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Vetoshkin A, Mikhaylova K. Learning curve in the arthroscopic Latarjet procedure: An analysis of the first 171 cases. J Orthop 2024; 50:58-64. [PMID: 38173830 PMCID: PMC10758696 DOI: 10.1016/j.jor.2023.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024] Open
Abstract
Background Arthroscopic Latarjet procedure is accepted as effective and safe. However, it is more likely to be challenging in execution. Therefore, the analysis of the learning curve remains to be worth examination. Objective To examine the learning curve in the arthroscopic Latarjet procedure through an analysis of the correlation between the average operative time, complications rate, and the total number of performed surgeries and execution frequency. Materials and method A total of 171 patients who underwent arthroscopic Latarjet surgery between 2013 and 2020 were included. Clinical findings were recorded postoperatively. We fixed the operative time with account taken of the execution frequency and the number of intra- and postoperative complications. All procedures were completed by one surgeon. Results By statistical analysis, a significant association between the operative time and the number of surgical interventions was found (p < 0.05). After 120 procedures, the average operative time demonstrated a constant reduction and reached 62.8 min (p < 0.05). We detected the relation between the average operative time and surgery frequency. The significant correlation between the number of intraoperative complications and the number of procedures performed manifests after the 20th surgery (p < 0.05). In total, 13 episodes of complications were recorded (7.6 %). 9 cases of intraoperative complications (5.3 %) conversed into the open Latarjet procedure. 4 episodes of postoperative complications (2.3 %) were documented, among them 2 hematomas which were treated conservatively, and 2 cases of recurrent shoulder instability. There were no neurological, neurovascular, and infection complications seen in our cohort. Discussion It took more than 120 arthroscopic procedures to reach the stable and reproducible indices in operative time, and more than 20 surgeries to achieve a significant reduction in the intraoperative complications rate. There was no correlation between the postoperative complication rate and the number of performed procedures. The overall level of complications did not exceed the level mentioned in the literature. The high surgical activity could be considered as a favorable factor to increase the efficiency of the learning process. Conclusion Gaining clinical experience with the passing of the learning stages impacts significantly the rate of intraoperative complications and operative time. The arthroscopic Latarjet procedure is safe and characterized with good clinical results even within the initial stages of the learning curve.
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Affiliation(s)
- A.A. Vetoshkin
- Traumatology and Orthopedics Department, Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia, 4/2, Academica Lebedeva Str., St. Petersburg, 194044, Russia
| | - K.D. Mikhaylova
- Traumatology and Orthopedics Department, Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia, 4/2, Academica Lebedeva Str., St. Petersburg, 194044, Russia
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Billaud A, Baverel L, Metais P. Arthroscopic Latarjet yields better union and prevention of instability compared to arthroscopic bony Bankart repair in shoulders with recurrent anterior instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5994-6005. [PMID: 37980282 DOI: 10.1007/s00167-023-07655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/24/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE To determine whether arthroscopic Latarjet procedure or arthroscopic bony Bankart repair provide better outcomes in terms of rates of recurrent instability, non-union and complications, as well as clinical scores and range of motion. METHODS An electronic literature search was performed using PubMed, Embase®, and Cochrane databases, applying the following keywords: "Arthroscopic bony Bankart" OR "Arthroscopic osseous Bankart" AND "Arthroscopic Latarjet" OR "Arthroscopic coracoid bone block". RESULTS The systematic search returned 1465 records, of which 29 were included (arthroscopic bony Bankart repair, n = 16; arthroscopic Latarjet, n = 13). 37 datasets were included for data extraction, on 1483 shoulders. Compared to arthroscopic Latarjet, arthroscopic bony Bankart repair had significantly higher instability rates (0.14; CI 0.10-0.18; vs 0.04; CI 0.02-0.06), significantly lower union rates (0.63; CI 0.28-0.91 vs 0.98; CI 0.93-1.00), and significantly lower pain on VAS (0.42; CI 0.17-0.67 vs 1.17; CI 0.96-1.38). There were no significant differences in preoperative glenoid bone loss, follow-up, complication rate, ROWE score, ASES score, external rotation, and anterior forward elevation between arthroscopic Latarjet and arthroscopic bony Bankart repair. CONCLUSION Compared to arthroscopic Latarjet, arthroscopic bony Bankart repair results in significantly (i) higher rates of recurrent instability (14% vs 4%), (ii) lower union rates (63% vs 98%), but (iii) slightly lower pain on VAS (0.45 vs 1.17). There were no differences in complication rates, clinical scores, or postoperative ranges of motion. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Anselme Billaud
- Clinique du Sport, 2 rue Georges Negrevergne, 33700, Mérignac, France
| | | | - Pierre Metais
- Hopital Prive de la Châtaigneraie, ELSAN, Clermont-Ferrand, France
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Shin SJ, Kim JH, Ahn J. Arthroscopic Latarjet procedure: current concepts and surgical techniques. Clin Shoulder Elb 2023; 26:445-454. [PMID: 37442776 DOI: 10.5397/cise.2022.01396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/25/2023] [Indexed: 07/15/2023] Open
Abstract
The Latarjet procedure is a surgical procedure that can effectively restore glenohumeral stability, especially in patients with anterior shoulder instability and glenoid bone loss. Many studies have shown comparable clinical outcomes between patients undergoing the arthroscopic Latarjet procedure and those undergoing traditional open methods or other glenohumeral joint stabilization procedures. However, the arthroscopic Latarjet procedure is a challenging technique due to the unfamiliar portal placements, proximity of neurovascular structures, and serious postoperative complications. The arthroscopic Latarjet procedure has not yet been widely applied, and a clear understanding of the anatomical structure and the precise methods is required prior to operation performance. Satisfactory clinical outcomes can be achieved by thorough preoperative planning and proper implant fixation methods.
