Classic Versus Congruent-Arc Latarjet Procedures

Clinical Significance Thresholds in Primary and Revision Latarjet Procedures With Comparable Outcome Achievements

BACKGROUND

Given the variability across populations and settings, defining the MCID and the PASS for the Rowe and ASOSS scores and patients undergoing primary and revision Latarjet it is essential to have accurate benchmarks relevant to these groups when interpreting clinical results.

PURPOSE

To determine the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds for the visual analog scale (VAS) for pain during sports, Athletic Shoulder Outcome Scoring System (ASOSS), and Rowe scores after primary and revision Latarjet procedures for treatment of shoulder instability.

STUDY DESIGN

Cohort study (diagnosis); Level of evidence, 3.

METHODS

Between January 2018 and January 2020, a retrospective review of 149 patients undergoing primary Latarjet (n = 82) and revision Latarjet (n = 67) to treat shoulder instability was performed in a single institution. Patient-reported outcome measures were collected preoperatively and 1 year postoperatively. The delta was defined as the change between the pre- and postoperative scores. Distribution-based and anchored-based approaches were used to estimate the MCID and the PASS, respectively. The optimal cutoff point and the percentage of patients achieving those thresholds were also calculated.

RESULTS

The distribution-based MCIDs after primary Latarjet were 1.1, 7.5, and 9.6 for the VAS, Rowe, and ASOSS scores, respectively. The rates of patients who achieved the MCID thresholds were 93.9%, 98.7%, and 100% for the VAS, Rowe, and ASOSS scores, respectively. The PASS thresholds after primary Latarjet were ≤1, ≥90, and ≥85 for the VAS, Rowe, and ASOSS scores, respectively. The percentages of patients who achieved PASS thresholds were 82.9%, 89%, and 86.5% for the VAS, Rowe, and ASOSS scores, respectively. The distribution-based MCIDs after revision Latarjet were 0.6, 6.2, and 3.4 for the VAS, Rowe, and ASOSS scores, respectively. The rates of patients who achieved MCID thresholds were 89.3%, 100%, and 100% for the VAS, Rowe, and ASOSS scores, respectively. The PASS thresholds were ≤3, ≥87, and ≥86 after revision Latarjet for the VAS, Rowe, and ASOSS scores, respectively. The rates of patients who achieved the PASS thresholds were 88%, 88%, and 91% for the VAS, Rowe, and ASOSS, respectively.

CONCLUSION

This study identified useful values for the MCID and PASS thresholds in VAS, Rowe, and ASOSS scores after primary and revision Latarjet procedures for treating shoulder instability. Most patients achieved MCID and PASS benchmarks, indicating successful primary and revision Latarjet procedure outcomes. These metrics can serve as valuable parameters when analyzing parameters in future studies and have the potential to enhance patient care by optimizing treatment strategies and surgical decision making.

Arthroscopy Journal: Reflections on 2023 and Auld Lang Syne

Auld lang syne; times long past. We were unsuspecting of the coming pandemic. Things changed. COVID-19 impacted each of us, our families, our patients, our medical practices, and our daily lives. The year 2020 was one of cancellation and loss; 2021 and 2022 were years of adaptation, caution, and continued loss. Finally, 2023 began a time of recovery; while COVID-19 is still with us, the pandemic has been declared ended, and we emerge with gratitude. We slowly removed our masks and rediscovered the vitality of meeting face-to-face. And throughout, Arthroscopy has continued to develop, including new journals; special issues on rehabilitation, biologics, and diversity as they relate to musculoskeletal care; collaboration with the American Board of Orthopaedic Surgery, Maintenance of Certification, Web-Based Longitudinal Assessment Pathway; Arthroscopy Techniques; Infographics; Visual Abstracts; and Podcasts. At year end, we extend special thanks to editors whose terms have expired, our team and leaders, our reviewers, our authors and readers, and our patients who offer us their trust and an opportunity to serve.

Use of 3D-Printed Patient-Specific Guide for Latarjet Procedure in Patients With Anterior Shoulder Instability: Technical Note

Anterior shoulder instability can lead to anterior glenoid bone loss associated with humeral posterior deformity (bipolar bone loss). Latarjet procedure is a commonly used surgical option in such cases. However, the procedure is associated with complications in up 15% of the cases often associated with inadequate positioning of coracoid bone graft and screws. Considering that acknowledgment of patient anatomy and use of surgical planning intraoperatively can reduce such complications, we describe the use of 3D printing tools to obtain a 3D Patient-Specific Surgical Guide to aid in the Latarjet procedure. Such tools present advantages and limitations compared to other tools available, which are also discussed in this article.