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Cohen M, Leal AC, Motta Filho GR. Risk factors associated with glenohumeral arthritis before and after the Latarjet procedure: minimum follow-up of 5 years, using computed tomography imaging. J Shoulder Elbow Surg 2025; 34:1433-1442. [PMID: 39617121 DOI: 10.1016/j.jse.2024.09.037] [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: 04/11/2024] [Revised: 09/12/2024] [Accepted: 09/14/2024] [Indexed: 02/02/2025]
Abstract
BACKGROUND Latarjet surgery has emerged as a prevalent option for managing anterior glenohumeral instability. Despite its efficacy, concerns persist regarding the development of postoperative osteoarthritis (OA), a significant complication. Understanding arthritis pathogenesis in patients undergoing this procedure proves challenging, as OA can manifest even in cases without surgical repair. Additionally, studies suggest correlation between inadequate surgical technique and the occurrence of postoperative arthritis. Traditional radiographic imaging may also underestimate the identification of early OA. Therefore, the objective of this study aimed to analyze the risk factors associated with glenohumeral arthritis before and after the Latarjet procedure, with a minimum follow-up of 5 years, using computed tomography imaging (CT). METHODS This retrospective study involved patients who underwent the Latarjet procedure between 2012 and 2017. Inclusion criteria were availability of preoperative and at least 5 years postoperative CT and physical examinations. The primary outcome studied was the presence of glenohumeral OA, classified preoperatively and postoperatively using CT scans. Risk factors for progression to pre and postoperative OA were assessed, including etiology, age at the initial injury, number of dislocation episodes before surgery, time interval from the initial injury to surgical stabilization, size of glenoid defect, position and presence of graft resorption, and screw position. RESULTS Fifty joints of 45 patients were included in the final analysis. The presence of preoperative OA was found in 21 of 50 cases (42%). The risk of osteoarthritis (OA) was significantly associated with both shoulder dislocation following a seizure disorder and a larger glenoid size defect (P < .05). Of the 29 shoulders without preoperative arthritis, 8 developed arthritis postoperatively (27.5%). Of those 21 cases with preoperative osteoarthritis, progression occurred in 11 cases (52.3%) (P = .25). When considering all cases with OA progression, significant risk factors were the presence of intraarticular screws and when both screws had angulation equal or above 16° (P < .06). When considering those patients with progression of OA above 1 grade, significant risk factors were lateral graft position, screw angulation, and the presence of intra-articular screws. CONCLUSION Our study reveals a higher incidence of osteoarthritis than reported in the literature, likely attributed to the imaging method employed. Preoperatively, risk factors for the presence of OA included cases resulting from seizure disorders and larger glenoid bone defects. Postoperatively, the only factors related to the progression of osteoarthritis were those associated with potential surgical technique issues.
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Affiliation(s)
- Marcio Cohen
- Department of Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil.
| | - Ana Carolina Leal
- Teaching and Research Division of the National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | - Geraldo Rocha Motta Filho
- Department of Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
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Moore F, Labattut L, Chauvet T, Bordet A, Martz P. Arthroscopic Trillat technique for chronic anterior shoulder instability: outcomes at 2-year follow-up in 74 at-risk sports patients. J Shoulder Elbow Surg 2025; 34:1225-1235. [PMID: 39396610 DOI: 10.1016/j.jse.2024.08.029] [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: 02/08/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND Chronic anterior shoulder instability affects a young and athletic population, with a high demand for functional recovery and return to sport. The arthroscopic Trillat dynamic stabilization technique has shown great results at 2 years in terms of stabilization and functional outcomes on the general population. The hypothesis is that it could do so in at-risk for dislocation athletic population for stabilization and return to sport, with results comparable to the reference techniques. METHODS This is a multicenter retrospective study of Walch-Duplay type 2, 3, and 4 at-risk sports patients treated by arthroscopic Trillat for chronic anterior shoulder instability between January 2012 and January 2021, at a 2-year follow-up. The primary endpoint was the occurrence of dislocation recurrence. Secondary endpoints were subluxation recurrence, functional outcomes, time and level of return to sport, functional scores, bony fusion, and complications. RESULTS A total of 74 patients were analyzed, with a mean age of 24.4 years (15-50 years). Sports levels were moderate risk of dislocation Walch-Duplay type 2 for n = 34 (46%), medium-risk Walch-Duplay type 3 for n = 19 (26%), and high-risk Walch-Duplay type 4 for n = 21 (28%). Dislocation recurred in 3 patients (4.1%). All patients (100%) returned to sport, with an average delay of 4.6 months, with 56 (76%) returning to the same previous level. The mean Constant score was 94.5 (79-100), the Rowe score was 94.7 (70-100), the Walch-Duplay score was 90.2 (50-100), and the Shoulder Subjective Value score was 90.5 (65-100). Subgroup analysis of athletes at moderate risk of dislocation recurrence (Walch-Duplay type 2) vs. medium and high risk of dislocation recurrence (Walch-Duplay types 3 and 4) revealed no statistically significant difference. One patient presented with asymptomatic pseudarthrosis. CONCLUSIONS Arthroscopic Trillat offers highly satisfactory results in the treatment of chronic anterior shoulder instability for athletes regardless of the type of sport practiced and the type of risk according to Walch-Duplay. This simple and quick technique enables a rapid return to sport and at the previous level in the majority of cases. After showing its effectiveness in the general population at 2 years, arthroscopic Trillat offers a reliable alternative to the reference procedures in young athletic patients.
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Affiliation(s)
- Floriane Moore
- Department of Orthopaedic Surgery, Dijon University Hospital, Dijon, France.
| | - Ludovic Labattut
- Department of Orthopaedic Surgery, Dijon University Hospital, Dijon, France
| | - Thomas Chauvet
- Shoulder Department, Nice Institute of Sport and Arthrosis, Nice, France
| | - Alice Bordet
- Department of Orthopaedic Surgery, Dijon University Hospital, Dijon, France
| | - Pierre Martz
- Department of Orthopaedic Surgery, Dijon University Hospital, Dijon, France; INSERM, UMR1093-CAPS, Université Bourgogne Franche-Comté, UB, Dijon, France; INSERM, CIC 1432, Module Plurithématique, Plateforme d'Investigation Technologique, Dijon, France
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3
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Oliver-Welsh L, Beni R, O'Flaherty E, Pearse Y, Arnander M, Tennent D. The scapula spine may not be a suitable source of bone graft for glenoid reconstruction in critical bone loss. J Shoulder Elbow Surg 2025; 34:e126-e132. [PMID: 39151669 DOI: 10.1016/j.jse.2024.07.003] [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: 01/11/2024] [Revised: 07/01/2024] [Accepted: 07/04/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND The hypothesis is that the scapula spine can provide a graft of suitable dimensions for use in cases of shoulder instability with critical bone loss. We aimed to investigate its utility with grafts of differing sizes. METHODS The scapula spine was measured on computed tomography scans of 50 patients who had undergone anterior stabilization. The theoretical ability to harvest a graft of either 2 × 1 × 1 cm or 2 × 0.8 × 0.8 cm was analyzed. RESULTS Using the 2 × 1 × 1 cm threshold, 36% of the scapulae had at least 1 zone from which a suitable graft could be obtained. 61% had only 1 zone from which a suitable graft could be obtained. Using the 2 × 0.8 × 0.8 cm threshold, 72% had at least 1 zone from which a graft could be obtained. A total of 47% met the threshold in 1 zone only. CONCLUSION The scapula spine can be used as a source of autograft. Grafts up to 2 x 1 × 1 cm can be harvested in some individuals; however, the anatomy is very variable.
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Affiliation(s)
- Lucy Oliver-Welsh
- St George's Shoulder Unit, St George's University Hospital London, London, UK.
| | - Rebecca Beni
- St George's Shoulder Unit, St George's University Hospital London, London, UK
| | - Emmett O'Flaherty
- St George's Shoulder Unit, St George's University Hospital London, London, UK
| | - Yemi Pearse
- St George's Shoulder Unit, St George's University Hospital London, London, UK
| | - Magnus Arnander
- St George's Shoulder Unit, St George's University Hospital London, London, UK
| | - Duncan Tennent
- St George's Shoulder Unit, St George's University Hospital London, London, UK
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Meyer AM, Lorentz SG, Klifto CS, Bradley KE, Lau BC, Dickens JF, Hurley ET. Open Latarjet Results in Lower Recurrent Instability and Revision Rates Than Arthroscopic Bankart Repair at a 10-Year Follow-Up: A Systematic Review. Arthroscopy 2025:S0749-8063(25)00008-8. [PMID: 39788392 DOI: 10.1016/j.arthro.2024.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 12/15/2024] [Accepted: 12/26/2024] [Indexed: 01/12/2025]
Abstract
PURPOSE To compare arthroscopic Bankart repair versus the open Latarjet procedure at a minimum of a 10-year follow-up evaluating recurrence and arthropathy development rates. METHODS A systematic review was performed in concordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they reported on the arthroscopic Bankart repair or open Latarjet procedure with a minimum 10-year follow-up. Recurrent instability, revisions, and instability arthropathy were evaluated. RESULTS Overall, 40 studies met our criteria and were included, with 2,019 shoulders undergoing arthroscopic Bankart repair and 1,069 undergoing the open Latarjet procedure. The rate of recurrent instability was 0.0% to 22.6% (redislocations: 0.0%-9.6%) in those undergoing an open Latarjet procedure and 13.3% to 82.2% (redislocations: 9.6%-25.7%) among those undergoing arthroscopic Bankart repair. The rate of total revisions was 0.0% to 17.9% in those undergoing an open Latarjet procedure and 4.8% to 42.9% among those undergoing arthroscopic Bankart repair. The rate of overall arthritis was 10.3% to 71.4% in those undergoing an open Latarjet procedure and 16.7% to 89.3% among those undergoing arthroscopic Bankart repair. CONCLUSIONS There was a lower recurrent instability rate and revision rate in the open Latarjet group compared to the arthroscopic Bankart group at long-term follow-up. The rates of moderate to severe arthritis were comparable between the 2 procedures. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Alex M Meyer
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Samuel G Lorentz
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Kendall E Bradley
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A..
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Kizilkurt T, Darilmaz MF, Okatar F, Ersen A. Does Scapular and Thoracic Morphology Affect Latarjet Alpha Angle? J Clin Med 2025; 14:274. [PMID: 39797355 PMCID: PMC11721271 DOI: 10.3390/jcm14010274] [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: 12/06/2024] [Revised: 12/24/2024] [Accepted: 01/04/2025] [Indexed: 01/13/2025] Open
Abstract
Purpose: This study aimed to determine the relationship between alpha angle (the angle between the screws and the glenoid) and thoracic diameters in patients undergoing the Latarjet procedure. Defining the relationship between thoracic morphology and alpha angle is aimed at filling the gap in the literature and improving surgical outcomes. Methods: This retrospective study analyzed 74 patients who underwent the Latarjet procedure for recurrent anterior shoulder instability between 2022 and 2024. All procedures were performed by the same surgeon using a standardized protocol to ensure consistency of surgical technique across cases. In postoperative chest CT scans, alpha angle, anteroposterior diameter of the thorax, transverse diameter of hemithorax, scapular inclination, and glenoid version were evaluated. Results: The study included predominantly male patients (90%) with a mean age of 26.4 ± 6.4 years who underwent Latarjet procedures predominantly on the right side (60%). Significant associations were observed between thoracic morphology and alpha angle on postoperative CT scans. There was a significant positive correlation between anterior-posterior/transverse diameter ratio (AP/T) and alpha angle (r = 0.407, p < 0.001), as well as correlations between scapular inclination, glenoid version, thoracoscapular angle, and alpha angle (r = 0.275, p = 0.018; r = 0.241, p = 0.039; r = -0.288, p = 0.013, respectively). Patients were divided based on an alpha angle threshold of 15 degrees, with results indicating worse outcomes for angles above this threshold. Additionally, the AP/T ratio demonstrated predictive value for poor outcomes (AUC = 0.660, p = 0.018) with a threshold of 1.2545. Conclusions: This study highlights the direct impact of thoracic morphology on the alpha angle observed on post-Latarjet chest CT scans. Specifically, patients with a higher ratio of anterior-posterior to transverse thoracic diameter (AP/T) show a proportional increase in alpha angle. When the AP/T ratio exceeds 1.25, surgeons may face challenges in achieving the target alpha angle.
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Affiliation(s)
| | - Muhammed Furkan Darilmaz
- Department of Orthopedics and Traumatology, Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey; (T.K.); (F.O.); (A.E.)