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Affiliation(s)
- Sang-Jin Shin
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jae Hyung Kim
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jonghyun Ahn
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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Fouasson-Chailloux A, Estoppey D, Perdreau A, Bessière C, Goldstein Y, Duysens C. Recurrent Anterior Shoulder Instability Treated Using the Arthroscopic Bankart-Latarjet Technique: Experience of a Peripheral Hospital. J Clin Med 2023; 12:5274. [PMID: 37629316 PMCID: PMC10455497 DOI: 10.3390/jcm12165274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
The arthroscopic Bankart-Latarjet procedure is used in the surgical management of anterior shoulder instability. This technique is mainly performed in referral centers due to its high technicity. This study aimed to evaluate surgical outcomes in a peripheral hospital center. This is a retrospective study of patients treated for recurrent anterior shoulder instability. The clinical scores (Walch-Duplay, Rowe, and Western Ontario Shoulder Instability Index (WOSI)) were assessed preoperatively and at 12 months after surgery. The consolidation and the position of the bone block were evaluated at 6 months using a CT scan. Between 2016 and 2020, 40 patients had been operated on (mean age: 28.5 ± 7.9 years). During a mean follow-up of 29.5 ± 11.6 months, we noted only one complication, a case of fracture of the callus of a consolidated bone block. No recurrence of instability was recorded. The Walch-Duplay score increased from 17.8 to 94.6, the Rowe score from 24.9 to 96.8, and the WOSI score decreased from 52.1% to 6.9%. The bone block was consolidated in 35 patients (87.5%), and a flush position with the anterior edge of the glenoid was noted for all patients. At one year, 67.0% of the patients practicing sport had returned to sports. The arthroscopic Bankart-Latarjet technique was a reliable procedure in the hands of an experienced shoulder surgeon, even in a peripheral hospital center.
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Affiliation(s)
- Alban Fouasson-Chailloux
- Institut Européen de la Main, Hôpital Kirchberg, 9 Rue Edward Steichen, L-2540 Luxembourg, Luxembourg; (D.E.); (C.D.)
- Médecine Physique et Réadaptation Locomotrice, CHU Nantes, Nantes Université, 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, 44042 Nantes, France
| | - Daniel Estoppey
- Institut Européen de la Main, Hôpital Kirchberg, 9 Rue Edward Steichen, L-2540 Luxembourg, Luxembourg; (D.E.); (C.D.)
| | - Alan Perdreau
- Service D’orthopédie, Vivalia, Centre Hospitalier de l’Ardenne, Avenue de Houffalize 35, 6800 Libramont-Chevigny, Belgium;
| | - Charles Bessière
- OrthoVar, Pôle Médical Epsilon 3, 87 Avenue Archimede, 83700 Saint Raphaël, France;
| | - Yariv Goldstein
- Assuta Samsom University Hospital, 7 HaRefu’ah St., Ashdod 747629, Israel;
| | - Christophe Duysens
- Institut Européen de la Main, Hôpital Kirchberg, 9 Rue Edward Steichen, L-2540 Luxembourg, Luxembourg; (D.E.); (C.D.)
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Lacouture-Suarez JD, Azar M, Brusalis CM, Ranieri R, Brotat-Rodriguez M, Boileau P. Screw-Related Complications May Occur at a Greater Rate After Arthroscopic Versus Open Latarjet Procedure: A Systematic Review. Arthrosc Sports Med Rehabil 2023; 5:100726. [PMID: 37645398 PMCID: PMC10461157 DOI: 10.1016/j.asmr.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/18/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To determine the rate of complications attributable to the use of screw fixation during the Latarjet procedure and to delineate screw-related complications for open and arthroscopic Latarjet surgery. Methods A systematic review of the literature was performed by querying MEDLINE and EMBASE computerized databases for relevant articles that reported clinical outcomes associated with the Latarjet procedure. Clinical studies of open and/or arthroscopic Latarjet surgery that employed screw fixation of the coracoid were included in our analysis. Results From 692 articles identified initially, 32 studies met eligibility criteria. The study cohort comprised 2,758 shoulders, with a mean age of patients ranged from 17 to 62 years, and the mean duration of follow-up ranged from 0.3 to 25.6 years. Twenty-two studies reported outcomes of an open Latarjet technique whereas 10 studies reported on an arthroscopic Latarjet technique. Across all studies, the overall complication rate ranged from 1.4% to 36%. The rate of screw-related complications ranged from 0% to16%, and the rate of screw removal ranged from 0% to 18%. Among the subset of studies that reported specific indications for screw removal, the most common indications were pain and screw loosening. Reported rates of screw-removal among arthroscopic Latarjet procedures range from 0% to 18% and among open procedures range from 0% to 7.3%. Conclusions (1) Up to one-third of the overall surgical complications associated with the Latarjet procedure may be related to the use of screw fixation, (2) arthroscopic Latarjet procedure did not decrease the rate of screw related complications. The reported rate of screw-removal may be higher after the arthroscopic Latarjet procedures (up to 18%) than after open procedures (up to 7,3%), and is mainly indicated for persistent shoulder pain and/or screw loosening. Level of Evidence Level IV, systematic review of Level III-IV studies.
