1
|
Espejo Reina MJ, Delgado C, Ruiz Díaz R, Díaz Heredia J, Asenjo Gismero C, Ruiz Ibán MA. Outcomes of an anterior bone block technique with iliac crest allograft for the management of anteroinferior shoulder instability with subcritical glenoid defects. J Shoulder Elbow Surg 2025:S1058-2746(25)00242-3. [PMID: 40118439 DOI: 10.1016/j.jse.2025.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 01/28/2025] [Accepted: 02/02/2025] [Indexed: 03/23/2025]
Abstract
BACKGROUND Glenoid bone defects play a significant role in anterior shoulder instability. Their management is controversial, and the use of anterior bone grafting is one appealing option. The purpose of this study is to assess the clinical and radiologic outcomes at a 5-year follow-up of an arthroscopic bone block procedure with iliac crest allograft for the management of subcritical glenoid bone loss in subjects with recurrent anterior shoulder instability. METHODS Prospective longitudinal study of a consecutive case series of subjects with anterior glenohumeral instability and subcritical (between 8% and 17%) glenoid bone defects managed with an arthroscopic bone block procedure with iliac crest allograft fixed with a double-button system associated with a Bankart repair and, when necessary, a remplissage. Preoperative computed tomographic (CT) scans were used to quantify the dimensions of the glenoid and the humeral bone defects. Postoperative CT scans 1 month after surgery and at 1-year follow-up were used to assess the graft's positioning, integration, and resorption. Clinical assessment was performed using the Constant-Murley (CS) and Rowe (RS) scores preoperatively and at a minimum 3-year follow-up. RESULTS Fourteen subjects were included (all male, median age 27 years, interquartile range [IQR] = 5.75), with a median of 8 (IQR = 14) dislocation episodes before surgery and a median preoperative glenoid bone defect of 13% (IQR = 14%, range: 9.3%-15.4%). A remplissage was added in 12 of 14 cases (85.7%). Graft position was excellent in all cases (100%) in the axial plane and in 12 of 14 (85.7%) in the sagittal plane. The median reconstructed glenoid surface in the postoperative CT scan was 99.4% (IQR 2.1%, range: 96.6%-100%). One-year postoperative CT scans showed bone resorption of ≥20% of volume in 13 of 14 cases (93%), with a median resorption of 80.3% (IQR = 40.8%) of the graft volume. Graft integration was observed in 6 of 14 cases (42.8%). The median reconstructed glenoid surface decreased to 93.6% (IQR = 2%, range: 87.5%-97.3%) (P < .0001). At the latest follow-up (58.9 months [IQR = 11.2]: range: 39.6-67.8), 2 subjects (14.3%) presented with recurrence of instability. There were substantial improvements in the RS (from 25 [5] to 95 [6.2], P < .0001) and in the CS (from 84 [5] to 94.5 [4.2] points, P < .0001) at the final follow-up. CONCLUSIONS Arthroscopic bone block procedure employing an iliac crest allograft achieves accurate graft positioning and good clinical outcomes with low recurrence rates at a mean of 5-year follow-up. However, early graft resorption and low consolidation rates are worrisome issues that must be considered.