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Calvo E, Delgado C, Luengo-Alonso G, Dzidzishvili L. Good clinical outcomes and low recurrence rate in patients undergoing arthroscopic revision Latarjet for failed arthroscopic Bankart repair. J Shoulder Elbow Surg 2024; 33:2842-2849. [PMID: 39094760 DOI: 10.1016/j.jse.2024.05.054] [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: 01/07/2024] [Revised: 05/15/2024] [Accepted: 05/28/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The role of arthroscopic Latarjet stabilization after failed arthroscopic Bankart repair has yet to be definitively established and merits further investigation. OBJECTIVE To assess clinical and radiological outcomes after arthroscopic Latarjet stabilization as a revision procedure for failed Bankart repair, as well as the return to athletic activity and complication rates. METHODS Between 2009 and 2020, patients with a previous failed arthroscopic Bankart repair who were treated with an arthroscopic Latarjet were retrospectively evaluated. Clinical outcomes at a minimum of 24 months postoperatively included the Rowe score, Western Ontario Shoulder Instability Index, Constant-Murley Shoulder Outcome score, and Single Assessment Numeric Evaluation. Dislocations, subluxations, complications, pre- and postoperative levels of activity, and degree of osteoarthritis were also assessed. RESULTS A total of 77 patients, with a mean age at revision surgery of 31.2 ± 9.1 years and with either 1 (n = 59), 2 (n = 13), or 3 (n = 4) previous arthroscopic stabilizations, who underwent revision surgery using an arthroscopic Latarjet procedure were studied. Postoperatively, the mean Rowe and Constant-Murley Shoulder Outcome scores increased from 41.8 ± 16 to 90.7 ± 14.3 (P < .001) and from 50.5 ± 13.8 to 90.5 ± 10.3 (P < .001), respectively. Western Ontario Shoulder Instability Index decreased from 1247 ± 367.6 to 548.9 ± 363 at the final follow-up (P < .001). After a mean follow-up of 39.6 ± 23.1 months, 64 shoulders (83.1%) were subjectively graded as good to excellent using the Single Assessment Numeric Evaluation score. Grade 1, 2, and 3 osteoarthritis, according to Ogawa et al, was found in 18 (23.4%), 6 (7.8%), and 3 (3.9%) shoulders, respectively. Six (7.8%) dislocations after revision surgery were reported. In 4 failed cases, an Eden-Hybinette procedure was conducted, and in the remaining 2 patients, an arthroscopic extra-articular anterior capsular reinforcement was performed. A significantly decreased level of athletic activity was observed postoperatively (P = .01). CONCLUSIONS Arthroscopic Latarjet for the revision of failed arthroscopic Bankart repair provides satisfactory patient-reported subjective outcomes with a low rate of recurrences and complications. However, a decreased level of athletic activity is expected.
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Affiliation(s)
- Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jimenez Diaz, Universidad Autónoma, Madrid, Spain.
| | - Cristina Delgado
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jimenez Diaz, Universidad Autónoma, Madrid, Spain
| | - Gonzalo Luengo-Alonso
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jimenez Diaz, Universidad Autónoma, Madrid, Spain
| | - Lika Dzidzishvili
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jimenez Diaz, Universidad Autónoma, Madrid, Spain
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7
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Arenas-Miquelez A, Barco R, Cabo Cabo FJ, Hachem AI. Management of bone loss in anterior shoulder instability. Bone Joint J 2024; 106-B:1100-1110. [PMID: 39348897 DOI: 10.1302/0301-620x.106b10.bjj-2024-0501.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
Bone defects are frequently observed in anterior shoulder instability. Over the last decade, knowledge of the association of bone loss with increased failure rates of soft-tissue repair has shifted the surgical management of chronic shoulder instability. On the glenoid side, there is no controversy about the critical glenoid bone loss being 20%. However, poor outcomes have been described even with a subcritical glenoid bone defect as low as 13.5%. On the humeral side, the Hill-Sachs lesion should be evaluated concomitantly with the glenoid defect as the two sides of the same bipolar lesion which interact in the instability process, as described by the glenoid track concept. We advocate adding remplissage to every Bankart repair in patients with a Hill-Sachs lesion, regardless of the glenoid bone loss. When critical or subcritical glenoid bone loss occurs in active patients (> 15%) or bipolar off-track lesions, we should consider anterior glenoid bone reconstructions. The techniques have evolved significantly over the last two decades, moving from open procedures to arthroscopic, and from screw fixation to metal-free fixation. The new arthroscopic techniques of glenoid bone reconstruction procedures allow precise positioning of the graft, identification, and treatment of concomitant injuries with low morbidity and faster recovery. Given the problems associated with bone resorption and metal hardware protrusion, the new metal-free techniques for Latarjet or free bone block procedures seem a good solution to avoid these complications, although no long-term data are yet available.
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Affiliation(s)
| | - Raul Barco
- La Paz University Hospital, Madrid, Spain
| | - Francisco J Cabo Cabo
- Orthopaedics and Traumatolgy, Hospital Universitario de Bellvitge, Hospitalet de llobregat, Barcelona, Spain
| | - Abdul-Ilah Hachem
- Orthopaedics and Traumatolgy, Hospital Universitario de Bellvitge, Hospitalet de llobregat, Barcelona, Spain
- Shoulder unit, Centro Medico Teknon, Barcelona, Spain
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8
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Luengo-Alonso G, Valencia M, Martinez-Catalan N, Delgado C, Calvo E. Characterization of articular lesions associated with glenohumeral instability using arthroscopy. Bone Joint J 2024; 106-B:1125-1132. [PMID: 39348905 DOI: 10.1302/0301-620x.106b10.bjj-2024-0262.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
Aims The prevalence of osteoarthritis (OA) associated with instability of the shoulder ranges between 4% and 60%. Articular cartilage is, however, routinely assessed in these patients using radiographs or scans (2D or 3D), with little opportunity to record early signs of cartilage damage. The aim of this study was to assess the prevalence and localization of chondral lesions and synovial damage in patients undergoing arthroscopic surgery for instablility of the shoulder, in order to classify them and to identify risk factors for the development of glenohumeral OA. Methods A total of 140 shoulders in 140 patients with a mean age of 28.5 years (15 to 55), who underwent arthroscopic treatment for recurrent glenohumeral instability, were included. The prevalence and distribution of chondral lesions and synovial damage were analyzed and graded into stages according to the division of the humeral head and glenoid into quadrants. The following factors that might affect the prevalence and severity of chondral damage were recorded: sex, dominance, age, age at the time of the first dislocation, number of dislocations, time between the first dislocation and surgery, preoperative sporting activity, Beighton score, type of instability, and joint laxity. Results A total of 133 patients (95%) had synovial or chondral lesions. At the time of surgery, shoulders were graded as having mild, moderate, and severe OA in 55 (39.2%), 72 (51.4%), and six (4.2%) patients, respectively. A Hill-Sachs lesion and fibrillation affecting the anteroinferior glenoid cartilage were the most common findings. There was a significant positive correlation between the the severity of the development of glenohumeral OA and the patient's age, their age at the time of the first dislocation, and the number of dislocations (p = 0.004, p = 0.011, and p = 0.031, respectively). Conclusion Synovial inflammation and chondral damage associated with instability of the shoulder are more prevalent than previously reported. The classification using quadrants gives surgeons more information about the chondral damage, and could explain the pattern of development of glenohumeral OA after stabilization of the shoulder. As the number of dislocations showed a positive correlation with the development of OA, this might be an argument for early stabilization.
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Affiliation(s)
- Gonzalo Luengo-Alonso
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Maria Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Natalia Martinez-Catalan
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Cristina Delgado
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain
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Bauer S, Neyton L, Collin P, Zumstein M. The open Latarjet-Patte procedure for the treatment of anterior shoulder instability in professional handball players at a mean follow-up of 6.6 years. J Shoulder Elbow Surg 2024; 33:924-931. [PMID: 37648015 DOI: 10.1016/j.jse.2023.07.029] [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: 01/28/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The popularity of team handball is increasing, with >10 million children playing this overhead throwing and collision sport with highest demands on the shoulder joint. Because of the risk of recurrent instability, the Latarjet-Patte (LP) procedure has been recommended to treat young competitive players. This is the first LP outcome study in professional handball players. METHODS We retrospectively included 20 shoulders (18 players [17 male patients]; mean age, 22.9 years [range, 17-35 years]; minimum follow-up period, 2 years; mean follow-up period, 6.6 years) operated on by 3 expert surgeons (2011-2020) with the Walch LP technique. We documented preoperative hyperlaxity (25%, n = 5), affected throwing arm (55%, n = 11), position (backcourt, winger, and goalkeeper, 22% each; full back and pivot, 17% each), >2 dislocations prior (20%, n = 4), >10 dislocations prior (5%, n = 1), previous failed Bankart or humeral avulsion of glenohumeral ligament (HAGL) repair (10%, n = 2), and large Hill-Sachs lesions (HSLs) (20%, n = 4). Clinical and radiographic outcomes, visual analog scale score, Subjective Shoulder Value, Walch-Duplay score, Rowe score, and return-to-sport (RTS) rate were recorded. RESULTS The RTS rate was 85% (17 of 20 shoulders); rate of RTS at the same level, 80% (16 of 20); and rate of RTS with no throwing pain, 73% (8 of 11). The time to training with a ball was 3.2 months, and the time to competition was 4.9 months. The mean Rowe score, Walch-Duplay score, and Subjective Shoulder Value were 90 points, 88 points, and 89%, respectively. Shoulder symptoms led players to give up handball in 2 cases (10%), whereas 1 player (5%) stopped playing handball for other reasons. We recorded 1 recurrent dislocation (5%) (non-throwing arm, winger, no recurrence after rehabilitation). Persistent apprehension occurred in 1 goalkeeper (5%). Residual pain was seen in 4 shoulders (20%); this was relieved by screw removal in 1. Resistant pain (throwing shoulder) was seen in 2 backcourt players (10%, 1 of whom had a large HSL) and 1 goalkeeper (5%; large HSL with >10 dislocations prior), all 3 of whom were aged > 30 years. Bone block positioning was correct (no lateral overhang) in all shoulders. At final follow-up, 1 shoulder (5%) showed mild arthritic changes (>10 dislocations, large HSL). CONCLUSION The open LP procedure is consistent in providing shoulder stability combined with return-to-throwing performance in professional handball players with a short time to RTS and high same-level RTS rate without increasing the risk of arthritic changes. Throwing shoulders of backcourt players, large HSLs, or age > 30 years may have an increased risk of persistent symptoms.
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Affiliation(s)
- Stefan Bauer
- Shoulder Surgery and Upper Limb Center, Ensemble Hospitalier de la Côte, Morges, Switzerland; School of Surgery, University of Western Australia, Perth, Australia.
| | - Lionel Neyton
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Philippe Collin
- Orthopedics and Traumatology, American Hospital of Paris, Neuilly-sur-Seine, France; Shoulder Surgery, Clinique Victor Hugo, Paris, France
| | - Matthias Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopädie Sonnenhof, Bern, Switzerland; Shoulder, Elbow Unit, SportsClinic#1, Bern, Switzerland
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10
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Do WS, Shin SH, Lim JR, Yoon TH, Chun YM. Congruent Concavity Restoration of the Reconstructed Glenoid After the Latarjet Procedure: Compensation for the Position of the Graft. J Bone Joint Surg Am 2024; 106:407-413. [PMID: 38271494 DOI: 10.2106/jbjs.23.00510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND Few clinical studies have addressed concavity restoration by natural remodeling after a Latarjet procedure. This study investigated the fibrous tissue and osseous remodeling of the reconstructed glenoid and concavity restoration after a Latarjet procedure using postoperative computed tomographic arthrography (CTA). METHODS This retrospective study included 31 patients who underwent immediate postoperative computed tomographic (CT) scanning followed by CTA at 6 months postoperatively. We investigated whether fibrous tissue was newly created over the graft, whether the created fibrous tissue restored the congruity of the articular surface and the osseous remodeling of the graft to the glenoid level (whether the osseous portion of the graft was remodeled flush to the glenoid level) and the concavity of the glenoid using the radius of a best-fit circle on the articular surface, and the relationship between the amount of created fibrous tissue and the position of the graft. RESULTS In all patients, the fibrous tissue on the graft yielded a smooth articular surface, as revealed by the CTA. The mean radius of the entire glenoid, including the transferred graft, was significantly smaller (p = 0.010) at 33.2 ± 8.5 mm than that of the glenoid posterior to the osseous step-off at 37.6 ± 9.4 mm, which is presumed to be the glenoid before the surgical procedure. Despite the congruity of the articular surfaces due to fibrous tissue seen in the CTA, 14 (45%) of 31 patients showed a subchondral osseous step-off on either the medial side or the lateral side in the immediate postoperative CT scans. However, through osseous remodeling, 8 of the 10 grafts with a lateral step-off and 2 of the 4 grafts with a medial step-off converted to a flush position. The position of the step-off was correlated with the thickness of the fibrous tissue, with a tendency for thicker tissue in cases of a step-off on the medial side (p = 0.014). CONCLUSIONS Fibrous tissue formation plus remodeling of the transferred graft resulted in the restoration of a congruent concavity after a Latarjet procedure by compensating for initially non-flush positioning of the graft. However, due to the small sample size in our study, clinical outcomes could not be correlated with radiographic findings, and our recommendation is to continue placing the graft as anatomically as possible. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Woo-Sung Do
- Arthroscopy and Joint Research Institute, Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Rodriguez K, Hurley ET, Park CN, Bulleit C, Levin JM, Klifto CS, Dickens JF, Lau BC. Complications following arthroscopic Bankart repair: a systematic review. J Shoulder Elbow Surg 2024; 33:435-440. [PMID: 37774834 DOI: 10.1016/j.jse.2023.08.013] [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: 06/30/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Complications are rare after arthroscopic Bankart repair, and as a result, there is a lack of guidance over rates of complications that can be used to consent patients. The purpose of this study is to systematically review the literature to assess the complications after arthroscopic Bankart repair, other than recurrent instability. METHODS A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies reporting on the complications after arthroscopic Bankart repair were included. RESULTS A total of 194 studies were included in the analysis, with 13,979 patients and 14,019 shoulders undergoing arthroscopic Bankart repair. The overall complication rate was 0.67%, with frozen shoulder being the most common complication occurring in 0.32%. Persistent pain occurred in 0.17%. The rates of nerve, hardware, and wound complications were 0.07%, 0.05%, and 0.03%, respectively. CONCLUSION The arthroscopic Bankart repair has a very low rate of complications. Frozen shoulder and persistent pain are the most frequently encountered complications.