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Affiliation(s)
- Juan David Lacouture-Suarez
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| | - Michel Azar
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| | | | - Riccardo Ranieri
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| | - Maria Brotat-Rodriguez
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| | - Pascal Boileau
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
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Wu C, Xu J, Fang Z, Chen J, Ye Z, Wu X, Li Z, Wang L, Kang Y, Zhao S, Xu C, Zhao J. Clinical and Radiological Outcomes in Patients With Anterior Shoulder Instability and Glenoid Bone Loss after Arthroscopic Free Bone Block Combined With Dynamic Anterior Stabilization. Am J Sports Med 2023; 51:187-197. [PMID: 36468855 DOI: 10.1177/03635465221137883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND As an alternative to the Latarjet procedure, the arthroscopic free bone block (FBB) procedure combined with dynamic anterior stabilization (DAS) has been recently proposed to provide both glenoid augmentation and a tendon sling effect for treating anterior shoulder instability (ASI) with glenoid bone loss. PURPOSE To evaluate the clinical and radiological outcomes of FBB-DAS for ASI with glenoid bone loss. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent arthroscopic FBB-DAS for ASI with >15% glenoid bone loss between February 2017 and March 2020 were screened and enrolled in this study. Clinical outcome measures were assessed preoperatively and at a minimum 2-year follow-up, including recurrence, complications, shoulder functional scores, range of motion, and return to sports. Postoperative computed tomography and magnetic resonance imaging were also performed. RESULTS Of a total of 65 patients with a mean follow-up of 46.1 ± 13.1 months, no patients experienced a recurrent dislocation or subluxation postoperatively, while 2 had a positive anterior apprehension test (3.1%). Additionally, 2 patients (3.1%) experienced complications of hematoma and shoulder stiffness, respectively. The mean visual analog scale score, American Shoulder and Elbow Surgeons score, Rowe score, and Oxford Shoulder Instability Score all improved significantly from 3.2 ± 2.4, 75.0 ± 18.9, 43.6 ± 27.3, and 33.8 ± 9.0 preoperatively to 1.3 ± 0.8, 95.1 ± 8.0, 95.5 ± 7.8, and 14.8 ± 3.5 at final follow-up, respectively (all P < .001). No difference was detected in range of motion except for 8.1° and 7.5° external rotation limitations in adduction and abduction, respectively. There were 62 patients (95.4%) who returned to sports, and 54 patients (83.1%) returned to the preinjury level. The transferred biceps tendon was intact in all 59 patients who completed radiological examination at the latest follow-up. Good bone healing was achieved in 98.3% of patients, and the glenoid bone defect decreased from 18.1% to 4.9%. Osseous and labral glenoids were significantly enlarged in width and depth on the latest magnetic resonance imaging (all P < .001). CONCLUSION Arthroscopic FBB-DAS provided satisfactory clinical and radiological outcomes for ASI with glenoid bone loss. Despite slight external rotation restrictions, it achieved low recurrence and complication rates, excellent shoulder functional scores, a high return-to-sports rate, and favorable graft healing and remodeling.
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Affiliation(s)
- Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaoyi Fang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiulin Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyun Li
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liren Wang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhao Kang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abstract
BACKGROUND In cases of recurrent anterior shoulder instability with a glenoid defect, Latarjet procedures are widely used for stabilization. Although complications with this procedure have been reported, few studies have comprehensively analyzed issues related to the Latarjet procedure. PURPOSE To identify the overall complication rate of the Latarjet procedure used for anterior shoulder instability and to compare the rate of complications between arthroscopic and open approaches. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed by using the PubMed, EMBASE, Scopus, and Cochrane Library databases. Data on complications were extracted and classified as intraoperative, postoperative, or instability-related for further analysis. Quality assessments were performed with criteria from the Methodological Index for Nonrandomized Studies (MINORS). A quantitative synthesis of data was conducted to compare the complication rates between arthroscopic and open approaches. RESULTS A total of 35 articles were included in this analysis. The MINORS score was 11.89. A total 2560 Latarjet procedures (2532 patients) were included. The overall complication rate was 16.1% (n = 412). The intraoperative complication rate was 3.4% (n = 87) and included a 1.9% (n = 48) incidence of nerve injuries and a 1.0% (n = 25) incidence of iatrogenic fractures. Screw problems, vascular injuries, and conversion arthroscopic to open surgery each occurred at a rate of <1%. The postoperative complication rate was 6.5% (n = 166), and the most common complication was nonunion (1.3%; n = 33). The instability-related complication rate was 6.2% (n = 159) and included a 1.5% (n = 38) rate of redislocation, a 2.9% (n = 75) rate of positive apprehension test, and a 1.0% (n = 26) rate of instability. Overall, 2.6% (n = 66) of patients required an unplanned secondary operation after the initial surgery. The arthroscopic approach was associated with a higher rate of intraoperative complications compared with the open approach (5.0% vs 2.9%; P =.020) and a lower rate of instability-related complications (3.1% vs 7.2%; P < .001). CONCLUSION The Latarjet procedure for anterior shoulder instability results in an overall complication rate of 16.1% and a reoperation rate of 2.6%. However, serious complications at short-term follow-up appear rare. When the arthroscopic approach was used, the rate of intraoperative complications was higher, although instability-related complications were lower when compared with the open approach.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Sang Soo Na
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Byung-Chan Choi
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
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Maiotti M, De Vita A, De Benedetto M, Cerciello S, Massoni C, Di Giunta A, Raffelini F, Lo Cascio R, Pirani P, Castricini R. Clinical outcomes and recurrence rate of 4 procedures for recurrent anterior shoulder instability: ASA, remplissage, open, and arthroscopic Latarjet: a multicenter study. J Shoulder Elbow Surg 2022; 32:931-938. [PMID: 36470517 DOI: 10.1016/j.jse.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of the present study was to compare the clinical outcomes of 4 surgical techniques in patients with recurrent anterior shoulder dislocation, glenoid bone loss (GBL) <15% and Instability Severity Index (ISI) score >3. METHODS A retrospective multicenter study was conducted on 226 patients who underwent 1 of 4 different techniques (Bankart plus arthroscopic subscapularis augmentation (ASA), Bankart plus remplissage, Latarjet, Arthro-Latarjet). The inclusion criteria were: recurrent dislocation, GBL <15%, and ISI score >3. The exclusion criteria were: GBL >15%, voluntary instability, multidirectional instability, preexisting osteoarthritis, throwing athletes' first dislocation, and ISI score<3. Follow-up ranged from 24 months to 6 years. Hyperlaxity was clinically evaluated according to Neer and Coudane-Walch tests. Clinical outcomes were assessed using the Rowe score and the Western Ontario Shoulder Instability Index (WOSI) for each technique. Before surgery, all patients underwent magnetic resonance imaging and computed tomography scanning. The Pico area method was used to assess the percentage of GBL. The operations were performed by 10 experienced surgeons; the functional outcomes were evaluated by 2 independent observers. RESULTS A total of 226 patients who met the inclusion criteria were included in the present series. A total of 89.2% of patients in the ASA group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale, improved from 838 to 235 points. A total of 79.9% of patients in remplissage (R) group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale improved from 1146 to 465 points. A total of 98.5% of patients in the Latarjet (L) group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale improved from 1456 to 319 points. A total of 81.6% of patients in the Arthro-Latarjet (AL) group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale improved from 1250 to 221 points. The recurrence rates were as follows: ASA group (7%), remplissage group (6.1%), L group (1.5%), Arthro-Latarjet group (0%). Patients in the open L group had 15.5% (10/66) more complications. CONCLUSION The use of ASA and remplissage to augment the Bankart repair have been demonstrated to be effective for restoring joint stability, yielding good clinical outcomes similar to the L procedure in patients affected by recurrent anterior dislocation with GBL <15% and an ISI score score >3. Soft tissues augmentations of the Bankart repair have been demonstrated to be effective for addressing anterior soft tissue deficiency dysfunction and critical Hill-Sachs lesions.