Collapse
Affiliation(s)
- María J Espejo Reina
- Hospital Universitario Ramón y Cajal, Madrid, Spain; Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | | | - Raquel Ruiz Díaz
- Hospital Universitario Ramón y Cajal, Madrid, Spain; Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | - Jorge Díaz Heredia
- Hospital Universitario Ramón y Cajal, Madrid, Spain; Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | | | - Miguel A Ruiz Ibán
- Hospital Universitario Ramón y Cajal, Madrid, Spain; Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Delgado C, Calvo E, Díaz Heredia J, Cañete P, García Navlet M, Ruiz Ibán MA. Graft Position, Healing, and Resorption in Anterior Glenohumeral Instability: A Comparison of 4 Glenoid Augmentation Techniques. Orthop J Sports Med 2024; 12:23259671241253163. [PMID: 38840788 PMCID: PMC11151773 DOI: 10.1177/23259671241253163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 06/07/2024] Open
Abstract
Background The success of glenoid augmentation procedures depends on accurate placement and healing of the graft to the glenoid. Different glenoid augmentation techniques have been described, but no comparative studies between them exist. Purpose To assess the bone graft position, healing, and resorption in a group of patients treated with 1 of 4 procedures: arthroscopic anterior bone-block procedure using either (1) fresh-frozen iliac crest allograft or (2) iliac crest autograft, (3) open Latarjet, or (4) arthroscopic Latarjet. Study Design Cohort study; Level of evidence, 3. Methods A total of 40 patients (87.5% men; mean age, 29.5 ± 7.9 years) were included, with 10 patients in each of the procedure groups. The graft position in the axial and sagittal planes was assessed on postoperative computed tomography (CT). Graft healing and resorption were assessed in a second CT scan performed 1 year postoperatively. Qualitative variables were compared between the 4 procedures using the chi-square test, and quantitative variables were compared with the Student t test or Mann-Whitney U test. Results No differences were found between the procedures in the axial or sagittal position. The healing rate was significantly lower in the allograft bone-block group (20%) compared with the autograft bone-block (80%), open Latarjet (90%), and arthroscopic Latarjet (90%) groups (P < .001). Graft resorption developed in 17 of 40 (42.5%) cases overall. Osteolysis occurred in 100% of cases in the allograft bone-block group compared with 50% in the autograft group, 20% in the open Latarjet group, and 0% in the arthroscopic Latarjet group (P < .001). The glenoid surface area on 1-year CT scan was significantly lower in the allograft bone-block group compared with the autograft bone-block, open Latarjet, and arthroscopic Latarjet groups (P < .001). Conclusion Arthroscopic bone-block, open Latarjet, and arthroscopic Latarjet procedures provided accurate bone graft positioning. However, very high rates of osteolysis and nonunion were observed in the iliac crest fresh-frozen allograft bone-block procedure when compared with the other procedures.
Collapse
Affiliation(s)
- Cristina Delgado
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jorge Díaz Heredia
- Shoulder and Elbow Reconstructive Surgery Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Departamento de Cirugía, Ciencias Sanitarias y Medicosociales, Universidad de Alcalá de Henares, Madrid, Spain
| | | | | | - Miguel Angel Ruiz Ibán
- Shoulder and Elbow Reconstructive Surgery Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Departamento de Cirugía, Ciencias Sanitarias y Medicosociales, Universidad de Alcalá de Henares, Madrid, Spain
- Patología Quirurgica, Universidad Ceu San Pablo, Madrid, Spain
| |
Collapse
|
4
|
Gaujac N, Bouché PA, Belas M, Bonnevialle N, Charousset C. The arthroscopic Latarjet procedure with a posterior guided system and suture-button fixation enables more precise bone block positioning in the axial plane versus anterior screws fixation. Knee Surg Sports Traumatol Arthrosc 2024; 32:750-762. [PMID: 38341626 DOI: 10.1002/ksa.12063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE Adequate position of the bone block during arthroscopic Latarjet procedure is critical for an optimal functional outcome. However, this procedure is complex with a long learning curve. Our aim was to compare the bone block position between a dedicated glenoid posterior instrumentation and suture button fixation versus an anterior screw fixation, on a