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Affiliation(s)
- Kaitlyn Rodriguez
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Caroline N Park
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Clark Bulleit
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jay M Levin
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jonathan F Dickens
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Brian C Lau
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
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Li L, Lu M, Zhao L, Shen Z, He L, Xing J, Wang C. All-Arthroscopic Glenoid Bone Augmentation Using Iliac Crest Autograft Procedure for Recurrent Anterior Shoulder Instability: Button Fixation Is a Feasible and Satisfactory Alternative to Screw Fixation. Arthroscopy 2024; 40:16-31. [PMID: 37355185 DOI: 10.1016/j.arthro.2023.05.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To investigate the efficacy of all-arthroscopic glenoid bone augmentation surgery using the iliac crest autograft procedure. Furthermore, we sought to compare the clinical and radiographic outcomes of using screw versus button fixation, in patients with recurrent anterior shoulder instability. METHODS Between 2015 and 2019, 134 shoulders with persistent instability were surgically treated with an arthroscopically placed autologous iliac crest bone graft transfer procedure. Preoperative and postoperative clinical follow-up data were evaluated using the range of motion, and the Walch-Duplay, American Shoulder and Elbow Society, and Rowe scores. Radiologic assessment on 3-dimensional computed tomography scans was performed preoperatively, immediately after surgery, as well as postoperatively, at 3 months, 6 months, 1 year, and at the final follow-up stage. Graft positions, healing, and resorption were evaluated from postoperative images. RESULTS This study included 102 patients who underwent arthroscopic iliac crest bone grafting procedure with 2 screws fixation (n = 37; group 1) and 2 button fixation (n = 65; group 2). The mean follow-up period was 37 months. There were no significant differences between groups in terms of clinical scores, shoulder motion range, graft healing, or graft positions on computed tomography scans (P>.05). In group 1, 1 patient showed mechanical irritation and persistent pain around the screw insertion site, being treated through the arthroscopic removal of the screws. The average postoperative bony resorption percentages were 20.3% and 11.2% at 6 months, and 32.4% and 19.3% at 12 months, in group 1 and group 2, respectively. A statistically significant difference was detected between the two groups (P<.05). CONCLUSIONS In the arthroscopic iliac crest bone grafting procedure for the treatment of chronic osseous anterior shoulder instability, excellent functional results were obtained after both button fixation and screw fixation techniques. In addition, less graft resorption and no hardware-related complications were detected with suture button fixation technique. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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Affiliation(s)
- Lingzhi Li
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, China; Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingfeng Lu
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, China; Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lilian Zhao
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, China.
| | - Zhaoxiong Shen
- Guangzhou University of Chinese Medicine, Guangzhou, China; 6th Department of Orthopaedics, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Lilei He
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Jisi Xing
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Changbing Wang
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
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Kawakami EFKI, Godoy GPD, Cohen MT, Yamada AF, Motta Filho GR, Ejnisman B, Belangero PS. Evaluation of Screws Positioning in Latarjet Surgery: Is There a Correlation between Parallelism to Glenoid and Radiographic Complications? Rev Bras Ortop 2023; 58:e876-e884. [PMID: 38077761 PMCID: PMC10708985 DOI: 10.1055/s-0042-1751110] [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: 03/08/2022] [Accepted: 05/19/2022] [Indexed: 10/17/2022] Open
Abstract
Objective To evaluate whether the parallelism of screws with glenoid in Latarjet surgery interferes in the positioning of the graft and to verify the reproducibility of a method of measuring screws positioning. Methods Retrospective, multicenter study, of patients with anterior shoulder instability submitted to modified Latarjet surgery and at least one year of postoperative follow-up. Two radiologists analyzed the postoperative tomographic images, acquired in a database, to evaluate the positioning of screws and radiographic complications. Results We evaluated 34 patients, aged between 21 and 60 years, one of them with bilateral shoulder involvement, totaling 35 shoulders evaluated. The tomographic evaluation of the inclination angles of the screws showed no difference between the observers. There was intra- and interobserver agreement to evaluate the following surgical parameters: graft position, presence or not of radiographic complications. Conclusion The technique described for measuring the parallelism of screws in Latarjet surgery presented a very good and excellent intra-observer agreement, respectively. Screw parallelism with glenoid is recommended; however, it is not a mandatory and unique condition to avoid radiographic complications.
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Affiliation(s)
- Eduardo Felipe Kin Ito Kawakami
- Médico radiologista do Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Gabriel Paris de Godoy
- Médico ortopedista e traumatologista da Disciplina de Medicina Esportiva - Grupo de Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Marcio T. Cohen
- Médico ortopedista e traumatologista do Grupo de Ombro e Cotovelo do Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Andre Fukunishi Yamada
- Médico radiologista do Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
- Médico radiologista do Hospital do Coração (HCOR), São Paulo, SP, Brasil
| | - Geraldo R. Motta Filho
- Médico ortopedista e traumatologista do Grupo de Ombro e Cotovelo do Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Benno Ejnisman
- Chefe da Disciplina de Medicina Esportiva - Grupo de Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Paulo Santoro Belangero
- Chefe da Disciplina de Medicina Esportiva - Grupo de Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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Song Q, Gao A, Bai J, Shao Z, Cui G. The Arthroscopic Bristow Procedure Is Superior to the Arthroscopic Latarjet Procedure in Return to Sports but Inferior in Graft Healing: A Comparative Study With 3.4-Year Follow-Up. Arthroscopy 2023; 39:2423-2433. [PMID: 37270110 DOI: 10.1016/j.arthro.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 05/13/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To compare clinical and computed tomography outcomes between the arthroscopic Latarjet procedure and the arthroscopic Bristow procedure. METHODS Patients who underwent arthroscopic Latarjet or Bristow procedures with at least 2 years of follow-up were retrospectively reviewed. Thirty-eight shoulders were included in the Latarjet group, and 34 were included in the Bristow group. Recurrence of dislocation, clinical scores, rate of return to sports (RTS), and computed tomography assessment findings (position of transferred coracoid, graft healing, graft absorption, and glenohumeral degenerative osteoarthritis [OA]) were obtained at final follow-up. RESULTS No recurrent dislocation occurred in either group, and no significant differences in clinical scores were found between the 2 procedures, with a mean follow-up period of 3.4 years. The operative time in the Bristow group was significantly shorter than that in the Latarjet group (P < .001). The transferred coracoid had healed in 94.7% of the patients in the Latarjet group and 85.3% in the Bristow group at final follow-up (P = .01). No significant difference in graft absorption or the degree of glenohumeral OA was detected between the 2 groups. However, moderate to severe OA only occurred in the Latarjet group at final follow-up (4 of 38 shoulders, 10.5%). The postoperative external rotation angle and level of RTS favored the Latarjet procedure (P = .030 and P = .034, respectively). CONCLUSIONS Both the arthroscopic Latarjet and arthroscopic Bristow procedures led to good clinical scores with no new dislocation episodes. The Bristow group showed significantly less graft healing than the Latarjet group. However, the arthroscopic Bristow procedure took less operative time and showed a lower rate of early moderate to severe glenohumeral OA, better range of motion, and a higher rate of RTS. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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Affiliation(s)
- Qingfa Song
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Aofei Gao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jucheng Bai
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Zhenxing Shao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Guoqing Cui
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China.
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Lalanne C, Vervoort T, Cassagnaud X, Szymanski C, Bourgault C, Pougès C, Maynou C. Long-term prevalence and impact of glenohumeral osteoarthritis after Latarjet-Patte procedure for anterior instability. Orthop Traumatol Surg Res 2023; 109:103050. [PMID: 34506990 DOI: 10.1016/j.otsr.2021.103050] [Citation(s) in RCA: 3] [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: 04/08/2020] [Revised: 02/11/2021] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The Latarjet procedure provides satisfactory functional results, with low rates of recurrence. It is, however, sometimes claimed to induce osteoarthritis due to the positioning of the bone-block and hardware. The aims of the present study were to assess the long-term prevalence of osteoarthritis following the procedure, to determine risk factors and assess clinical impact. The study hypothesis was that osteoarthritis risk can be reduced by good bone-block positioning. The secondary objective was to assess long-term recurrence of instability. MATERIALS AND METHODS Out of a cohort of 102 patients (106 shoulders) operated on between 1984 and 1998, 77 had complete radiology files for analysis in a previous study published in 2003. Forty-four of these patients were seen again for clinical and radiological assessment at a mean 22 years' follow-up, to be compared to results previously reported at 8 years. Clinical assessment comprised range of motion and Constant and Walch-Duplay scores. X-rays were taken systematically to determine Samilson osteoarthritis stage; 31 patients also underwent CT. RESULTS In the 44 patients, the rate of osteoarthritis was 34.1%. 90.9% of patients were satisfied. Mean Constant score was 83.5±14 and mean Walch-Duplay score was 71.6±23.4. Advanced age at surgery and at assessment, length of follow-up and age >30 years at first episode of instability were the main factors for onset of osteoarthritis, independently of surgery. Lateral bone-block overhang correlated with onset of osteoarthritis: 71.4%, versus 16.7% in medial or flush bone-block (p=0.0004). Humeral notch, glenoid bone defect and number of preoperative episodes of instability were unrelated to onset of osteoarthritis. Lateral bone-block overhang was the only risk factor related to surgery. The clinical impact of the osteoarthritis was significant only in advanced stages (Samilson 3 and 4). CONCLUSION Lateral bone-block overhang was the only surgical risk factor for osteoarthritis in the long-term. Strict coracoid positioning is therefore essential, and could be facilitated by specific instrumentation and by arthroscopy. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Clément Lalanne
- Orthopédie A, université Lille 2, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France.
| | | | | | - Christophe Szymanski
- Orthopédie A, université Lille 2, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
| | - Caroline Bourgault
- Orthopédie A, université Lille 2, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
| | - Cecile Pougès
- Orthopédie A, université Lille 2, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
| | - Carlos Maynou
- Orthopédie A, université Lille 2, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
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O’Driscoll CS, Davey MS, Molony DC, Shannon FJ, Mullett H. Shoulder arthroplasty in the setting of previous stabilization surgery: a systematic review of matched case control studies at minimum 2 years follow-up. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:166-180. [PMID: 37588435 PMCID: PMC10426623 DOI: 10.1016/j.xrrt.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Anterior shoulder instability causes considerable patient morbidity and the volume of shoulder stabilization surgery being performed annually is rising. Despite stabilization surgery, instability arthropathy in the long-term may arise requiring consideration of shoulder arthroplasty. This study evaluated the outcomes of shoulder arthroplasty following previous stabilization surgery with their associated changes in bony anatomy or soft tissue structure. Methods A systematic review was performed as per Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to identify all studies reporting outcomes of shoulder arthroplasty in the setting of previous stabilization surgery. Studies of >10 patients with a minimum of 24 months follow-up were included. Results Overall, 377 shoulder arthroplasties composed of 247 anatomical total shoulder arthroplasties (aTSAs), 102 reverse total shoulder arthroplasties (RTSAs), and 28 hemiarthroplasties (HAs) were reported across 14 included studies at mean age 55.4 years, with 203 compared to 451 control shoulders in 7 matched case-control studies. The mean interval from arthroplasty to stabilization procedure was 19.7 years, with 27.2% of patients having undergone multiple procedures and 39.5% bone transfer procedures. Improvements in patient outcomes were observed both for patients who had underwent aTSA or RTSA, with the American Shoulder and Elbow Surgeons score the most commonly used scoring system. Across matched studies comparing to control, large improvements in American Shoulder and Elbow Surgeons were seen for both aTSA and RTSA implants, 38.1-80.5 and 34.9-82.3, which compared to control groups 38.0-85.5 and 35.5-82.3, respectively. There were differences observed in complication profiles between aTSA and RTSA procedures, with lower revision rates in the short-term to medium-term for RTSA implants in present literature. A significantly higher rate of aTSA revision was observed compared to matched control patients undergoing aTSA for primary osteoarthritis without previous stabilization surgery, 9.4% (13/139) vs. 4.1% (11/269) (P = .044). Aseptic loosening posed a particular challenge in the aTSA group, with significantly higher rates of 5.0% (7/139 f = 54.6 months) compared to control 0.74% (2/269 f = 49.1 months, P = .0088). No significant difference in infection rate was observed between matched study and control groups, 1.5% vs. 2.2% (P = .76). Conclusion Shoulder arthroplasty may improve functional outcomes for patients experiencing instability arthropathy with a history of stabilization surgery. Careful consideration of potential complications is warranted both in surgical planning and patient counselling given the altered anatomy and biomechanics, with significantly higher revision and loosening rates observed following aTSA compared to control.