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Affiliation(s)
- Marco Maiotti
- Villa Stuart Hospital, Rome, Italy; Mediterranea Hospital, Naples, Italy.
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Bøe B, Støen RØ, Blich I, Moatshe G, Ludvigsen TC. Learning Curve for Arthroscopic Shoulder Latarjet Procedure Shows Shorter Operating Time and Fewer Complications with Experience. Arthroscopy 2022; 38:2391-2398. [PMID: 35157966 DOI: 10.1016/j.arthro.2022.01.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the learning curve of the arthroscopic Latarjet procedure in a consecutive series of 103 shoulders in 102 patients by comparing the early clinical and radiologic outcomes and complications of the first 25 patients with the latter 25 patients. Our hypothesis was that the studied parameters would be enhanced over time. METHODS A consecutive cohort of 103 shoulders in 102 patients treated with arthroscopic Latarjet procedure was prospectively registered from December 2014 until November 2019. Patients in this cohort represent the first cases of arthroscopic Latarjet for the 2 shoulder surgeons. All patients had a double screw fixation technique. The Western Ontario Shoulder Instability Index (WOSI) score preoperatively and at 1-year follow-up and 3-dimensional computed tomography scans preoperatively, postoperatively, and at 1-year follow-up were prospectively registered. Patient demographics, intraoperative data, complications, and reoperations were all recorded. In total, 85 of 103 shoulders (83%) had complete data sets. Patient demographics, WOSI scores, operating time, complications, satisfaction rate, and radiology scores in the first and last 25 patients were compared to evaluate learning curve. RESULTS There was longer operating time in the early group compared with the latter (130 vs 105 minutes, P = .001) and number of complications was reduced with experience (16 vs 4, P = .0005). Serious complications requiring a reoperation were 4 (16%) in the early group compared to 1 (4%) in the latter group (P = .157). Clinical results were good with major improvement in WOSI scores and 84 % satisfaction rates in both groups. CONCLUSIONS Arthroscopic Latarjet was associated with a learning curve where the early group had longer operating time and greater rates of complications. This is a procedure with few serious complications, acceptable surgery time and learning curve. LEVEL OF EVIDENCE Level III, retrospective comparative observation trial.
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Affiliation(s)
- Berte Bøe
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.
| | | | - Ingvild Blich
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Gilbert Moatshe
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Oslo Sports Trauma Research Center, Oslo, Norway
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Wang L, Kang Y, Li Y, Wu C, Jiang J, Yu S, Zhao J, Xie G. Dynamic Double-Sling Augmentation Prevents Anteroinferior Translation for Recurrent Anteroinferior Shoulder Dislocation With 20% Glenoid Bone Loss: A Cadaveric Biomechanical Study. Arthroscopy 2022; 38:1433-1440. [PMID: 34838644 DOI: 10.1016/j.arthro.2021.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To biomechanically compare the dynamic double-sling with single-sling augmentation using the conjoined tendon (CT) with 20% of an anteroinferior glenoid bone defect under the high loads in shoulders. METHODS With the shoulder in 60° of glenohumeral abduction and 60° of external rotation, the 12 shoulders stability was tested sequentially in 5 conditions: intact, 20% glenoid bone loss, Bankart repair, single-sling augmentation with the CT, and double-sling augmentation with both the CT and long head of the biceps tendon (LHBT). The anteroinferior humeral head (HH) translation force of 20N, 30N, 40N, 50N, or 60N was applied to determine the shoulder stability in each condition. RESULTS The total HH translation over 8.77 mm represented the anteroinferior shoulder instability (95% confidence interval of bone defect: 7.76-8.77 mm). A significant increase in anteroinferior HH translation was demonstrated after the creation of 20% glenoid bone defect under the 20N translational force (10.52 ± 0.71 mm). Structural failure after the Bankart repair and the single-sling augmentation under the 30N (9.84 ± 1.25 mm) and 40N (9.59 ± 0.66 mm) translational forces, respectively, were observed. The double-sling augmentation effectively prevented the anteroinferior HH translation under the translational force of less than 40N, and only half of the augmentation structure (8.25 ± 1.66 mm) had failed under the 50N translational forces. CONCLUSION In the absence of any Hill-Sachs lesion and when tested at 60° abduction and external rotation in shoulders with 20% glenoid bone defects, at time-zero, the double-sling augmentation strategy could effectively prevent anteroinferior translation when compared with the Bankart repair or the single-sling augmentation technique under all magnitudes of the translational force in biomechanical simulation. Nevertheless, none of the constructs restored the HH translation to the normal intact state. CLINICAL RELEVANCE Double-sling augmentation technique may represent a reliable option for preventing anteroinferior translation.
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Affiliation(s)
- Liren Wang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Yuhao Kang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Yufeng Li
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Suiran Yu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai.
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai.