postoperative computed tomography (CT) scan. METHOD Seventy-nine consecutive patients operated on for an anterior shoulder instability were included in this retrospective study. The same surgeon performed arthroscopically the Latarjet procedure either with an anterior drilling and screw fixation (Group A), or with a specific posterior glenoid guide pin, a posterior drilling, and a suture cortical button fixation (Group B). Evaluations were made by two independent observers. The position was evaluated by CT scan in the axial and sagittal planes. Learning curves with operative time, complications and clinical outcomes were assessed at a minimum of 2 years of follow-up. RESULTS Thirty-five patients were included in Group A and 44 in Group B. In Group A, 27 bone blocks were flush (87.1%) and 38 in Group B (92.7%) (p < 0.01). In Group A, 72% of the bone block height was below the equator and 76%, in Group B (ns). The mean operating time was 123 ± 32.5 min in Group A and 95 ± 34.1 min in Group B (p < 0.0001). At the final follow-up, the mean aggregate Rowe score was respectively 94.6 ± 10.4 and 93.1 ± 9.8 points in Groups A and B. The mean aggregate Walch-Duplay score was respectively 94.2 ± 11.6 and 93.4 ± 10.6 points in Groups A and B. There were 11 complications (31.4%) in Group A and five complications (11.3%) in Group B (ns). CONCLUSION The arthroscopic Latarjet procedure with a posterior drilling guided system and suture-button fixation allows more precise positioning in the axial plane than with anterior drilling and screw fixation. This posterior-guided procedure could reduce intraoperative and short-term complications. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Nicolas Gaujac
- Department of Orthopedic Surgery and Sports Traumatology, Cochin Hospital, Paris, France
| | - Pierre-Alban Bouché
- Department of Orthopedic Surgery and Sports Traumatology, Lariboisière Hospital, Paris, France
| | - Maxime Belas
- Department of Orthopedic Surgery and Sports Traumatology, Pôle Santé Sud Clinic, Le Mans, France
| | - Nicolas Bonnevialle
- Department of Orthopedic Surgery and Sports Traumatology, Pierre Paul Riquet Hospital, Toulouse, France
| | - Christophe Charousset
- Department of Orthopedic Surgery and Sports Traumatology, Turin Clinic, Paris, France
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Delgado C, De Rus I, Cañete P, Díaz J, Ruiz R, García Navlet M, Ruiz Ibán MÁ. Evaluation of the inter and intraobserver reproducibility of the "defect coverage index method", a new computed tomography assessment method of sagittal graft positioning in arthroscopic bone block procedures. J Exp Orthop 2023; 10:35. [PMID: 36995539 PMCID: PMC10063754 DOI: 10.1186/s40634-023-00590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/10/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE To assess the reproducibility of a new 2-dimensional computed tomography (CT) method of assessing graft positioning in arthroscopic bone block procedure. METHODS This is a prospective observational study. Twenty-seven patients, (all men, mean [Standard deviation] age at surgery 30.9 [8.49] years) were included. Vertical graft position was assessed on the sagittal view by measuring the amount of glenoid bone defect covered by the graft. The length of the bone defect and the amount of graft covering the defect were measured. Positioning of the graft on the sagittal plane was classified as accurate if the graft covered at least 90% of the defect. Intraobserver and interobserver reproducibility was analyzed using intraclass correlation coefficients (ICC) and Kappa coefficient with 95% confidence. RESULTS Excellent intraobserver reproducibility was found, with an ICC of 0.94 (CI 95%, 0.86-0.97). Interobserver reproducibility was good, with the ICC value of 0.71, ranging from 0.45 to 0.86 (CI 95%). CONCLUSION This new method of assessing graft positioning in arthroscopic bone block procedures on 2-dimensional computed tomography scans is reliable, with an excellent intraobserver and good interobserver reproducibility. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
| | | | | | - Jorge Díaz
- Shoulder and Elbow Reconstructive Surgery Unit. Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Raquel Ruiz
- Shoulder and Elbow Reconstructive Surgery Unit. Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | | | - Miguel Ángel Ruiz Ibán
- Shoulder and Elbow Reconstructive Surgery Unit. Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain.