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Affiliation(s)
- Conor S. O’Driscoll
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Martin S. Davey
- Royal College of Surgeons of Ireland, Dublin, Ireland
- Galway University Hospital, Galway, Ireland
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Functional biomechanical comparison of Latarjet vs. distal tibial osteochondral allograft for anterior glenoid defect reconstruction. J Shoulder Elbow Surg 2023; 32:374-382. [PMID: 36206982 DOI: 10.1016/j.jse.2022.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Glenoid reconstruction is indicated for recurrent glenohumeral instability with significant glenoid bone deficiency. Coracoid autograft (Latarjet) and distal tibial osteochondral allograft (DTA) reconstructions have been used to successfully restore glenohumeral stability. Relative advantages and disadvantages associated with each reconstruction technique have been described. However, direct comparisons of functional glenohumeral biomechanics associated with Latarjet vs. DTA reconstruction are lacking. This study was designed to compare these 2 glenoid reconstruction techniques with respect to joint kinematics and cartilage pressure mapping using a robotic testing system. METHODS In accordance with institutional review board policies, human cadaveric shoulders (n = 8) were cyclically tested in the neutral position and 90° of external rotation with 60° and 90° of abduction under a 45-N joint-compression load to measure clinically relevant translations, loads, and torques. Joint contact pressure maps were obtained under a 120-N joint-compression load using pressure mapping sensors. After confirming that a 25% anterior glenoid defect resulted in glenohumeral dislocation, testing was performed to compare 3 conditions: native intact glenoid, 25% anterior glenoid defect with Latarjet reconstruction, and 25% anterior glenoid defect with DTA reconstruction. Analyses of variance and t tests were used to analyze data with statistical significance set at P < .05. RESULTS Significant differences in anterior translation, inferior drawer, anterior drawer, compression loads, horizontal abduction, negative elevation (adduction), and external rotation torques during cyclical testing in 90° of external rotation with 60° and/or 90° of abduction were noted when comparing the 2 different glenoid bone reconstruction techniques to native, intact shoulders. The only significant difference between Latarjet and DTA reconstructions for measured translations, loads, and torques was a significantly higher absolute maximum compressive load for Latarjet compared to DTA at 60° of abduction. CONCLUSION Latarjet coracoid osseous autograft and distal tibial osteochondral allograft reconstructions of large (25%) glenoid bone defects prevent failure (dislocation) and are associated with significant glenohumeral kinematic differences that largely confer less translation, load, and torque on the joint in abduction when compared to the native state. These findings suggest that these 2 surgical techniques exhibit similar glenohumeral kinematics such that each provides adequate functional stability following anterior glenoid bone reconstruction. Joint compression load and articular contact pressure distribution may favor distal tibial osteochondral allograft reconstruction for treatment of large (25%) anterior glenoid bone defects associated with shoulder instability.
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[Chronic posttraumatic shoulder instability]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:145-154. [PMID: 36729203 PMCID: PMC9898333 DOI: 10.1007/s00113-022-01283-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 02/03/2023]
Abstract
Chronic posttraumatic shoulder instability is characterized by trauma-associated, recurrent dislocations. Surgical treatment is indicated in most cases but it remains controversial how risk factors should be weighted to decide between arthroscopic Bankart repair (ABR), Latarjet or alternative procedures. Known risk factors for recurrence are patient age, hyperlaxity, sports profile and bone loss. Surgical techniques are discussed in detail. The ABR leads to high patient satisfaction and return to sports; however, in association with risk factors, recurrent dislocations are seen even several years later. Latarjet or bone block procedures lead to high patient satisfaction, sustainable stability as a revision procedure, but can also be primarily indicated for chronic instability depending on risk factors. Early complications are more frequent but of a minor nature in most cases. All techniques are known for a serious learning curve. If performed well, they do not seem to increase the risk of arthritis, which is most affected by the number of lifetime dislocations and higher energy trauma.
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Saeed AZ, Pandit N, Jordan RW, Laprus H, D'Alessandro P, Lo IKY, Malik SS. Open and arthroscopic posterior bone block with iliac crest autograft for posterior shoulder instability - systematic review of clinical and radiological outcomes. Orthop Traumatol Surg Res 2022; 109:103424. [PMID: 36182090 DOI: 10.1016/j.otsr.2022.103424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/17/2022] [Accepted: 07/25/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Posterior shoulder instability (PSI) is a rare and challenging pathology to manage. The aim of this review was to assess and compare whether open and arthroscopic iliac crest bone graft (ICBG) bone block procedures succeeded in improving functional and clinical outcomes as well as radiological outcomes of union and graft resorption. HYPOTHESIS We hypothesised that there will be no difference in recurrence rate and functional outcome between open and arthroscopic procedures but there will be a higher complication rate with open bone block procedures. METHODS A systematic review was conducted in accordance with PRISMA guidelines using the online databases MEDLINE and Embase. The review was registered on the PROSPERO database. Studies of open or arthroscopic ICBG bone block procedures reporting patient reported outcome measures, recurrence, complications and progression to osteoarthritis and radiological outcomes of graft union and resorption were selected. Studies were appraised using the Methodical index for non-randomised studies (MINORS) tool. RESULTS 14 studies satisfied the inclusion criteria; five studies were arthroscopic and nine used open techniques. A total of 183 patients and 201 shoulders were included, mean age was 25 years range (14-75 years). Recurrent instability ranged from 0% to 12.5% for arthroscopic and 0% to 36.4% for open studies. Arthroscopic studies had statistically significant increases in numerous functional outcome scores but there was no evidence for similar improvements in open studies. Osteoarthritis at follow-up ranged from 12.5% to 47% in arthroscopic and 0% to 81.8% for open studies. Arthroscopic complication rate ranged from 6.7% to 75% compared to 0% to 80% for open studies. Majority of complications were metalware related requiring surgical intervention. Partial graft resorption ranged from 7.7-100% after arthroscopic and 4.8-100% after open procedures. High union rates were seen with both open and arthroscopic techniques. CONCLUSION This study highlights a lack of high-level evidence for arthroscopic and open posterior bone block procedures using ICBG to manage PSI. Functional and instability outcome scores showed significant improvement with arthroscopic ICBG bone block procedures however limited evidence was available for open studies. Metalwork related complications requiring revision and radiographic progression to osteoarthritis was high in both arthroscopic and open studies. LEVEL OF EVIDENCE IV, systematic review.
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Affiliation(s)
- Abu Z Saeed
- Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, WR5 1DD Worcester, UK.
| | - Nikhil Pandit
- Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, WR5 1DD Worcester, UK
| | - Robert W Jordan
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, B15 2TH Birmingham, UK
| | - Hubert Laprus
- Saint-Luke's Hospital, Bystrzańska 94B, 43-309 Bielsko-Biała, Poland
| | - Peter D'Alessandro
- Orthopaedic Research Foundation of Western Australia, 25, Queenslea Drive, WA 6010 Claremont, Australia
| | - Ian K Y Lo
- University of Calgary, 2500, University Drive Northwest, AB T2N 1N4 Calgary, Canada
| | - Shahbaz S Malik
- Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, WR5 1DD Worcester, UK
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Hsu KL, Yeh ML, Kuan FC, Hong CK, Chuang HC, Wang WM, Su WR. Biomechanical comparison between various screw fixation angles for Latarjet procedure: a cadaveric biomechanical study. J Shoulder Elbow Surg 2022; 31:1947-1956. [PMID: 35398164 DOI: 10.1016/j.jse.2022.02.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Latarjet procedure is a reliable treatment for the management of anterior glenohumeral instability with glenoid bone loss. However, the biomechanical properties of different fixation angles between screw and glenoid surface (α angle) have rarely been studied. The aim of the study was to investigate and compare the fixation stability, failure load, and failure mechanism between different α angles for Latarjet procedures, which were performed on cadaver specimens. METHODS Twenty-four shoulder specimens (8 in each of 3 groups) were dissected free of all soft tissue, and a 25% glenoid defect was created. The coracoid process was osteomized and fixed with 2 screws at 3 different α angles: 0° (group A), 15° (group B), and 30° (group C). Specimens were mounted to a testing apparatus, and cyclic loading (100 cycles at 1 Hz) was applied with a staircase protocol (50, 100, 150, and 200 N). Gross graft displacement and interface displacement were measured. The ultimate failure loads and failure mechanisms were recorded. RESULTS There was no significant difference in gross displacement under any cyclic load between 3 groups. However, a significant larger interface displacement was noted in group C than in group A in 150-N cyclic loading (P = .017). Under failure strength testing, all 24 specimens failed because of screw cutout from the glenoid, and the ultimate failure load was similar among the three groups. CONCLUSION Compared with the 0° α angle, the displacement after cyclic loading did not significantly increase when the α angle was increased to 15° but significantly increased at 30° for Latarjet procedures, which were performed on cadaver specimens. The results suggest that surgeons should apply the screws as parallel as possible to the glenoid surface when performing the Latarjet procedure. Although mild deviation may not reduce fixation stability, α angles greater than 30° should be avoided.
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Affiliation(s)
- Kai-Lan Hsu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, National Cheng Kung University, Yunlin, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ming Wang
- Department of Statistics and Institute of Data Science, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Boileau P, Gendre P, Saliken DJ, Thélu CÉ, Trojani C. Tensioning device increases coracoid bone block healing rates in arthroscopic Latarjet procedure with suture-button fixation. J Shoulder Elbow Surg 2022; 31:1451-1462. [PMID: 35172210 DOI: 10.1016/j.jse.2022.01.126] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is growing interest in using suture buttons for coracoid fixation to avoid the complications associated with screws during the Latarjet procedure. However, achieving bone block healing is critical for successful shoulder stabilization and return to sport. The purpose of this study was to assess and compare the healing rates and positioning of the coracoid bone block fixed with cortical suture buttons that were either manually tensioned (using a knot pusher) or mechanically tensioned (using a tensioning device) during arthroscopic Latarjet procedures. METHODS This prospective, nonrandomized, comparative study enrolled 69 consecutive patients (mean age, 27 years) who underwent an arthroscopic guided Latarjet procedure with suture-button fixation. Hand tensioning was performed in the first 34 shoulders, whereas the next 35 shoulders underwent mechanical tensioning. Twelve patients (17%) had a history of failed Bankart stabilization. The characteristics of the patients in each group in terms of age, sex, type of sport, bone loss, number of previous failed surgical procedures, smoking, and length of follow-up were comparable. Intraoperatively, the tensioning device was set at 100 N successively 3 times until complete immobilization of the bone block was confirmed, as assessed with a probe. The primary outcome measure was coracoid bone block union and position on computed tomography scan images at 6 months' follow-up. Secondary outcome measures included functional outcome scores, shoulder stability, return to sports, and complications at last follow-up. RESULTS Overall, the rate of bone block healing was 74% (25 of 34 patients) in the hand-tensioning group and 94% (33 of 35 patients) in the mechanical tensioning group (P = .043). Smoking was an independent risk factor associated with nonunion (P < .001) in each group. Patient age, size of the preoperative glenoid bone defect (<20% or >20%), and a history of surgery were not found to have any influence. The tensioning modality did not affect the bone block position, which was subequatorial in 92% of the cases and flush with the glenoid rim in 92%. At a mean of 34 months of follow-up (range, 24-62 months), 96% of the patients (65 of 69) had a stable shoulder and 87% returned to sports. At final follow-up, no significant difference in clinical scores was noted between the groups; no neurologic or hardware complications were observed. CONCLUSION Mechanical tensioning achieves significantly higher healing rates than hand tensioning during the arthroscopic Latarjet procedure with suture-button fixation. The use of a suture-tensioning device is a key step to the suture-button fixation technique during arthroscopic Latarjet procedures. By making the suture-button construct rigid, the tensioning device transforms the initially flexible suture into a "rigid fixation", similar to a bolt (or a rivet).
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Affiliation(s)
- Pascal Boileau
- Institut de Chirurgie Réparatrice (ICR)-Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France.
| | | | | | | | - Christophe Trojani
- Institut de Chirurgie Réparatrice (ICR)-Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
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Menon A, Fossati C, Magnani M, Boveri S, Compagnoni R, Randelli PS. Low grade of osteoarthritis development after Latarjet procedure with a minimum 5 years of follow-up: a systematic review and pooled analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2074-2083. [PMID: 34677621 PMCID: PMC9165270 DOI: 10.1007/s00167-021-06771-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this systematic review and pooled analysis was to evaluate incidence and risk factors for glenohumeral osteoarthritis (OA) in patients who underwent Latarjet procedure with a minimum of 5-year follow-up. METHODS The PRISMA guidelines were followed to perform this systematic review. PubMed and EMBASE were searched up to February 29, 2020 for English, human in vivo studies that evaluated glenohumeral OA in patients undergoing Latarjet procedure at least 5 years after surgery. A pooled analysis on the included databases sent by authors was performed to evaluate the risk factors influencing the development or progression of dislocation arthropathy after the Latarjet procedure. RESULTS Four studies, including a total of 280 patients (213 males and 67 females), were analysed. In our study population, the median age at surgery was 25.0 years (range 20.8-32.6 years). and 92.1% were athletes. In 90% of the cases, the number of dislocations before surgery were fewer than 5. The recurrence of instability after Latarjet procedure was observed only in seven patients (2.5%). The position of the bone graft resulted flush to the anterior glenoid rim in 238 cases (85.3%), medial in 8 (2.9%) and overhanging in 33 (11.8%). Radiological signs of development or progression of shoulder OA were observed in 25.8% of the patients, of which 88.6% presented a grade 1 of OA according to Samilson and Prieto classification. The overhanging position of the bone graft resulted statistically significant for onset or worsening of OA. The age at surgery, the number of dislocations before surgery and the Hill-Sachs lesion were not significantly associated with joint degeneration. Instead, hyperlaxity showed a prevention role in the development of OA after open Latarjet procedure. CONCLUSION The Latarjet procedure is a valid and safe surgical treatment in recurrent anterior shoulder instability with a low risk of developing moderate or severe OA also at long-term follow-up. The overhanging position of the bone graft represents the principal risk factor of joint degeneration, whereas the hyperlaxity seems to be protective. Finally, age, gender, time between first dislocation and surgery, and number of dislocations do not seem to affect the onset of OA after Latarjet procedure. Therefore, an accurate execution of the Latarjet procedure can be considered a valid treatment even in young and athletes thanks to the low recurrence rates and the low development of major long-term complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Chiara Fossati
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Mauro Magnani
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, Milan, Italy
| | - Riccardo Compagnoni
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Pietro Simone Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
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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: 4] [Impact Index Per Article: 1.3] [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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Jassim SS, Amaranath J, Taylor DM, Warby SA, Hoy G. Unicortical Fixation Does Not Compromise Bony Union in the Latarjet Procedure. JSES Int 2022; 6:555-562. [PMID: 35813149 PMCID: PMC9264013 DOI: 10.1016/j.jseint.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - David McD. Taylor
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
- The Austin Hospital, Melbourne, VIC, Australia
| | - Sarah Ann Warby
- Melbourne Shoulder Group, Melbourne, VIC, Australia
- La Trobe University, Department of Rehabilitation, Nutrition and Sport, Corner of Kingsbury Drive and Plenty Road Bundoora, Melbourne, VIC, Australia
- Corresponding author: Sarah Ann Warby, PhD, B.Physio (Hon), Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Gregory Hoy
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia
- Monash University, Department of Surgery, Melbourne, VIC, Australia
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Dislocation Arthropathy of the Shoulder. J Clin Med 2022; 11:jcm11072019. [PMID: 35407627 PMCID: PMC8999818 DOI: 10.3390/jcm11072019] [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] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 12/04/2022] Open
Abstract
Glenohumeral osteoarthrosis (OA) may develop after primary, recurrent shoulder dislocation or instability surgery. The incidence is reported from 12 to 62%, depending on different risk factors. The risk of severe OA of the shoulder following dislocation is 10 to 20 times greater than the average population. Risk factors include the patient’s age at the first episode of instability or instability surgery, bony lesions, and rotator cuff tears. For mild stages of OA, arthroscopic removal of intraarticular material, arthroscopic debridement, or arthroscopic arthrolysis of an internal rotation contracture might be sufficient. For severe stages, mobilization of the internal rotation contracture and arthroplasty is indicated. With an intact rotator cuff and without a bone graft, results for anatomical shoulder arthroplasty are comparable to those following primary OA. With a bone graft at the glenoidal side, the risk for implant loosening is ten times greater. For the functional outcome, the quality of the rotator cuff is more predictive than the type of the previous surgery or the preoperative external rotation contracture. Reverse shoulder arthroplasty could be justified due to the higher rate of complications and revisions of non-constrained anatomic shoulder arthroplasties reported. Satisfactory clinical and radiological results have been published with mid to long term data now available.