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11
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Huang J, Huang D, Wang J, Ye Z, Liu H. Arthroscopic Subscapularis Augmentation Using the Long Head of the Biceps Tendon for Anterior Shoulder Instability. Arthrosc Tech 2022; 11:e805-e811. [PMID: 35646585 PMCID: PMC9134250 DOI: 10.1016/j.eats.2021.12.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/22/2022] [Indexed: 02/03/2023] Open
Abstract
The limitations of transferring the coracoid process along with the conjoined tendon are coracoacromial arch damage, technical difficulty, and nerve injury. The long head of the biceps tendon (LHBT) proximal transposition technique has a weaker sling effect and a risk of nerve injury. The arthroscopic subscapularis augmentation technique may have risks of shoulder external rotation restriction and subscapularis transection. Herein, we introduce an arthroscopic technique for the transfer of the LHBT for subscapularis augmentation to address these risks. Indications of this technique were patients younger than 45 years of age who engage in competitive sports, require forceful external rotation and abduction, have a related capsule-ligament insufficiency, and have a glenoid bone loss <25%. The steps include detaching the LHBT at the upper edge of the pectoralis major, transecting and braiding the LHBT, establishing a scapular tunnel, placing a guide suture through the upper third of the subscapular and scapular tunnel, passing the LHBT through the established tunnels, and fixating the LHBT. This technique achieves stability of the anterior shoulder by transecting and transferring the distal end of the LHBT to press on the upper third of the subscapularis muscle.
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Affiliation(s)
- Jianming Huang
- Address correspondence to Jianming Huang, M.D., and Haoyuan Liu, M.M., Department of Othopedics, the 73th Group Military Hospital of PLA, NO.94, Wenyuan Rd., Siming District, Xiamen City 361003, Fujian, China.
| | | | | | | | - Haoyuan Liu
- Address correspondence to Jianming Huang, M.D., and Haoyuan Liu, M.M., Department of Othopedics, the 73th Group Military Hospital of PLA, NO.94, Wenyuan Rd., Siming District, Xiamen City 361003, Fujian, China.
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12
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Hurley ET, Ben Ari E, Lorentz NA, Mojica ES, Colasanti CA, Matache BA, Jazrawi LM, Virk M, Meislin RJ. Both Open and Arthroscopic Latarjet Result in Excellent Outcomes and Low Recurrence Rates for Anterior Shoulder Instability. Arthrosc Sports Med Rehabil 2021; 3:e1955-e1960. [PMID: 34977653 PMCID: PMC8689257 DOI: 10.1016/j.asmr.2021.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 09/28/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose The purpose of this study is to evaluate the patient-reported outcomes of open Latarjet (OL) compared to arthroscopic Latarjet (AL) for anterior shoulder instability. Methods A retrospective review of patients who underwent either OL or AL for anterior shoulder instability between 2011 and 2019 was performed. Recurrent instability, visual analog scale (VAS) score, Shoulder Instability-Return to Sport after Injury (SIRSI), Subjective Shoulder Value (SSV), Western Ontario Shoulder Instability (WOSI) score, patient satisfaction, willingness to undergo surgery again, and return to work/sport (RTW/RTS) were evaluated. A P value of < .05 was considered to be statistically significant. Results Our study included 102 patients in total; 72 patients treated with OL, and 30 treated with AL. There were no demographic differences between the two groups (P > .05 for all). At final follow up (mean of 51.3 months), there was no difference between those that underwent OL or AL in the reported WOSI, VAS, VAS during sports, SSV, and SIRSI scores, nor in patient satisfaction, or whether they would undergo surgery again (P > .05). Overall, there was no significant difference in the total rate of RTP (65% vs 60.9%; P = .74), or timing of RTP (8.1 months vs 7 months; P = .35). Additionally, there was no significant difference in the total rate of RTW (93.5% vs 95.5%; P = .75). Overall, 3 patients in the OL group and 2 patients in the AL group had recurrent instability events (6.9% vs 6.7%; P = .96), with no significant difference in the rate of recurrent dislocation (4.2% vs 3.3%; P = .84). Conclusion In patients with anterior shoulder instability, both the OL and AL are reliable treatment options, with a low rate of recurrent instability, and similar patient-reported outcomes.
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13
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Choe JS, Bin SI, Lee BS, Kim JM, Song JH, Cho HK. Learning Curve For Lateral Meniscal Allograft Transplantation: Preventing Meniscal Extrusion. Arthroscopy 2021; 37:3326-3334. [PMID: 33940123 DOI: 10.1016/j.arthro.2021.04.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE This study analyzes the large number of lateral meniscal allograft transplantation (LMAT) procedures conducted by a single surgeon over 23 years to determine whether the absolute amount of graft subluxation and the incidence of extrusion are different at the present time compared to the early MAT era. METHODS We reviewed 320 cases of LMAT performed by a single surgeon between 1996 and 2019. This cohort was chronologically divided into 8 groups (of 40 subjects). The absolute amount of subluxation was measured by the coronal sections of magnetic resonance images taken 1 year after operation. Subluxation by more than 3 mm was considered as extrusion. The graft extrusion learning curve was plotted in each series using the learning curve cumulative summation test (LC-CUSUM). RESULTS Extrusion incidence was 41.6%, and the mean absolute amount of graft subluxation was 3.4 ± 2.2 mm for all subjects. There were significant between-group differences in extrusion incidence and absolute amount of graft subluxation (extrusion incidence, P < .001; absolute amount of graft subluxation, P < .001), and the extension incidence and graft subluxation decreased from Group I (72.5%, 4.6 ± 1.7) to Group VIII (27.5%, 2.5 ± 2.1). LC-CUSUM analysis signaled that the surgeon had achieved predefined acceptable outcomes in avoiding extrusion after 128 cases. CONCLUSION The incidence of extrusion and absolute amount of graft subluxation decreased significantly over a period of 23 years, and the surgeon achieved a certain level of proficiency after 128 cases. LEVEL OF EVIDENCE Level IV, Case series.
