off-Track" Hill-Sachs Lesions? Am J Sports Med 2018; 46:72-78. [PMID: 28952782 DOI: 10.1177/0363546517728717] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The glenoid track concept describes the dynamic interaction of bipolar bone loss in anterior glenohumeral instability. Initial studies have successfully demonstrated this concept's application in clinical populations. In clinical practice, the Latarjet procedure is commonly the preferred treatment in addressing "off-track" Hill-Sachs lesions. The effectiveness of this procedure in restoring such lesions to an "on-track" state, however, has not yet been evaluated or described in the literature. HYPOTHESIS The Latarjet procedure would transform "off-track" Hill-Sachs lesions to "on-track" lesions. Lesions would remain "on-track" during follow-up, despite glenoid remodeling. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients with "off-track" Hill-Sachs lesions treated with the arthroscopic Latarjet procedure between March 2013 and May 2014 were included. Glenoid track and coracoid graft contact surface area measurements using 3-dimensional computed tomography (3D-CT) were performed preoperatively and at 6-week, 6-month, and at least 12-month (final) follow-up. The mean final follow-up was 23 months. The glenoid diameter, as a percentage of the native glenoid, was also calculated from this imaging. RESULTS Twenty-six patients met the inclusion criteria. 3D-CT scans were available for all patients preoperatively and postoperatively, with 21 patients (81%) undergoing 6-month follow-up CT and 19 patients (73%) undergoing final follow-up CT. Hill-Sachs lesions remained "on-track" at all follow-up time points. The mean glenoid diameter changed significantly from 84.6% preoperatively to 122.8% at 6 weeks ( P < .001) and from 120.5% at 6 months to 113.9% at final follow-up ( P = .005). This was also reflected in significant remodeling seen in the coracoid graft articular contact area (6 weeks to 6 months, P = .024; 6 months to final follow-up, P = .002). This persisting glenoid arc enlargement at final follow-up avoided "off-track" Hill-Sachs lesions in 6 of 19 patients (32%), which would otherwise have occurred had the coracoid graft remodeled to native glenoid dimensions. CONCLUSION The Latarjet procedure provides an effective treatment for "off-track" engaging Hill-Sachs lesions, despite an evident glenoid remodeling process. At a mean of 23 months postoperatively, a mean persisting enlargement of the glenoid arc of 14% beyond native dimensions remained, avoiding a recurrent "off-track" lesion in 32% of patients, which would otherwise have occurred with complete remodeling.
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Affiliation(s)
- Johannes E Plath
- Alps Surgery Institute, Annecy, France.,Department of Trauma Surgery, Klinikum Augsburg, Augsburg, Germany
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Latarjet procedure using subscapularis split approach offers better rotational endurance than partial tenotomy for anterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 2018; 26:88-93. [PMID: 28258327 DOI: 10.1007/s00167-017-4480-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Latarjet, which is a coracoid bone block procedure, is an effective treatment for anterior shoulder instability with glenoid bone loss. During this reconstructive procedure the subscapularis may be tenotomized or be split to expose the glenoid neck. The aim of this study was to assess the effect of subscapularis management on functional outcomes and internal and external rotation durability and strength. Hypothesis is that the subscapularis split approach will result in better functional results and superior internal rotation strength and endurance. METHODS The study included 48 patients [median age 30 (range 16-69); 42 males, 6 females], who underwent a modified Latarjet procedure for anterior shoulder instability. There were 20 patients in the subscapularis tenotomy group and 28 patients in the subscapularis split group. The groups were compared isokinetically using a computerized dynamometer for internal and external rotation durability and strength. At the latest follow-up, the patients were evaluated with the American Shoulder and Elbow Surgeons (ASES) and ROWE scores for functional outcomes. RESULTS At a median follow-up period of 25 (range 12-73) months after the Latarjet procedure, the internal rotation durability was significantly higher in the split group (p = 0.045). However, a statistically significant difference could not be found for internal and external rotational strengths (n.s.). There was also no significant difference between the final ASES and ROWE scores (n.s.). CONCLUSION Although both approaches offer promising results, the subscapularis split approach appears to provide better internal rotation durability compared to subscapularis tenotomy. Therefore, the subscapularis split approach may be more preferable for the management of the subscapularis muscle during Latarjet procedure. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Hardy A, Gerometta A, Granger B, Massein A, Casabianca L, Pascal-Moussellard H, Loriaut P. Preoperative CT planning of screw length in arthroscopic Latarjet. Knee Surg Sports Traumatol Arthrosc 2018; 26:24-30. [PMID: 27562373 DOI: 10.1007/s00167-016-4286-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/09/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The Latarjet procedure has shown its efficiency for the treatment of anterior shoulder dislocation. The success of this technique depends on the correct positioning and fusion of the bone block. The length of the screws that fix the bone block can be a problem. They can increase the risk of non-union if too short or be the cause of nerve lesion or soft tissue discomfort if too long. Suprascapular nerve injuries have been reported during shoulder stabilisation surgery up to 6 % of the case. Bone block non-union depending on the series is found around 20 % of the cases. The purpose of this study was to evaluate the efficiency of this CT preoperative planning to predict optimal screws length. The clinical importance of this study lies in the observation that it is the first study to evaluate the efficiency of CT planning to predict screw length. METHODS Inclusion criteria were patients with chronic anterior instability of the shoulder with an ISIS superior to 4. Exclusion criteria were patients with multidirectional instability or any previous surgery on this shoulder. Thirty patients were included prospectively, 11 of them went threw a CT planning, before their arthroscopic Latarjet. Optimal length of both screws was calculated, adding the size of the coracoid at 5 and 15 mm from the tip to the glenoid. Thirty-two-mm screws were used for patients without planning. On a post-operative CT scan with 3D reconstruction, the distance between the screw tip and the posterior cortex was measured. A one-sample Wilcoxon test was used to compare the distance from the tip of the screw to an acceptable positioning of ±2 mm from the posterior cortex. RESULTS In the group without planning, screw 1 tended to differ from the acceptable positioning: mean 3.44 mm ± 3.13, med 2.9 mm, q1; q3 [0.6; 4.75] p = 0.1118, and screw 2 differed significantly from the acceptable position: mean 4.83 mm ± 4.11, med 3.7 mm, q1; q3 [1.7; 5.45] p = 0.0045. In the group with planning, position of screw 1 or 2 showed no significant difference from the acceptable position: mean 2.45 mm ± 2.07 med 1.8 mm, q1; q3 [1; 3.3] p = 1; mean 2.75 mm ± 2.32 med 2.3 mm, q1; q3 [1.25; 3.8] p = 0.5631. CONCLUSION Unplanned Latarjet can lead to inaccurate screw length especially in the lower screw and can increase the risk of non-union and nerve damage. The clinical relevance of this article is that CT planning of screw length before surgery showed good results on post-operative CT.
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Affiliation(s)
- Alexandre Hardy
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Antoine Gerometta
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Benjamin Granger
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Audrey Massein
- Department of Radiology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Laurent Casabianca
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Hugues Pascal-Moussellard
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Philippe Loriaut
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France.
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Reliability of a CT reconstruction for preoperative surgical planning in the arthroscopic Latarjet procedure. Knee Surg Sports Traumatol Arthrosc 2018; 26:40-47. [PMID: 27734111 DOI: 10.1007/s00167-016-4329-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The arthroscopic Latarjet procedure has provided reliable results in the treatment of anterior shoulder instability. However, this procedure remains technically challenging and is related to several complications. The morphology of the coracoid and the glenoid are inconsistent. Inadequate coracoid and glenoid preparing may lead to mismatching between their surfaces. Inadequate screws lengthening and orientation are a major concern. Too long screws can lead to suprascapular nerve injuries or hardware irritation, whereas too short screws can lead to nonunions, fibrous unions or migration of the bone block. The purpose of the study was to investigate the application of virtual surgical planning and digital technology in preoperative assessment and planning of the Latarjet procedure. METHODS Twelve patients planned for an arthroscopic Latarjet had a CT scan evaluation with multi-two-dimensional reconstruction performed before surgery. Interobserver and intraobserver reliability were evaluated. The shape of the anterior rim of the glenoid and the undersurface of the coracoid were classified. Coracoid height was measured, respectively, at 5 mm (C1) and 10 mm (C2) from the tip of the coracoid process, corresponding to the drilling zone. Measurements of the glenoid width were then taken in the axial view at 25 % (G1) and 50 % (G2) of the glenoid height with various α angles (5°, 10°, 15°, 20°, 25°, 30°) 7 mm from the anterior glenoid rim. Shapes of the undersurface of the coracoid and the anterior rim of the glenoid were noted during the surgical procedure. Post-operative measurements included the α angle. RESULTS Concerning coracoid height measurements, there was an almost perfect to substantial intra- and inter-reliability, with values ranging from ICC = 0.75-0.97. For the shape of the coracoid, concordances were, respectively, perfect (ICC = 1) and almost perfect (0.87 [0.33; 1]) for the intra- and interobserver reliabilities. Concerning the glenoid, concordance was always almost perfect for 50 % height. Concordance was almost perfect for 25 % height 15° and 30° for inter- and intraobserver, for intraobserver at 0° and 25°. All the other values were still showing moderate concordance. Shape of the coracoid analysis reproducibility was perfect for both intra- and interobserver ICC = 1. There was a total agreement (ICC = 1) between the preoperative evaluation of the shape of the glenoid and the coracoid and the intraoperative assessment. CONCLUSION The ideal and accurate preoperative planning of screwing of the coracoid graft in the arthroscopic Latarjet can be achieved in the real surgery assisted by the virtual planning. The clinical importance of this study lies in the observation that this new preoperative planning could offer a simple, effective and reproducible tool for surgeons helping them to prepare in the best possible way a technically challenging procedure usually associated with a high rate of complications.