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Surgical treatment of the humeral head osteochondral defects in chronic shoulder dislocation: Literature review. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.6-2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. The shoulder joint is the one most amenable to dislocation. Dislocation of the humeral head is complicated by combined injuries of the shoulder joint, and if the patient does not seek treatment on the first day after the dislocation, irreversible changes in bone and soft tissue structures are formed.The aim of this review was to analyze modern methods of diagnosis and treatment of patients with defects in the articular surfaces of the scapula and humerus head with chronic shoulder dislocations.Material and methods. To search for literature data, we used the electronic databases MEDLINE, PudMed, eLIBRARY with a selection of sources published from 2000 to 2020. The analysis was carried out on works devoted to the diagnosis, surgical treatment and complications of traumatic shoulder dislocations.Results. When analyzing the literature on the surgical treatment of shoulder dislocations, we did not find clear criteria for planning the extent of surgery. The obtained results of surgical treatment testify to well-studied technologies for treating osteochondral defects of the humeral head up to 25 % of its total area. In the presence of a defect of 50 % of humeral head area or more, satisfactory results are shown when carrying out arthroplasty of the joint using a reverse endoprosthesis. However, the treatment of defects ranging in size from 25 to 50 % is still an unexplored problem. There are single techniques using allografts, mainly in English-speaking countries and, to a lesser extent, on the territory of the Russian Federation. Thus, the search for an algorithm for choosing a surgical treatment based on multi-layer spiral computed tomography and/or magnetic resonance imaging data, and the development of a new method of surgical treatment taking into account the obtained data are priority areas in modern traumatology and orthopedics.
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Clowez G, Gendre P, Boileau P. The Bristow-Latarjet procedure for revision of failed arthroscopic Bankart: a retrospective case series of 59 consecutive patients. J Shoulder Elbow Surg 2021; 30:e724-e731. [PMID: 34087273 DOI: 10.1016/j.jse.2021.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recurrence of anterior instability after arthroscopic Bankart prevents return to sports and remains a surgical challenge. We aim to assess clinical and radiologic outcomes after coracoid bone-block performed either open or under arthroscopy, for the management of failed arthroscopic Bankart PATIENTS AND METHODS: Fifty-nine consecutive patients with anterior instability recurrence after arthroscopic Bankart were revised with a Bristow or Latarjet procedure performed either open (25 cases) or under arthroscopy (34 cases). Patients were reviewed for clinical and radiologic examination at a minimum 2-year follow-up. Glenohumeral bony lesions were evaluated preoperatively with computed tomographic scans. Postoperative bone-block position, union, and postinstability arthritis were also evaluated. RESULTS The mean follow-up was 89 months (24-193). The epidemiologic analysis showed that patients with failed arthroscopic Bankart were young (age <23 years), 58 (98%) were practicing sports, with contact/forced overhead sports (53%), often in competition (53%), had hyperlaxity (71%), and for the most part of them glenohumeral bone loss (88%). Their mean preoperative Instability Severity Index Score was 5.4 ± 2.2 points. After revision with Bristow-Latarjet procedure, 53 patients (91%) returned to sports, 37 (70%) to their previous sports activity, and 17 (46%) to their previous level. No patient suffered recurrent dislocation. Four patients (7%) had recurrent subluxations, all after open procedure; 8 patients (14.5%) had persistent anterior apprehension. A large and deep Hill-Sachs lesion was a risk factor for persistent anterior apprehension (P = .002) and lower level when returned to sports (P = .04). Ninety-two percent of bone-blocks were positioned flush with the glenoid anterior rim, with 84% of bone union. At last follow-up, 5% of patients had severe postinstability osteoarthritis (Samilson 4). CONCLUSION The Bristow-Latarjet, performed either open or under arthroscopy, is an efficient procedure to restore shoulder stability and allow returning to sports in patients with failed arthroscopic Bankart and glenoid bone loss. Patients with a large and deep Hill-Sachs lesion had more persistent anterior apprehension and a lower sports level.
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Affiliation(s)
- Gilles Clowez
- University Institute for Locomotion & Sports (iULS), Côte d'Azur University, Nice, France
| | | | - Pascal Boileau
- ICR-Institut de Chirurgie Réparatrice, Locomoteur & Sports, Nice, France.
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Joshi S, Rao V, Shetty UC, Rai S, Arora S, Kumar SR. Functional Outcome of Open Latarjet Procedure in Non-Athletic Middle-Aged Patients. Malays Orthop J 2021; 15:151-158. [PMID: 34429836 PMCID: PMC8381674 DOI: 10.5704/moj.2107.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/19/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: The movement and steadiness of the shoulder joint is due to both the dynamic and static stabilisers. Recurrent anterior shoulder instability is common due to the Bankart lesion or the Hill Sachs lesion. The bone loss and soft tissue failure due to these lesions causing instability is well compensated by Latarjet procedure which acts by triple blocking effect of the bone graft, the sling effect of the conjoint tendon of subscapularis and the ligament of the coracoacromial ligament stump. Materials and methods: Middle-aged patients with recurrent anterior shoulder dislocation and a mid-range instability on clinical assessment with an isolated glenoid bone loss of 20% or Bankart lesion with engaging Hill Sachs lesion were selected for the study. The surgical procedure included a subscapularis split to expose the glenoid. The coracoid graft harvested was prefixed with Kirschner wires and placed flush over the glenoid ensuring no medial or lateral overhang and fixed with 4.0mm cancellous screws with the washer. The functional outcome was measured with the ROWE score and ASES score and the movements were evaluated. Results: A total of 24 patients fulfilled the inclusion criteria. Post-operatively at final follow-up, the mean ROWE score was 97.08 ±8.45 and the mean ASES score was 94.4±9.10. One patient had screw breakage as a complication and another had restriction of movement which was managed with physiotherapy. Conclusion: Open Latarjet is an effective procedure for recurrent anterior shoulder instability in non-athletic middle-aged patients as a excellent functional outcome was achieved with this technique. We therefore recommend open Latarjet as an alternative to arthroscopic treatment in developing countries where patient affordability and the availability of the resources are the issues.
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Affiliation(s)
- S Joshi
- Department of Orthopaedics, Government Medical College Kota, Kota, India
| | - Vkv Rao
- Department of Orthopaedics, Government Medical College Kota, Kota, India
| | - U C Shetty
- Department of Orthopaedics, Kundapur Hospital, Kundapur, India
| | - S Rai
- Department of Orthopaedics, Orthocity Hospital, Varanasi, India
| | - S Arora
- Department of Orthopaedics, Government Medical College Kota, Kota, India
| | - S R Kumar
- Department of Orthopaedics, Government Medical College Kota, Kota, India
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Cohen M, Fonseca R, Gribel B, Galvão MV, Monteiro M, Motta Filho G. Incidence and Risk Factors of the Complications Related to the Latarjet Surgery. Rev Bras Ortop 2021; 56:307-312. [PMID: 34239194 PMCID: PMC8249070 DOI: 10.1055/s-0040-1712987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 03/02/2020] [Indexed: 11/02/2022] Open
Abstract
Objective The Latarjet procedure is a well-accepted treatment of shoulder instability. This technique is associated with a unique set of complications with overall rates of up to 30%. The purpose of the present study was to investigate the incidence and risk factors associated with complications after open Latarjet procedure. Methods We retrospectively reviewed 102 patients submitted to open Latarjet procedure. Complications were divided into three types: clinical; graft-related; and screw-related. All of the patients were submitted to radiography and computed tomography (CT). The risk factors analyzed were gender, age, previous surgery, epilepsy, experience of the surgeon. Results A total of 102 consecutive patients (108 cases) underwent the Latarjet procedure. The mean age was 33.7 years old (18 to 61 years old), with 88 males and 14 females. The overall complication rate was 21.2%, being 12% clinical-related, 7.4% graft-related, and 2.7% screw-related. The most frequent were anterior apprehension (eight cases) and lateral overhang of the graft in six patients. Computed tomography scan at a minimum of 6 months was performed in 79 cases (73%), and graft union occurred in 75 patients (94.9%). There were no cases of instability in the remaining four cases of nonunion. Ten patients (9.2%) required revision surgery. The risk factors associated with complications were epilepsy ( p = 0.0325), experience of the surgeon ( p = 0.0499) and patients ≥ 40 years old at the time of the surgery ( p = 0.0151). There was no correlation with gender and previous surgery. Conclusion The complication rate following the Latarjet procedure was 21.2%, with 9% requiring revision surgery. Epilepsy, age > 40 years old and experience of the surgeon were risk factors.
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Affiliation(s)
- Marcio Cohen
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - Raphael Fonseca
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - Bernardo Gribel
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - Marcus Vinicius Galvão
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - Martim Monteiro
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
| | - Geraldo Motta Filho
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil
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Qin Q, Liang X, Liang D, Deng Z, Qiu Z, Li S, Wu B, Li Y, Li H, Liu H, Lu W. [Radiographic study of effect of lateral placement of bone graft on shoulder joint degeneration after modified arthroscopic Latarjet surgery with elastic fixation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:414-419. [PMID: 33855823 PMCID: PMC8171623 DOI: 10.7507/1002-1892.202011089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the mid-term effect of lateral placement of bone graft on shoulder joint degeneration after modified arthroscopic Latarjet surgery with elastic fixation for recurrent anterior shoulder dislocation with an anterior glenoid bone defect. METHODS According to the inclusion and exclusion criteria, 18 patients with recurrent anterior shoulder dislocation and anterior glenoid bone defect who received the modified arthroscopic Latarjet surgery with elastic fixation between January 2015 and November 2016 were enrolled in this study. There were 12 males and 6 females with an average age of 26.2 years (range, 19-37 years). The number of shoulder dislocation ranged from 4 to 30 times (mean, 8.8 times). The disease duration was 8-49 months (mean, 23.8 months). The mean anterior glenoid bone defect was 25.2% of the glenoid surface (range, 20%-29%). The mean preoperative Instability Severity Index Score (ISIS) was 7.6 (range, 7-10). According to Samilson-Prieto classification, the shoulder joint degeneration was rated as grade 0 in 13 cases, grade Ⅰ in 3 cases, and grade Ⅱ in 2 cases. Before and after operation, the visual analogue scale (VAS) score, American Society of Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, Rowe score, and shoulder mobility were used to evaluate the effectiveness. Imaging examination was performed to observe the shoulder joint degeneration, the position of the bone graft, and the postoperative shaping of the scapular glenoid. RESULTS All patients were followed up 55-62 months, with an average of 59.6 months. There was no neurovascular injuries, infections, fixation-related and bone graft-related complications. No re-dislocation and revision occurred. All patients returned to normal life, 17 of whom returned to sport. The VAS score was significantly decreased and ASES, Walch-Duplay, and Rowe scores were significantly improved at last follow-up ( P<0.05). No significant difference was found in range of motion of forward flexion, abduction, lateral rotation at 90° abduction, internal rotation at 90° abduction, or lateral rotation at 0° between pre- and post-operation ( P>0.05). Three-dimensional CT showed that the centers of all bone grafts were between 3∶30 and 4∶30 (right shoulder) or between 7∶40 and 8∶20 (left shoulder) and no bone grafts were positioned superiorly or inferiorly in the glenoid En-face view. All bone grafts were positioned lateral to the scapular glenoid with an average distance of 3.5 mm (range, 2.3-4.6 mm) in cross-sectional imaging by CT. Compared with the preoperative Samilson-Prieto classification results, all cases showed no progression of shoulder joint degeneration at 36, 48 months and last follow-up. All bone grafts remodeled to a steady state within 24 months after operation. The bone graft and glenoid finally remodeled analogous to the shape of the intact glenoid in the En-face view and became flush with the glenoid rim, remodeling to a curved shape congruent to the humeral head in cross-sectional imaging by CT. The shape of the remodeled glenoid at last follow-up was not significantly different from that at 24 months after operation. CONCLUSION The lateral placement of the bone graft during modified arthroscopic Latarjet surgery with elastic fixation do not accelerate the imaging changes of shoulder joint degeneration.