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Affiliation(s)
- Jung-Su Choe
- Department of Orthopedic Surgery, Cheju Halla Hospital, Jeju
| | - Seong-Il Bin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju-Ho Song
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung-Kwon Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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14
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Lami D, Fauvet N, Ollivier M, Argenson JN, Grillo JC. A hybrid open-arthroscopic latarjet coracoid bone-block technique using "HyLa" instrumentation. Orthop Traumatol Surg Res 2021; 107:102978. [PMID: 34098147 DOI: 10.1016/j.otsr.2021.102978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 02/03/2023]
Abstract
Latarjet coracoid bone-block is a gold-standard procedure for anteroinferior instability of the shoulder. Nowadays, it can be performed as open surgery or entirely under arthroscopy. The pure arthroscopic technique has the advantage of allowing concomitant intra-articular surgery, but involves a long learning curve. Here we present a hybrid concept using dedicated instrumentation comprising a specific guide with or without arthroscopic step, and notably ensuring the safety and reproducibility of the procedure, whatever the modality. This technique offers an alternative to arthroscopic coracoid bone block, performing the more complex steps as open surgery without major change to Latarjet's original technique, so as to enable concomitant intra-articular surgery if needed while getting around some of the limitations of the purely arthroscopic procedure.
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Affiliation(s)
- Damien Lami
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Sainte-Marguerite Hospital, 270, Bd Sainte Marguerite, 13006 Marseille, France
| | - Nicolas Fauvet
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Sainte-Marguerite Hospital, 270, Bd Sainte Marguerite, 13006 Marseille, France.
| | - Matthieu Ollivier
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Sainte-Marguerite Hospital, 270, Bd Sainte Marguerite, 13006 Marseille, France
| | - Jean-Noël Argenson
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Sainte-Marguerite Hospital, 270, Bd Sainte Marguerite, 13006 Marseille, France
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15
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Short-term complications of the Latarjet procedure: a systematic review. J Shoulder Elbow Surg 2021; 30:1693-1699. [PMID: 33607332 DOI: 10.1016/j.jse.2021.01.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the short-term complication rate following the open and arthroscopic Latarjet procedures and to meta-analyze the studies comparing the 2 approaches. METHODS PubMed was searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to find clinical and biomechanical studies comparing complication rates in open and arthroscopic Latarjet procedures. A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the PRISMA guidelines. Clinical studies reporting on the complications following the open or arthroscopic Latarjet were included. Meta-analysis was performed for comparative studies using Review Manager, version 5.3. A P value of <.05 was considered statistically significant. RESULTS Overall, 89 studies (Level of Evidence [LOE] I: 2, LOE II: 2, LOE III: 24, LOE IV: 61) met inclusion criteria, with 7175 shoulders. Following the open Latarjet procedure, the overall complication rate was 6.1%, with a 1.9% occurrence of graft-related complications, 1.1% hardware, 1.1% wound, 0.9% nerve, and 1.2% other complications. Following the arthroscopic Latarjet procedure, the overall complication rate was 6.8%, with a 3.2% occurrence of graft-related complications, 1.9% hardware, 0.5% wound, 0.7% nerve, and 0.5% other complications. Complications were reported in 7 studies comparing 379 patients treated with the open Latarjet and 531 treated with the arthroscopic Latarjet, with no statistically significant difference between the two (P = .81). CONCLUSION Our study established that the overall complication rate following the Latarjet procedure was 6%-7%, with the most common complication being graft-related. Furthermore, based on the current evidence, there is no significant difference in the complication rate between the open and arthroscopic Latarjet procedures.
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16
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Buda M, D'Ambrosi R, Bellato E, Blonna D, Cappellari A, Delle Rose G, Merolla G. Failed Latarjet procedure: a systematic review of surgery revision options. J Orthop Traumatol 2021; 22:24. [PMID: 34155563 PMCID: PMC8217356 DOI: 10.1186/s10195-021-00587-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/03/2021] [Indexed: 12/14/2022] Open
Abstract
Background Revision surgery after the Latarjet procedure is a rare and challenging surgical problem, and various bony or capsular procedures have been proposed. This systematic review examines clinical and radiographic outcomes of different procedures for treating persistent pain or recurrent instability after a Latarjet procedure. Methods A systematic review of the literature was performed using the Medline, Cochrane, EMBASE, Google Scholar and Ovid databases with the combined keywords “failed”, “failure”, “revision”, “Latarjet”, “shoulder stabilization” and “shoulder instability” to identify articles published in English that deal with failed Latarjet procedures. Results A total of 11 studies (five retrospective and six case series investigations), all published between 2008 and 2020, fulfilled our inclusion criteria. For the study, 253 patients (254 shoulders, 79.8% male) with a mean age of 29.6 years (range: 16–54 years) were reviewed at an average follow-up of 51.5 months (range: 24–208 months). Conclusions Eden–Hybinette and arthroscopic capsuloplasty are the most popular and safe procedures to treat recurrent instability after a failed Latarjet procedure, and yield reasonable clinical outcomes. A bone graft procedure and capsuloplasty were proposed but there was no clear consensus on their efficacy and indication. Level of evidence Level IV Trial registration PROSPERO 2020 CRD42020185090—www.crd.york.ac.uk/prospero/
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Affiliation(s)
- Matteo Buda
- Division of Orthopaedics and Trauma, Madre Teresa Di Calcutta Hospital, Monselice, Padova, Italy
| | | | - Enrico Bellato
- Department of Surgical Sciences, San Luigi Gonzaga Hospital, University of Turin Medical School, Turin, Italy
| | - Davide Blonna
- Orthopaedic and Traumatology Department, University of Turin Medical School, Turin, Italy
| | - Alessandro Cappellari
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Giacomo Delle Rose
- Shoulder and Elbow Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Merolla
- Shoulder and Elbow Unit, Cervesi Hospital, Cattolica, AUSL Romagna, Cattolica, Italy.,Doctorate School in Clinical and Experimental Medicine, UNIMORE, Modena, Italy
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17
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Calvo E, Itoi E, Landreau P, Arce G, Yamamoto N, Ma J, Sparavalo S, Wong I. Anterior and posterior glenoid bone augmentation options for shoulder instability: state of the art. J ISAKOS 2021; 6:308-317. [PMID: 34145077 DOI: 10.1136/jisakos-2019-000413] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/24/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022]
Abstract
Bony lesions are highly prevalent in anterior shoulder instability and can be a significant cause of failure of stabilisation procedures if they are not adequately addressed. The glenoid track concept describes the dynamic interaction between the humeral head and glenoid defects in anterior shoulder instability. It has been beneficial for understanding the role played by bone defects in this entity. As a consequence, the popularity of glenoid augmentation procedures aimed to treat anterior glenoid bone defects; reconstructing the anatomy of the glenohumeral joint has risen sharply in the last decade. Although bone defects are less common in posterior instability, posterior bone block procedures can be indicated to treat not only posterior bony lesions, attritional posterior glenoid erosion or dysplasia but also normal or retroverted glenoids to provide an extended glenoid surface to increase the glenohumeral stability. The purpose of this review was to analyse the rationale, current indications and results of surgical techniques aimed to augment the glenoid surface in patients diagnosed of either anterior or posterior instability by assessing a thorough review of modern literature. Classical techniques such as Latarjet or free bone block procedures have proven to be effective in augmenting the glenoid surface and consequently achieving adequate shoulder stability with good clinical outcomes and early return to athletic activity. Innovations in surgical techniques have permitted to perform these procedures arthroscopically. Arthroscopy provides the theoretical advantages of lower morbidity and faster recovery, as well as the identification and treatment of concomitant pathologies.