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Lädermann A, Denard PJ, Arrigoni P, Narbona P, Burkhart SS, Barth J. Level of the Subscapularis Split During Arthroscopic Latarjet. Arthroscopy 2017; 33:2120-2124. [PMID: 28822639 DOI: 10.1016/j.arthro.2017.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/17/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the location of the subscapularis split during arthroscopic Latarjet created by an inside-out technique passing a switching stick from the posterior portal across the glenohumeral joint. METHODS An inside-out technique was used to arthroscopically create a subscapularis split in 20 fresh-frozen human cadaveric shoulders. The distance between the exit point of the switching stick and the upper border of the subscapularis and the anterior circumflex vessels was measured arthroscopically and after open dissection. RESULTS Twelve splits were in the upper third of the subscapularis, 3 were at the junction of the upper third and the middle third, and 5 were in the middle third. None were at the junction between the middle and lower third as desired. CONCLUSIONS Using the inside-out method during arthroscopic Latarjet may produce a high subscapularis split if it is performed from with a switching stick that is inserted through the posterior approach, and passed across the glenohumeral joint at the level of the inferior glenoid. CLINICAL RELEVANCE This study analyzed the relative risk of high subscapularis split during the arthroscopic Latarjet procedure.
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
| | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, Oregon, U.S.A.; Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Paolo Arrigoni
- Policlinico San Donato, Università degli studi di Milano, San Donato Milanese, Italy
| | - Pablo Narbona
- Department of Shoulder Surgery, Sanatorio Allende, Córdoba, Argentina
| | - Stephen S Burkhart
- The San Antonio Orthopaedic Group, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - Johannes Barth
- Centre Ostéo-Articulaire des Cèdres, Parc Sud Galaxie, Echirolles, France
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Identification of a Remodeled Neo-tendon After Arthroscopic Latarjet Procedure. Arthroscopy 2017; 33:534-542. [PMID: 27876234 DOI: 10.1016/j.arthro.2016.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/15/2016] [Accepted: 08/23/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To macroscopically, histologically, and radiologically describe a time-dependent remodeling process of a neo-tendon or -ligament in the shoulder after the arthroscopic Latarjet procedure. METHODS During follow-up surgery after the arthroscopic Latarjet procedure, 17 shoulders in 16 patients were evaluated for a remodeled tendon-like structure. The mean overall follow-up period was 27.4 months. The mean time between the arthroscopic Latarjet procedure and revision was 11.6 months. All shoulders were evaluated with magnetic resonance imaging, and seven histologic specimens were obtained during revision surgery. RESULTS A distinct, oriented strand of tissue was found in 16 of 17 shoulders on revision surgery. Postoperative magnetic resonance imaging analyses showed a signal-free, longitudinal tendon-like structure originating at the tip of the acromion, traversing the space of the former subcoracoid bursa to attach in the course of the transposed conjoint tendon or the proximal short head of the biceps. Histologic analysis of seven specimens showed a characteristic timeline of remodeling. CONCLUSIONS A tendon- or ligament-like structure is remodeled between the anterior bottom tip of the acromion and the transposed coracoid process in a time-dependent manner after the arthroscopic Latarjet procedure. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Tibone J. Editorial Commentary: Not for The Faint of Heart: The Arthroscopic Latarjet Procedure, A North American Experience. Arthroscopy 2016; 32:1971-1972. [PMID: 27697180 DOI: 10.1016/j.arthro.2016.06.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 02/02/2023]
Abstract
The Latarjet operation is a very difficult operation both when performed arthroscopically and when performed with an open approach. I do not think that this is an operation that should be done by a casual shoulder surgeon. I think, in the best interests of the patient, that this surgery should be performed only by orthopaedic surgeons who are trained in it.