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Affiliation(s)
- Qihuang Qin
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China
- Shantou University Medical College, Shantou Guangdong, 515041, P.R.China
| | | | - Daqiang Liang
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - Zhenhan Deng
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - Zhihe Qiu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - Sheng Li
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - Bing Wu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - Ying Li
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - Hao Li
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - Haifeng Liu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - Wei Lu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China
- Shantou University Medical College, Shantou Guangdong, 515041, P.R.China
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Gilat R, Haunschild ED, Lavoie-Gagne OZ, Tauro TM, Knapik DM, Fu MC, Cole BJ. Outcomes of the Latarjet Procedure Versus Free Bone Block Procedures for Anterior Shoulder Instability: A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:805-816. [PMID: 32795174 DOI: 10.1177/0363546520925833] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Free bone block (FBB) procedures for anterior shoulder instability have been proposed as an alternative to or bail-out for the Latarjet procedure. However, studies comparing the outcomes of these treatment modalities are limited. PURPOSE To systematically review and perform a meta-analysis comparing the clinical outcomes of patients undergoing anterior shoulder stabilization with a Latarjet or FBB procedure. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS PubMed, Embase, and the Cochrane Library databases were systematically searched from inception to 2019 for human-participants studies published in the English language. The search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement including studies reporting clinical outcomes of patients undergoing Latarjet or FBB procedures for anterior shoulder instability with minimum 2-year follow-up. Case reports and technique articles were excluded. Data were synthesized, and a random effects meta-analysis was performed to determine the proportions of recurrent instability, other complications, progression of osteoarthritis, return to sports, and patient-reported outcome (PRO) improvement. RESULTS A total of 2007 studies were screened; of these, 70 studies met the inclusion criteria and were included in the meta-analysis. These studies reported outcomes on a total of 4540 shoulders, of which 3917 were treated with a Latarjet procedure and 623 were treated with an FBB stabilization procedure. Weighted mean follow-up was 75.8 months (range, 24-420 months) for the Latarjet group and 92.3 months (range, 24-444 months) for the FBB group. No significant differences were found between the Latarjet and the FBB groups in the overall random pooled summary estimate of the rate of recurrent instability (5% vs 3%, respectively; P = .09), other complications (4% vs 5%, respectively; P = .892), progression of osteoarthritis (12% vs 4%, respectively; P = .077), and return to sports (73% vs 88%; respectively, P = .066). American Shoulder and Elbow Surgeons scores improved after both Latarjet and FBB, with a significantly greater increase after FBB procedures (10.44 for Latarjet vs 32.86 for FBB; P = .006). Other recorded PRO scores improved in all studies, with no significant difference between groups. CONCLUSION Current evidence supports the safety and efficacy of both the Latarjet and FBB procedures for anterior shoulder stabilization in the presence of glenoid bone loss. We found no significant differences between the procedures in rates of recurrent instability, other complications, osteoarthritis progression, and return to sports. Significant improvement in PROs was demonstrated for both groups. Significant heterogeneity existed between studies on outcomes of the Latarjet and FBB procedures, warranting future high-quality, comparative studies.
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Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Eric D Haunschild
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | | | - Tracy M Tauro
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Derrick M Knapik
- University Hospitals Cleveland Medical Center, Department of Orthopaedic Surgery, Cleveland, Ohio, USA
| | - Michael C Fu
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
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Abstract
The Latarjet procedure is a commonly used treatment for recurrent shoulder instability. However, its neurological complication rate has been reported to be as high as 10%. During the Latarjet procedure, the neurovascular structures are relocated inferiorly and medially. I hypothesized that the risk of nerve injury would be reduced by assisting the inferior-medial relocation of the neurovascular structures intraoperatively. Methods Seventeen consecutive patients with shoulder instability accompanied by glenoid bone loss were treated with an all-arthroscopic Latarjet procedure assisted by the novel low-profile SaSumata (SS) guide. The SS guide is inserted through a portal made above the coracoid process and is attached to the coracoid process by 2 pre-fix screws (i.e., temporary pre-fixation screws). Unlike previous techniques, the SS guide is not shuttled from 1 portal to the other to redirect the bone graft from the donor site to the recipient site; instead, it remains attached to the graft throughout the procedure. The SS guide brings the coracoid graft along an inferior-medial trajectory, pushing aside the neurovascular structures with the help of a switching stick. Owing to its semicircular pronged head, the SS guide holds the graft until the pre-fix screws are exchanged with permanent screws. All patients were clinically assessed and underwent computed tomography (CT) scans. Results This maneuver was performed arthroscopically in 17 patients, with no conversion to open surgery and no neurological injuries. No patient had recurrence of dislocation after follow-up for a minimum of 24 months. The mean Subjective Shoulder Value was 87.5% ± 11.7%. The mean Rowe score was 88 ± 15.7. The bone block was optimally positioned between 3 o'clock and 5 o'clock and was flush with the glenoid facet in 16 of the 17 patients. There was 1 fracture of the bone block. The mean operation time after the first 5 patients was 125 ± 23 minutes. Conclusions The SS guide was a useful tool for performing the arthroscopically assisted Latarjet procedure for recurrent anterior shoulder instability, with good functional results. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Shinji Imai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
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Verweij LPE, Pruijssen EC, Kerkhoffs GMMJ, Blankevoort L, Sierevelt IN, van Deurzen DFP, van den Bekerom MPJ. Treatment type may influence degree of post-dislocation shoulder osteoarthritis: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2312-2324. [PMID: 32936334 PMCID: PMC8225537 DOI: 10.1007/s00167-020-06263-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Age at primary dislocation, recurrence, and glenoid bone loss are associated with development of osteoarthritis (OA). However, an overview of OA following traumatic anterior shoulder instability is lacking and it is unclear to what degree type of surgery is associated with development of OA in comparison to non-operative treatment. The aim of this study was to determine the degree of OA at long-term follow-up after non-operative and operative treatments for patients with anterior shoulder instability. Surgery is indicated when patients experience recurrence and this is associated with OA; therefore, it was hypothesized that shoulders show a higher proportion or degree of OA following operative treatment compared to non-operative treatment. METHODS A literature search was performed in the PubMed/Medline, EMBASE, and Cochrane databases. Articles reporting the degree of OA that was assessed with the Samilson-Prieto or Buscayret OA classification method after non-operative and operative treatment for anterior shoulder instability with a minimum of 5 years follow-up were included. RESULTS Thirty-six articles met the eligibility criteria of which 1 reported the degree of OA for non-operative treatment and 35 reported the degree of OA for 9 different operative procedures. A total of 1832 patients (1854 shoulders) were included. OA proportions of non-operative and operative treatments are similar at any point of follow-up. The Latarjet procedure showed a lower degree of OA compared to non-operative treatment and the other operative procedures, except for the Bristow procedure and Rockwood capsular shift. The meta-analyses showed comparable development of OA over time among the treatment options. An increase in OA proportion was observed when comparing the injured to the contralateral shoulder. However, a difference between the operative subgroups was observed in neither analysis. CONCLUSION Non-operative and operative treatments show similar OA proportions at any point of follow-up. The hypothesis that shoulders showed a higher proportion or degree of OA following operative treatment compared to non-operative treatment is not supported by the data. Operative treatment according to the Latarjet procedure results in a lower degree of OA compared to other treatments, including non-operative treatment. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lukas P E Verweij
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands.
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Erik C Pruijssen
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
- Specialized Center of Orthopedic Research and Education (SCORE), Xpert Orthopedics, Amsterdam, The Netherlands
| | - Derek F P van Deurzen
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Gilat R, Lavoie-Gagne O, Haunschild ED, Knapik DM, Parvaresh KC, Fu MC, Forsythe B, Verma N, Cole BJ. Outcomes of the Latarjet procedure with minimum 5- and 10-year follow-up: A systematic review. Shoulder Elbow 2020; 12:315-329. [PMID: 33123221 PMCID: PMC7545530 DOI: 10.1177/1758573220945318] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/13/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate mid- and long-term outcomes following the Latarjet procedure for anterior shoulder instability. METHODS PubMed, MEDLINE, Embase, and Cochrane libraries were systematically searched, in line with PRISMA guidelines, for studies reporting on outcomes following the Latarjet procedure with minimum five-year follow-up. Outcomes of studies with follow-up between 5 and 10 years were compared to those with minimum follow-up of 10 years. RESULTS Fifteen studies reporting on 1052 Latarjet procedures were included. Recurrent instability occurred in 127 patients, with an overall random summary estimates in studies with a minimum five-year follow-up of 0-18% (I2 = 90%) compared to 5-26% (I2 = 59%) for studies with a minimum 10-year follow-up. Overall rates for return to sports, non-instability related complications, and progression of arthritis estimated at 65-100% (I2 = 87%), 0-20% (I2 = 85%), and 8-42% (I2 = 89%) for the minimum five-year follow-up studies and 62-93% (I2 = 86%), 0-9% (I2 = 28%), and 9-71% (I2 = 91%) for the minimum 10-year follow-up studies, respectively. All studies reported good-to-excellent mean PRO scores at final follow-up. CONCLUSIONS The Latarjet is a safe and effective procedure for patients with shoulder instability. The majority of patients return to sport, though at long-term follow-up, a trend towards an increased incidence of recurrent instability is appreciated, while a significant number may demonstrate arthritis progression.
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Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA,Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel,Ron Gilat, 1611 W Harrison St, Chicago, IL 60612, USA.
| | | | - Eric D Haunschild
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kevin C Parvaresh
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Michael C Fu
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil Verma
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
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Azoulay V, Briot J, Mansat P, Swider P, Bonnevialle N. Mechanical behavior of screw versus Endobutton for coracoid bone-block fixation. Orthop Traumatol Surg Res 2020; 106:1089-1093. [PMID: 32782172 DOI: 10.1016/j.otsr.2020.03.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Arthroscopic coracoid bone-block fixation by Endobutton was developed to avoid the complications associated with screwing. However, few studies have assessed the mechanical characteristics of the two. The aim of the present study was to assess and compare fixation rigidity by screw versus Endobutton. The study hypothesis was that rigidity is lower with Endobutton than with screws. MATERIAL AND METHOD 3D print-outs of a glenoid and a coracoid process were obtained from CT scans of a patient showing anterior shoulder instability with significant bone defect. Four types of coracoid fixation were implemented: 1 or 2 4.5mm malleolar screws, and 1 or 2 Endobuttons. Three specimens per assembly were placed on a specific test bench. Lateromedial bone-block compression was exerted at 0.1mm/sec at 3 points: superior, central, inferior. The resultant force and bone-block displacement were recorded. RESULTS Mean fixation rigidity with 1 screw, 2 screws, 1 Endobutton and 2 Endobuttons was respectively 158N/mm (range, 133-179), 249N/mm (241-259), 10N/mm (5-13) and 14N/mm (13-15), with significant difference between the screw and Endobutton groups (p<0.001). Displacement was greater with 1 than 2 Endobuttons under superior or inferior force, while the difference was non-significant under central force (7.45 vs 6.93mm; p=0.53) CONCLUSIONS: Screw fixation showed greater rigidity, while the Endobutton assembly showed less tension, leading to greater bone-block mobilization. The interest of using two Endobuttons is to reduce displacement under polar pressure. the present biomechanical study confirmed the mechanical vulnerability of bone-blocks fixed by endobutton until consolidation is achieved. LEVEL OF EVIDENCE Biomechanical study.
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Affiliation(s)
- Vadim Azoulay
- Service d'orthopédie, CHU de Toulouse, place Baylac, 31059 Toulouse cedex 09, France; Laboratoire de biomécanique, institut de mécanique des fluides de Toulouse UMR CNRS 5502, Toulouse, France
| | - Jérôme Briot
- Laboratoire de biomécanique, institut de mécanique des fluides de Toulouse UMR CNRS 5502, Toulouse, France
| | - Pierre Mansat
- Service d'orthopédie, CHU de Toulouse, place Baylac, 31059 Toulouse cedex 09, France; Laboratoire de biomécanique, institut de mécanique des fluides de Toulouse UMR CNRS 5502, Toulouse, France
| | - Pascal Swider
- Service d'orthopédie, CHU de Toulouse, place Baylac, 31059 Toulouse cedex 09, France; Laboratoire de biomécanique, institut de mécanique des fluides de Toulouse UMR CNRS 5502, Toulouse, France
| | - Nicolas Bonnevialle
- Service d'orthopédie, CHU de Toulouse, place Baylac, 31059 Toulouse cedex 09, France; Laboratoire de biomécanique, institut de mécanique des fluides de Toulouse UMR CNRS 5502, Toulouse, France.