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Affiliation(s)
- Emilio Calvo
- Department of Orthopaedic Surgery and Traumatology, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Universidad Autonoma, Madrid, Spain
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | | | - Guillermo Arce
- Department of Orthopedic Surgery, Instituto Argentino de Diagnostico y Tratamiento (IADT), Buenos Aires, Argentina
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jie Ma
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara Sparavalo
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan Wong
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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18
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Chapter 6: Attritional Glenoid Bone Loss in the Shoulder: Operative Considerations. Sports Med Arthrosc Rev 2021; 28:159-166. [PMID: 33156231 DOI: 10.1097/jsa.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with recurrent anterior shoulder instability often have glenoid bone loss present in addition to soft tissue pathologies. It is known that patients with significant glenoid bone loss are best treated with a boney augmentation procedure as opposed to a soft tissue Bankart repair because of the high rate of recurrent instability that results from a Bankart repair. Although the Latarjet technique has been the gold-standard treatment for patients with glenoid bone loss because of the low incidence of recurrent instability, it has a high complication rate and a steep learning curve. Herein, the authors present the technique and outcomes for arthroscopic anatomic glenoid reconstruction that has a similar complication rate to the Bankart repair but with a low recurrence rate similar to the Latarjet. This procedure is safe, has a short learning curve, low recurrence rate, and positive patient-reported outcomes.
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19
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Bradley KE, Jansson HL, Lansdown DA, Zhang AL. Arthroscopic Glenoid Reconstruction With Iliac Crest Bone Block Transfer in the Beach Chair Position. Arthrosc Tech 2021; 10:e1155-e1164. [PMID: 33981565 PMCID: PMC8085574 DOI: 10.1016/j.eats.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/10/2021] [Indexed: 02/03/2023] Open
Abstract
Large anterior glenoid defects pose significant challenges for shoulder stability. Arthroscopic glenoid reconstruction techniques using distal tibia allograft have been proposed as alternatives to open or arthroscopic Latarjet procedures but can increase operating room costs. Iliac crest bone block autograft is a cost-effective option without concern for the graft being undersized. Previous techniques have described arthroscopic glenoid reconstruction in the lateral position, but the beach chair position provides ease of access to both the iliac crest bone graft harvest and arthroscopic bone transfer, as well as facilitates possible conversion to an open approach if necessary. We present our surgical technique for performing an arthroscopic glenoid reconstruction with iliac crest autograft bone block transfer in the beach chair position.
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Affiliation(s)
| | | | | | - Alan L. Zhang
- Address correspondence to Alan L. Zhang, M.D., Department of Orthoapedic Surgery, University of California-San Francisco, 1500 Owens St., Box 3004, San Francisco, CA 94158.
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20
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Haskel JD, Colasanti CA, Hurley ET, Matache BA, Jazrawi LM, Meislin RJ. Arthroscopic Latarjet Procedure: Indications, Techniques, and Outcomes. JBJS Rev 2021; 9:01874474-202103000-00002. [PMID: 33690241 DOI: 10.2106/jbjs.rvw.20.00071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The proposed advantages of the arthroscopic approach in the Latarjet procedure for shoulder dislocation include improved visualization for accurate positioning of the coracoid graft, the ability to address any associated intra-articular pathologies, and the diminished potential for the formation of postoperative scar tissue and stiffness associated with an open procedure. » Young age, the presence of glenoid and/or humeral bone loss, a history of dislocation, a history of failed arthroscopic stabilization surgery, and an active lifestyle are all associated with recurrent dislocation and are relative indications for an osseous augmentation procedure. » Both the open and arthroscopic Latarjet procedures result in substantial improvements in patient function, with comparable rates of recurrent instability and complication profiles.