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Athwal GS, Meislin R, Getz C, Weinstein D, Favorito P. Short-term Complications of the Arthroscopic Latarjet Procedure: A North American Experience. Arthroscopy 2016; 32:1965-1970. [PMID: 27160460 DOI: 10.1016/j.arthro.2016.02.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To report on the intraoperative and early postoperative (<3 months) problems and complications encountered with the arthroscopic Latarjet procedure in patients with complex anterior shoulder instability. METHODS Between 2010 and 2014, 83 patients underwent an arthroscopic Latarjet procedure for recurrent post-traumatic anterior instability. The group's mean age was 28 ± 10 years and consisted of 76 (92%) male patients. A "problem" was defined as an unanticipated perioperative event that was not likely to affect the patient's final outcome. A "complication" was defined as an event that was likely to negatively affect outcome. RESULTS At a mean follow-up of 17 months (range, 3 to 43 months), 20 (24%) patients sustained either a problem and/or a complication. The problem rate was 18% and the complication rate was 10%. The most commonly encountered adverse event was intraoperative fracture of the coracoid graft, which occurred in 6 patients (7%). In addition, 1 arthroscopic case was intraoperatively converted to open and 1 patient sustained a transient axillary nerve injury. A total of 7 cases underwent secondary operative procedures. The rate of problems and/or complications in primary cases was not significantly different than revision cases (P = .335). CONCLUSIONS The rate of adverse events reported in this arthroscopic series is not insignificant and is similar to that reported with the traditional open Latarjet. With appropriate training, the arthroscopic Latarjet procedure can be effective for the management of patients with complex shoulder instability. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- George S Athwal
- Roth
- McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, Western University, London, Ontario, Canada.
| | - Robert Meislin
- Roth
- McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, Western University, London, Ontario, Canada
| | - Charles Getz
- Roth
- McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, Western University, London, Ontario, Canada
| | - David Weinstein
- Roth
- McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, Western University, London, Ontario, Canada
| | - Paul Favorito
- Roth
- McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, Western University, London, Ontario, Canada
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Graft position and fusion rate following arthroscopic Latarjet. Knee Surg Sports Traumatol Arthrosc 2016; 24:507-12. [PMID: 25726159 DOI: 10.1007/s00167-015-3551-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 02/24/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE The arthroscopic Latarjet procedure is recently becoming an increasingly popular technique. Nevertheless, position and fusion of the autograft had not been well studied yet. The purpose of this study was to assess the positioning of the coracoid graft and the fusion rate on CT scan in the arthroscopic Latarjet procedure. METHODS The study design was a prospective series of 19 consecutive patients who received arthroscopic Latarjet procedure. Radiological assessment on CT scan performed 3 months post-operatively included an analysis of the fusion and the position of the coracoid bone graft using a validated method. 02:30-04:20 was considered an ideal positioning in the sagittal view. In the axial view, the positioning was considered as flush, congruent, medial, too medial, or lateral. RESULTS The median age of patients was 27.6 (±6.9). Mean operative time was of 161 min ±34.8. The fusion rate was of 78 %. Coracoid grafts were positioned 01:52 h (56° ± 14°) to 4:04 h (122° ± 12.5°). In the axial view, 32 % of the grafts positioning were considered as flush, 38 % as congruent, 30 % as medial, and 6 % too medial. No lateral position was noted. Two complications occurred, one graft fracture during screwing requiring opening conversion and an early case of osteolysis in a medial-positioned graft. CONCLUSION The arthroscopic Latarjet procedure is a technically challenging technique that provides satisfactory fusion rate and graft positioning with a low complication rate. The clinical importance of this study lies in the observation that it is the first study to evaluate the position of the coracoid bone graft in arthroscopic Latarjet according to a detailed and validated method. LEVEL OF EVIDENCE IV.
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Abstract
The Latarjet procedure is an operation performed either arthroscopically or open for recurrent anterior shoulder instability, in the setting of glenoid bone loss; with good to excellent functional results. Despite excellent clinical results, the complication rates are reported between 15 and 30 %. Intraoperative complications such as graft malpositioning, neurovascular injury, and graft fracture can all be mitigated with meticulous surgical technique and understanding of the local anatomy. Nonunion and screw breakage are intermediate-term complications that occur in less than 5 % of patients. The long-term complications such as graft osteolysis are still an unsolved problem, and future research is required to understand the etiology and best treatment option. Recurrent instability after the Latarjet procedure can be managed with iliac crest bone graft reconstruction of the anterior glenoid. Shoulder arthritis is another complication reported after the Latarjet procedure, which poses additional challenges to both the surgeon and patient.
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Fogerty S, Dumont GD, Lafosse L. (iii) Shoulder arthroscopy: the past, present and future directions. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mporth.2014.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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