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Shao Z, Song Q, Cheng X, Luo H, Lin L, Zhao Y, Cui G. An Arthroscopic "Inlay" Bristow Procedure With Suture Button Fixation for the Treatment of Recurrent Anterior Glenohumeral Instability: 3-Year Follow-up. Am J Sports Med 2020; 48:2638-2649. [PMID: 32813567 DOI: 10.1177/0363546520943633] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Coracoid graft positioning, fixation, and bone union are key factors affecting the clinical outcomes of Bristow and Latarjet procedures. We developed an arthroscopic "inlay" Bristow procedure based on the "mortise-tenon" joint structure concept using suture button fixation to achieve more stable fixation and better bone union of the graft. PURPOSE To evaluate the positioning of the coracoid graft, bone union rate, and clinical outcomes of this arthroscopic inlay Bristow procedure with suture button fixation. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 62 patients who received the arthroscopic inlay Bristow procedure with suture button fixation between June 2015 to June 2016 were eligible for inclusion, and 56 patients who met the inclusion criteria were enrolled in this study. Radiological assessment on 3-dimensional computed tomography scan was performed preoperatively, immediately after the operation, and postoperatively at 3 months, 6 months, 1 year, and the final follow-up. Pre- and postoperative clinical results were also assessed. RESULTS A total of 56 patients were included in this study. The mean ± SD follow-up time was 36.1 ± 3.7 months. Coracoid grafts (middle point) were positioned at 4 o'clock (range, 123.8°± 12.3°) in the sagittal view. In the axial view, 94.6% (53/56) of the graft positioning was measured as flush and 5.4% (3/56) as medial. Neither lateral nor too medial positioning was noted. The bone union rate was 96.4% at final follow-up. The mean visual analog scale score for pain during motion, American Shoulder and Elbow Surgeons score, and Rowe score all improved significantly after surgery-from 4.8 ± 2.6 to 1.1 ± 1.0, 69.2 ± 12.5 to 92.5 ± 7.0, and 33.5 ± 12.1 to 96.0 ± 4.9 at last follow-up, respectively. Almost all patients (98%; 55/56) returned to sports within 1 year after surgery at the same or higher level as compared with their preinjury performance. The mean subjective value for sports participation was 90.3% ± 7.1% (range, 70%-100%) as compared with the normal shoulder. The overall complication rate was 3.6%. No degenerative changes were noted in any patients. CONCLUSION This study reported the first series of an inlay Bristow procedure with suture button fixation for recurrent shoulder dislocation, providing a satisfactory union rate and excellent graft positioning with a low complication rate. The mortise-tenon joint structure can provide excellent graft fixation and healing, while using suture button fixation instead of screw fixation could reduce osteolysis and complications related to hardware implantation.
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Affiliation(s)
- Zhenxing Shao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Qingfa Song
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Xu Cheng
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Hao Luo
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Lin Lin
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yuqing Zhao
- Radiology Department, Peking University Third Hospital, Beijing, China
| | - Guoqing Cui
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
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Frank RM, Roth M, Wijdicks CA, Fischer N, Costantini A, Di Giacomo G, Romeo AA. Biomechanical Analysis of Plate Fixation Compared With Various Screw Configurations for Use in the Latarjet Procedure. Orthop J Sports Med 2020; 8:2325967120931399. [PMID: 32704506 PMCID: PMC7361494 DOI: 10.1177/2325967120931399] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/05/2022] Open
Abstract
Background: The biomechanical properties of coracoid fixation with a miniplate during the Latarjet procedure have not been described. Purpose: To determine the biomechanical properties of miniplate fixation for the Latarjet procedure compared with various screw fixation configurations. Study Design: Controlled laboratory study. Methods: A total of 8 groups (n = 5 specimens per group) were tested at a screw insertion angle of 0°: (1) 3.75-mm single screw, (2) 3.75-mm double screw, (3) 3.75-mm double screw with washers, (4) 3.75-mm double screw with a miniplate, (5) 4.00-mm single screw, (6) 4.00-mm double screw, (7) 4.00-mm double screw with washers, and (8) 4.00-mm double screw with a miniplate. In addition, similar to groups 1 to 3 and 5 to 7, there were 30 additional specimens (n = 5 per group) tested at a screw insertion angle of 15° (groups 9-14). To maintain specimen uniformity, rigid polyurethane foam blocks were used. Testing parameters included a preload of 214 N for 10 seconds, cyclical loading from 184 to 736 N at 1 Hz for 100 cycles, and failure loading at a rate of 15 mm/min until 10 mm of displacement or specimen failure occurred. Results: All single-screw constructs and 77% of 15° screw constructs failed before the completion of cyclical loading. Across all groups, group 8 (4.00-mm double screw with miniplate) demonstrated the highest maximum failure load (P < .001). There were no differences in failure loads among specimens with single-screw fixation (groups 1, 5, 9, and 12; P > .05). All specimens in groups 9, 10, 11, 12, 13, and 14 (insertion angle of 15°) had significantly lower maximum failure loads compared with specimens in groups 2, 3, 4, 6, 7, and 8 (insertion angle of 0°) (P < .001 for all). Conclusion: These results indicate significantly superior failure loads with the miniplate compared with all other constructs. Across all fixation techniques and screw sizes, constructs with screws inserted at 0° performed better than constructs with screws inserted at 15°. Clinical Relevance: The use of a miniplate for coracoid fixation during the Latarjet procedure may provide a more durable construct for the high-demand contact athlete.
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Affiliation(s)
- Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Tytherleigh-Strong G, Aresti N, Begum R. Revision guided suture-button bone block stabilization of the shoulder in the presence of significant retained glenoid metalwork. JSES Int 2020; 4:803-813. [PMID: 33345219 PMCID: PMC7738448 DOI: 10.1016/j.jseint.2020.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Aim Positioning and fixation of the bone block during revision anterior stabilization of the shoulder, in the presence of significant retained glenoid metalwork, can be challenging. We present the results of a series of patients who underwent a revision bone block procedure secured with double suture buttons using a drill guide system, the position of which was calculated from a preoperative computed tomography (CT) scan. Materials and methods We undertook a revision bone block stabilization of the shoulder, using a guided double suture-button fixation, in 10 patients with significant retained glenoid metalwork from previous procedures. A preoperative CT scan was used to determine a position for the guide to allow a safe drill trajectory that would avoid any retained metalwork. A coracoid transfer was undertaken in 4 patients and an Eden-Hybinette in 6. Patients were assessed preoperatively and at final follow-up clinically and using the Oxford Shoulder Instability Score and the Subjective Shoulder Value score. Bone block position and healing was assessed by a CT scan at 6 months. The median follow-up was 36 months (range, 24-47 months). Results There were 3 female and 7 male patients with a median age of 24.5 years (17-49 years). At final follow-up, the mean Oxford Shoulder Instability Score had decreased from 25.9 (range, 21-35) to 5.8 (range, 3-14) (P < .005). The mean Subjective Shoulder Value score had risen from 87.1 (range, 10-60) to 80 (range, 60-90) (P < .05). All of the patients considered their shoulder to be stable apart from 1 patient. There had been no redislocations. The bone block positioned in the glenoid lower quadrant had healed for all of the patients on CT at 6 months. Conclusion Guided suture-button fixation of the bone block during revision anterior stabilization of the shoulder, in the presence of significant retained glenoid metalwork, provides a satisfactory outcome in terms of shoulder stability, graft position, and healing.
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Affiliation(s)
- Graham Tytherleigh-Strong
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
| | - Nicholas Aresti
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
| | - Rumina Begum
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
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Minuesa-Asensio A, García-Esteo F, Mérida-Velasco JR, Barrio-Asensio C, López-Fernández P, Aramberri-Gutiérrez M, Murillo-González J. Comparison of Coracoid Graft Position and Fixation in the Open Versus Arthroscopic Latarjet Techniques: A Cadaveric Study. Am J Sports Med 2020; 48:2105-2114. [PMID: 32667269 DOI: 10.1177/0363546520930419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Since the description of the arthroscopic Latarjet technique, discussion about the superiority of the open or arthroscopic procedure has arisen. The appropriate placement of the coracoid graft (CG) on the anterior glenoid neck is reported to be the most important step of the Latarjet procedure. PURPOSE To verify if there are differences in the parameters that may affect the final position and fixation of CG obtained from the open and arthroscopic Latarjet techniques. STUDY DESIGN Controlled laboratory study. METHODS Twenty fresh-frozen human paired cadaveric shoulder specimens were randomly distributed in 2 surgery groups (open group [OG] and arthroscopic group [AG]) with 10 specimens in each. Two surgeons, each with experience performing open and arthroscopic Latarjet techniques, executed these procedures: one surgeon performed all open techniques, and the other performed all arthroscopic techniques, respectively. After surgery, a computerized tomography scan was performed. The surgical time, the position of each CG, a series of variables that might affect the CG fixation, and the level of the subscapularis muscle split were evaluated. RESULTS The mean surgical time was significantly longer in the AG (mean, 26 minutes for OG and 57 minutes for AG). Three intraoperative complications (30%) were identified in the AG, consisting of graft fractures. The CG was determined to be in an optimal cranial-caudal position in 90% of specimens of the OG and 44% of the AG (Fisher, P = .057). In both groups, the CG was placed in an optimal medial-lateral position in all specimens. In the OG, the degree of parallelism between the major axes of the glenoid surface and CG was significantly greater than in the AG (mean, 3.8º for OG and 15.1º for AG). No significant differences were observed in superior and inferior screw orientation between the groups. In the longitudinal and transverse directions, significant differences were found in the centering of the superior screw, being closer to the ideal point in the OG than in the AG. The location where the longitudinal subscapularis muscle split was performed was significantly higher in the AG. CONCLUSION The open Latarjet technique required less surgical time; presented a lower number of intraoperative complications; and allowed more adequate placement of the CG, better centering of the screws, and a subscapularis muscle split closer to the ideal position. CLINICAL RELEVANCE The reported benefits of the arthroscopic Latarjet technique seem less clear if we take into account the added surgery time and complications.
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Affiliation(s)
| | - Francisco García-Esteo
- Service of Traumatology, Jiménez Díaz Foundation, Madrid, Spain.,Department of Basic Medical Sciences, Faculty of Medicine, Francisco de Vitoria University, Madrid, Spain
| | - José Ramón Mérida-Velasco
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Carmen Barrio-Asensio
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Pedro López-Fernández
- Division of Human Anatomy and Embryology, Department of Basic Health Sciences, Rey Juan Carlos University, Madrid, Spain.,Department of Surgery, University Hospital Rey Juan Carlos, Madrid, Spain
| | - Mikel Aramberri-Gutiérrez
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.,Alai Sports Medicine Clinic, Madrid, Spain
| | - Jorge Murillo-González
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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Updegrove GF, Buckley PS, Cox RM, Selverian S, Patel MS, Abboud JA. Latarjet Procedure for Anterior Glenohumeral Instability: Early Postsurgical Complications for Primary Coracoid Transfer Versus Revision Coracoid Transfer After Failed Prior Stabilization. Orthop J Sports Med 2020; 8:2325967120924628. [PMID: 32587873 PMCID: PMC7294484 DOI: 10.1177/2325967120924628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The Latarjet procedure (coracoid transfer) is often used to successfully treat failed instability procedures. However, given the reported increased complication rates in primary Latarjet surgery, there is a heightened concern for complications in performing the Latarjet procedure as revision surgery. PURPOSE To evaluate the early outcomes and complications of the Latarjet procedure as primary surgery compared with revision surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 157 patients were included and retrospectively reviewed: 103 patients in the revision group and 54 patients in the primary group. Patients were evaluated by physical examination findings as well as by documentation of complications and reoperations extracted from their electronic medical records. RESULTS The mean follow-up was 7.8 ± 11.0 months for the primary group and 7.0 ± 13.2 months for the revision group. There were no significant differences in overall complication rates between the primary and revision groups (16.7% vs 8.7%, respectively; P = .139). The complication rate was significantly higher in patients in the revision group who had undergone a prior open procedure compared with those who had undergone only arthroscopic procedures (30.0% vs 4.1%, respectively; P < .001). Of those patients who sustained a complication, 7 of the 9 underwent a reoperation in the primary group (13.0%), and 7 of the 9 did so in the revision group (6.8%); the risk of reoperations was not different between groups (P = .198). There were 4 patients in the primary group (7.4%) and 5 patients in the revision group (4.9%) who experienced recurrent dislocations during the follow-up period (P = .513). There was no difference in postoperative range of motion. CONCLUSION The Latarjet procedure is a reasonable option for the treatment of failed arthroscopic instability repair with an early complication rate similar to that found in primary Latarjet surgery.
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Affiliation(s)
- Gary F. Updegrove
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Patrick S. Buckley
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ryan M. Cox
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stephen Selverian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Manan S. Patel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph A. Abboud
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Domos P, Chelli M, Lunini E, Ascione F, Bercik MJ, Neyton L, Godeneche A, Walch G. Clinical and radiographic outcomes of the open Latarjet procedure in skeletally immature patients. J Shoulder Elbow Surg 2020; 29:1206-1213. [PMID: 31812583 DOI: 10.1016/j.jse.2019.09.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 09/06/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Recurrent anterior glenohumeral instability has been studied in the young population and limited evidence is available for adolescent patients. Our study is a retrospective review of patients aged <17 years who underwent open Latarjet procedure. METHODS Forty-five patients were available for review. Clinical outcomes were assessed by range of movements, stability, Walch-Duplay score (WDS), Rowe score (RS), Constant-Murley score (CMS), Subjective Shoulder Value (SSV), and return to sport. Radiographs were reviewed for osteoarthritis and complications. RESULTS The median age of patients was 15.7 years (13-17), and 56% had hyperlaxity. The median follow-up time was 6.6 years (3-26). The median postoperative movements showed recovered elevation (175°), external rotation (60°), and internal rotation (T9 level). Seventy-five percent of patients returned to the same level of sport, and 98% were satisfied. Clinical outcomes showed WDS, RS, and CMS scores of 85, 95, and 84 points, respectively, and an SSV of 95%. Twenty percent of patients described mild postoperative pain, and 1 had persistent stiffness. Other complications included 24% subjective apprehension, 4% redislocation, 4% wound problems, and 2% infection. Nine percent of cases had postoperative arthritis. The overall reoperation rate was 11%: 1 open washout for infection and 4 arthroscopic screw removal due to persistent pain. We found that hyperlaxity, female sex, and large or deep Hill-Sachs lesions were frequently associated with persistent apprehension at the last follow-up. CONCLUSIONS The open Latarjet procedure provides a low rate of recurrent instability with acceptable complication rates in the long term for skeletally immature patients. It is an effective, safe treatment option without any significant glenoid growth disturbance.