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Affiliation(s)
- Jonathan D Haskel
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY
| | | | - Eoghan T Hurley
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY.,Department of Surgery, National University of Ireland Galway, Galway, Ireland
| | - Bogdan A Matache
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY
| | - Robert J Meislin
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY
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21
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The Shoulder Trans-pectoralis Arthroscopic Portal Is a Safe Approach to the Arthroscopic Latarjet Procedure: A Cadaveric Analysis. Arthroscopy 2021; 37:470-476. [PMID: 33022364 DOI: 10.1016/j.arthro.2020.09.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the proximity of neurovascular structures in a layered approach during medial portal placement and determine standardized measurements for establishing a portal medial to the coracoid used in arthroscopic Latarjet-type procedures. METHODS Twelve shoulders (6 right and 6 left) in 6 fresh frozen cadaveric torsos were mounted in the modified beach-chair position. A standard posterior portal and 3 anterior portals-central, lateral, and medial-were used. A long spinal needle was placed along the path of the medial portal to the lateral tip of the coracoid, superficial to the conjoined tendon and pectoralis minor. A second long spinal needle was directed toward the medial base of the coracoid, penetrating the pectoralis minor. Superficial and deep plane dissections were performed, and distances to surrounding neurovascular structures were recorded. RESULTS In the superficial plane, the cephalic vein and lateral pectoral nerve were located a mean distance (± standard deviation) of 4.6 ± 1.9 mm and 9.4 ± 2.6 mm from the spinal needle, respectively. In the deep plane, the axillary nerve was 24.9 ± 7.4 mm from the needle; the lateral cord of the brachial plexus, 25.5 ± 8.1 mm; the axillary artery, 34.1 ± 6.0 mm; and the musculocutaneous nerve, 42.2 ± 9.2 mm. The portal was consistently established 45.0 to 50.0 mm distal and 30.0 to 35.0 mm medial to the coracoid, which was a minimum distance of 10 mm to the lateral pectoral nerve. CONCLUSIONS In a cadaveric model, the creation of a medial trans-pectoralis major portal used in the arthroscopic Bankart-Bristow-Latarjet procedure can avoid compromise of vital neurovascular structures, alleviating concerns of creating a portal medial to the coracoid. Portal placement 45.0 to 50.0 mm distal and 30.0 to 35.0 mm medial to the palpable tip of the coracoid process may be a safe approach to perform the arthroscopic Bankart-Bristow-Latarjet procedure. CLINICAL RELEVANCE Creation of a portal medial to the level of the coracoid may pose a risk to neurovascular structures. This cadaveric study establishes a working zone for medial trans-pectoralis portal placement, which avoids vital neurovascular structures, and provides standardized measurements for establishing this portal for use in the arthroscopic Bankart-Bristow-Latarjet procedure.
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22
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Hinckel BB, Baumann CA, Ejnisman L, Cavinatto LM, Martusiewicz A, Tanaka MJ, Tompkins M, Sherman SL, Chahla JA, Frank R, Yamamoto GL, Bicos J, Arendt L, Fithian D, Farr J. Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic. J Am Acad Orthop Surg Glob Res Rev 2020; 4:e20.00083. [PMID: 33986224 PMCID: PMC7537824 DOI: 10.5435/jaaosglobal-d-20-00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
Orthopaedic practices have been markedly affected by the emergence of the COVID-19 pandemic. Despite the ban on elective procedures, it is impossible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. Orthopaedic surgical procedures should consider COVID-19-associated risks and an assimilation of all available disease dependent, disease independent, and logistical information that is tailored to each patient, institution, and region. Using an evidence-based risk stratification of clinical urgency, we provide a framework for prioritization of orthopaedic sport medicine procedures that encompasses such factors. This can be used to facilitate the risk-benefit assessment of the timing and setting of a procedure during the COVID-19 pandemic.
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Affiliation(s)
- Betina B Hinckel
- From the Oakland University, Rochester (Dr. Hinckel, and Dr. Cavinatto); Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak (Dr. Hinckel, Dr. Cavinatto), MI; the University of Missouri-School of Medicine, Columbia, MO (Mr. Baumann); the Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, BR (Dr. Ejnisman); the Shoulder and Elbow Surgery, Beaumont Orthopaedic Associates, Beaumont Health (Dr. Martusiewicz); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Tanaka); the Department of Orthopedic Surgery, TRIA Orthopedic Center, University of Minnesota, Gillette Children's Specialty Healthcare, MN (Dr. Tompkins); the Department of Orthopedic Surgery, Stanford University, CA (Dr. Sherman); the Rush University Medical Center, Chicago, IL (Dr. Chahla); the Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, Aurora, CO (Dr. Frank); the Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA (Dr. Yamamoto); CEGH-CEL, Instituto de Biociências, Universidade de São Paulo (Dr. Yamamoto); DASA Laboratories, Sao Paulo, Brazil (Dr. Yamamoto); the Michigan Orthopedic Surgeons, Fellowship Director William Beaumont Sports Medicine Fellowship, Assistant Professor Oakland University William Beaumont School of Medicine, MI (Dr. Bicos); the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Dr. Arendt); the Southern California Permanente Medical Group and Torrey Pines Orthopaedic Medical Group, San Diego, CA (Dr. Fithian); and the Knee Preservation, Cartilage Regeneration and OrthoBiologics, Department of Orthopedic Surgery, Indiana University School of Medicine, OrthoIndy and OrthoIndy Hospital, Greenwood and Indianapolis, IN (Dr. Farr)
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23
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Santagada DA, Morris BJ, Cerciello S. Editorial Commentary: Arthroscopic Latarjet: An Analysis of Outcomes and Complications Through its Learning Curve. Arthroscopy 2019; 35:3238-3239. [PMID: 31785750 DOI: 10.1016/j.arthro.2019.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 02/02/2023]
Abstract
The arthroscopic Latarjet has been proposed in the past decade to reduce the rate of bone block malpositioning, decrease soft-tissue damage associated with open approach, and possibly decrease intraoperative complications. Several recent studies have reported similar or even superior results with arthroscopic Latarjet compared with those achieved with open technique. However, arthroscopic Latarjet is known to be more technically demanding and some feel that it should be performed by expert shoulder surgeons with advanced arthroscopic skills. Surgical innovations should be adopted when they have potential advantages for patients. Despite the initial challenges and learning curve of arthroscopic Latarjet, experience and technical skills may reduce the rate of intraoperative complications for this technically demanding procedure.
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