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Affiliation(s)
- Peter Domos
- Royal Free London NHS Foundation Trust, Barnet and Chase Farm Hospital, London, UK.
| | - Mikaël Chelli
- Institut Universitaire Locomoteur & Sport, Hôpital Pasteur 2, Nice, France
| | | | | | | | - Lionel Neyton
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz Ramsay GDS, Lyon, France
| | - Arnaud Godeneche
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz Ramsay GDS, Lyon, France
| | - Gilles Walch
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz Ramsay GDS, Lyon, France
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Komplikationsmanagement in der operativen Versorgung der glenohumeralen Schulterinstabilität. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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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: 29] [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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Xu J, Liu H, Lu W, Deng Z, Zhu W, Peng L, Ouyang K, Li H, Wang D. Modified Arthroscopic Latarjet Procedure: Suture-Button Fixation Achieves Excellent Remodeling at 3-Year Follow-up. Am J Sports Med 2020; 48:39-47. [PMID: 31765231 DOI: 10.1177/0363546519887959] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Some studies have advocated the use of suture-button fixation during the Latarjet procedure to reduce complications associated with screw fixation. However, the sample size of these studies is relatively small, and their follow-up period is short. PURPOSE To investigate the efficacy of the suture-button Latarjet procedure with at least 3 years of follow-up and remodeling of the coracoid graft. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 152 patients who underwent the suture-button Latarjet procedure between February 2013 and February 2016 were selected, and 128 patients who met the inclusion criteria were enrolled in this study. Preoperative and postoperative clinical results were assessed. The position and healing condition of the coracoid graft and arthropathy of the glenoid and humeral head were also assessed using radiography and 3-dimensional computed tomography (CT). RESULTS The mean follow-up time was 40.3 ± 5.8 months. There were 102 patients included in this study. The mean visual analog scale score for pain during motion, the American Shoulder and Elbow Surgeons score, the Rowe score, and the Walch-Duplay score were improved considerably. A total of 100 grafts achieved bone union. The overall absorption rate was 12.6% ± 4.3%. Graft absorption mostly occurred on the edge and outside the "best-fit" circle of the glenoid. A vertical position was achieved in 98 grafts (96% of all cases) immediately postoperatively, with the mean graft midline center at the 4 o'clock position. In the axial view, CT showed that 89 grafts were flush to the glenoid, whereas 2 and 11 grafts were fixed medially and laterally, respectively. In all cases, the bone graft and glenoid tended to extend toward each other to form concentric circles during the remodeling process. During follow-up observations, the height of the 11 grafts that were positioned laterally (ie, above the glenoid level) exhibited a wave-curved change. No arthropathy was observed in any patient. CONCLUSION Patient outcomes were satisfactory after the modified arthroscopic suture-button Latarjet technique. Graft absorption mostly occurred on the edge and outside the "best-fit" circle of the glenoid. The graft exhibited the phenomenon of ectatic growing when it fused with the glenoid and finally remodeled to a new concentric circle with the humeral head analogous to the original glenoid. Grafts positioned laterally did not cause arthropathy of the joints within the period of the study.
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Affiliation(s)
- Jian Xu
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Haifeng Liu
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Wei Lu
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zhenhan Deng
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Weimin Zhu
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Liangquan Peng
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Kan Ouyang
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Hao Li
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Daping Wang
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
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An Algorithmic Approach to the Management of Shoulder Instability. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:JAAOSGlobal-D-19-00168. [PMID: 32072126 PMCID: PMC7004496 DOI: 10.5435/jaaosglobal-d-19-00168] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The recurrence of anterior shoulder instability can be as high as 86.7% in high-risk patients who are treated nonoperatively after their first incident of instability. CT and MR arthrography are necessary for preoperative imaging and assessment of glenoid bone loss. Patient expectations in conjunction with appropriate preoperative imaging are critical for surgical planning. Arthroscopic shoulder stabilization is often sufficient in most cases where glenoid bone loss is minimal, with recurrent dislocation rates close to 4% in the literature. Open stabilization procedures are generally indicated in patients with greater than 20% glenoid bone loss.
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Ernstbrunner L, Wartmann L, Zimmermann SM, Schenk P, Gerber C, Wieser K. Long-term Results of the Open Latarjet Procedure for Recurrent Anterior Shoulder Instability in Patients Older Than 40 Years. Am J Sports Med 2019; 47:3057-3064. [PMID: 31513452 DOI: 10.1177/0363546519872501] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Subgroup analyses of the Latarjet procedure have suggested that age over 40 years is a risk factor for dislocation arthropathy. PURPOSE To analyze long-term results of the open Latarjet procedure for recurrent anterior shoulder dislocation in patients at least 40 years of age. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 39 consecutive patients (40 shoulders) with a mean age of 48 years (range, 40-66 years) at surgery were evaluated at a mean follow-up of 11.0 years (range, 8-16 years). Of these, 15 patients (38%) had undergone previous soft tissue stabilization surgery. Long-term results were assessed clinically and radiographically, including computed tomography scanning at final follow-up. RESULTS No recurrence of dislocation was noted. Subluxation had occurred in 3 patients (8%), and apprehension persisted in 5 patients (13%). The total Walch-Duplay score averaged 89 points at the final follow-up, and the mean Subjective Shoulder Value (60%-91%) had improved significantly (P < .001). In total, 36 patients rated their result as excellent, 3 as good. Further, 6 patients (15%) underwent joint-preserving reoperation, and 1 patient (3%) had reverse total shoulder arthroplasty for severe dislocation arthropathy. Dislocation arthropathy was severe in 14 patients (37%) and had progressed by at least 2 grades in 17 patients (45%). Patients with severe dislocation arthropathy had already shown degenerative changes preoperatively as opposed to those who ultimately had no or moderate dislocation arthropathy (n = 24) (P < .001). Progression of dislocation arthropathy was associated with lateral (>1 mm) graft positioning (P < .001) and older age at surgery (r = 0.58; P < .001). CONCLUSION The open Latarjet procedure for recurrent anterior shoulder instability in patients older than 40 years reliably restores stability and leads to high patient satisfaction. This procedure is, however, associated with a substantial rate of advanced but clinically mild symptomatic dislocation arthropathy, which is associated with the degree of preoperative joint degeneration, older age at surgery, and lateral graft placement.
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Affiliation(s)
- Lukas Ernstbrunner
- Shoulder and Elbow Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lara Wartmann
- Shoulder and Elbow Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan M Zimmermann
- Shoulder and Elbow Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Pascal Schenk
- Shoulder and Elbow Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Shoulder and Elbow Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Shoulder and Elbow Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Domos P, Lunini E, Ascione F, Serra N, Bercik MJ, Neyton L, Godeneche A, Walch G. Clinical and radiographic outcomes of open Latarjet procedure in patients aged 40 years or older. J Shoulder Elbow Surg 2019; 28:e304-e312. [PMID: 31043350 DOI: 10.1016/j.jse.2019.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/01/2019] [Accepted: 02/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Latarjet procedure is often used to treat shoulder instability in younger patients. Little is reported on the outcomes of this procedure in older (≥40 years) populations. The purpose of this study was to evaluate the clinical and radiographic outcomes of patients aged 40 years or older with recurrent anterior shoulder instability who underwent open Latarjet stabilization. METHODS A total of 168 patients aged 40 years or older were treated surgically for recurrent anterior shoulder instability with an open Latarjet procedure between 1988 and 2014. Bankart lesions or anteroinferior glenoid fractures were confirmed preoperatively with a computed tomography arthrogram. Outcomes were assessed with preoperative and postoperative physical examinations, clinical outcome scoring, and radiographic examinations. RESULTS Ninety-nine patients with complete data were available with a mean follow-up period of 13 years (range, 3-23 years). At the time of final follow-up, 94% of patients did not have recurrence of instability. Of the patients, 90% were satisfied or very satisfied with their outcomes and 54% returned to their preinjury level of activity. The overall complication rate was 21% (the most common complications being subjective apprehension [9%] and recurrent instability [6%]), with 9% of patients requiring reoperation. A full-thickness rotator cuff requiring repair was identified in 22% of patients. CONCLUSIONS The Latarjet procedure is an effective treatment option for older patients (aged ≥ 40 years) with recurrent anterior shoulder instability in the setting of an anteroinferior capsulolabral and/or bony injury.
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Affiliation(s)
- Peter Domos
- Royal Free London NHS Foundation Trust, Barnet and Chase Farm Hospitals, London, UK.
| | | | | | - Nicola Serra
- Department of Pediatrics, University Federico II of Naples, Naples, Italy
| | | | - Lionel Neyton
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz Ramsay GDS, Lyon, France
| | - Arnaud Godeneche
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz Ramsay GDS, Lyon, France
| | - Gilles Walch
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz Ramsay GDS, Lyon, France
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Tokish JM. Arthroscopic Distal Clavicle Glenoid Augmentation: An Ideal Graft Option. OPER TECHN SPORT MED 2019. [DOI: 10.1053/j.otsm.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Patel MK, Stone WZ, Struk AM, Farmer KW, Wright TW, King JJ. Shoulder arthroplasty after prior anterior stabilization procedures: do reverses have better outcomes? J Shoulder Elbow Surg 2019; 28:854-860. [PMID: 30545785 DOI: 10.1016/j.jse.2018.09.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/18/2018] [Accepted: 09/22/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have focused on shoulder arthroplasty after anterior stabilization procedures. This study compares the outcomes of total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) after anterior stabilization surgical procedures. METHODS All primary shoulder arthroplasties from 2000 to 2014 with prior surgery were retrospectively reviewed from a prospective research database. The inclusion criteria were primary TSA or RTSA, a history of anterior stabilization surgery, and minimum 2-year follow-up. Soft-tissue and bony anterior stabilization procedures were included. We compared the following between TSA and RTSA patients: active range of motion (ROM) and Shoulder Pain and Disability Index 130; Simple Shoulder Test; American Shoulder and Elbow Surgeons (ASES); Short Form 12; University of California, Los Angeles; and Constant scores. The RTSA group was also compared with an RTSA control group. RESULTS The study included 15 TSA and 10 RTSA patients with average follow-up periods of 3.3 and 4.0 years, respectively. RTSA patients experienced greater improvements in all ROMs except internal rotation; these were not statistically significant despite the mean values for RTSA being above the minimal clinically important difference compared with TSA for forward flexion and abduction. RTSA patients had better improvements in all functional outcomes; only the ASES score was statistically significant. TSA patients had a 33% complication rate and a 20% reoperation rate. RTSA patients had no complications or reoperations. The group that underwent RTSA with prior anterior stabilization surgery had similar improvements in ROM and outcome measures to the RTSA control group. CONCLUSION RTSA patients had better postoperative improvement in most ROMs and all functional scores; only the ASES score was statistically significant. This study suggests better outcomes with a lower complication rate with RTSA after prior anterior stabilization procedures compared with TSA.
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Affiliation(s)
- Maharsh K Patel
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - William Z Stone
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Aimee M Struk
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Kevin W Farmer
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
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Lacheta L, Siebenlist S, Imhoff AB, Willinger L. [Recurrent instability and instability arthropathy]. Unfallchirurg 2019; 121:142-151. [PMID: 28875360 DOI: 10.1007/s00113-017-0408-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Capsulolabral reconstruction (Bankart repair) is recommended as the first line treatment in young and functionally demanding active patients with anteroinferior shoulder instability, due to the high tendency to recurrent dislocation. This has become established both for arthroscopic and open primary shoulder stabilization with good clinical outcome; nevertheless, recurrence of dislocation is reported in up to 25% of patients. Risk factors for failed surgery are patient (e.g. young age, male gender and contact sports) and surgery (e.g. primarily underestimated glenoid bone loss, Hill-Sachs lesion, non-treatment of bipolar defects or malpositioned anchors) related. In the management of recurrent instability, it is necessary to carry out a thorough clinical investigation in addition to extended diagnostics with X‑ray and computed tomography. A second Bankart repair is only indicated in patients with low demands and without any glenoid bone loss. In the majority of patients, bony augmentation of the glenoid is necessary and realized by coracoid or iliac crest bone block transfer. The Latarjet procedure is biomechanically advantageous due to the additional sling effect of the conjoined tendons and both techniques show good clinical outcomes and a low recurrence rate. Furthermore, engaging Hill-Sachs lesions also require additional treatment. Remplissage of the infraspinatus muscle, iliac crest bone block transfer and partial joint replacement are viable options. A final consensus for treatment of Hill-Sachs lesions has yet to be defined. Dislocation arthropathy is an underestimated complication as a result of frequent recurrent dislocations. After development of dislocation arthropathy, patients reported a painful restriction of range of motion rather than instability. Arthroscopic arthrolysis and comprehensive arthroscopic management (CAM procedure) are possible joint-preserving treatment options.
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Affiliation(s)
- L Lacheta
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - S Siebenlist
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - A B Imhoff
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - L Willinger
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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