| |
Collapse
|
7
|
Valencia Mora M, Novo Rivas U, Calvo C, Martínez-Catalán N, Luengo-Alonso G, Morcillo Barrenechea D, Foruria de Diego AM, Calvo E. Does preoperative glenoid bony defect determine final coracoid graft positioning in arthroscopic Latarjet? JSES Int 2023. [DOI: 10.1016/j.jseint.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
|
8
|
Dalmas Y, Thélu CE, Laumonerie P, Martinel V, Robert S, Mansat P, Bonnevialle N. Arthroscopic double-button Latarjet osteolysis and remodeling at 1-year follow-up. J Shoulder Elbow Surg 2022; 31:e603-e612. [PMID: 35562033 DOI: 10.1016/j.jse.2022.04.004] [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: 10/13/2021] [Revised: 03/30/2022] [Accepted: 04/09/2022] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The aim of this study was to evaluate the osteolysis rate, graft remodeling, and risk factors for osteolysis at the 1-year threshold after an arthroscopic Latarjet procedure with double-button fixation. METHOD In this multicenter, retrospective study, postoperative computed tomography scans obtained after an arthroscopic Latarjet procedure with double-button fixation to treat anterior shoulder instability were analyzed at 15 days and at 3, 6, and 12 months. Graft volume, dimensions, and morphologic remodeling were analyzed. RESULTS Twenty-seven patients were included (mean age, 26 years). At 1 year, osteolysis occurred in 19 of 27 patients (70%). The volume initially decreased until 6 months' follow-up (-35%; range, -75% to +26%) and then increased until our last follow-up. At 1 year, the graft volume decreased by 17% (range, -61% to +56%) compared with the immediate postoperative volume. In multivariate analysis, the rate of osteolysis was inversely associated with an unhealed graft at 3 months (P = .02; β coefficient = -44.50 [95% confidence interval, -81 to -8]). The maximal height of the graft significantly grew 0.2 cm (range, -55 to +124 mm) (P = .015). In the sagittal plane, osteolysis occurred in the superior part in 100% of patients (27 of 27) whereas bone formation occurred in the inferior part. In the axial plane, osteolysis occurred in the anterior part whereas bone formation occurred in the posterior part. In the articular part, the observed remodeling was aimed to obtain a new anatomic and congruent glenoid. CONCLUSIONS At 1 year after an arthroscopic Latarjet procedure with double-button fixation, osteolysis occurred in 70% of patients. The rate of osteolysis was 17% of the initial volume. Osteolysis occurred mainly during the first 6 months, in the anterior and superior parts. Remodeling led to a circular anatomic glenoid. This osteolysis did not cause any recurrence of instability or require revision surgery.
Collapse
Affiliation(s)
- Yoann Dalmas
- Département de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France.
| | | | - Pierre Laumonerie
- Département de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France
| | | | - Suzanne Robert
- Département de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France
| | - Pierre Mansat
- Département de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France; Laboratoire de Biomécanique, IMFT-UMR-CNRS 5502, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Nicolas Bonnevialle
- Département de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France; Laboratoire de Biomécanique, IMFT-UMR-CNRS 5502, Hôpital Pierre Paul Riquet, Toulouse, France
| |
Collapse
|
9
|
Calvo C, Calvo J, Rojas D, Valencia M, Calvo E. Clinical Relevance of Persistent Off-Track Hill-Sachs Lesion After Arthroscopic Latarjet Procedure. Am J Sports Med 2021; 49:2006-2012. [PMID: 34101519 DOI: 10.1177/03635465211019979] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Latarjet procedure is often used to address off-track Hill-Sachs lesions (OFF-HS) in shoulders with anterior instability. There are concerns as to whether the Latarjet procedure is able to convert all OFF-HS into on-track Hill-Sachs lesions (ON-HS) and whether this limitation could explain the cases of recurrent postoperative instability. HYPOTHESIS Latarjet surgery converts many preoperative OFF-HS lesions, but not all of them, and there is a difference in the failure rate between shoulders with converted lesions and those with persistent OFF-HS lesions. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients with anterior shoulder instability and an OFF-HS lesion treated with an arthroscopic classic Latarjet procedure between January 2010 and September 2017 were retrospectively evaluated. Patients with moderate or severe shoulder arthrosis, rotator cuff tears, or age older than 50 years were excluded. Glenoid track (GT), HS, HS interval (HSI), and the difference between HSI and GT (ΔHSI-GT) were measured preoperatively. A postoperative computed tomography scan and a clinical evaluation, including the Rowe and Western Ontario Shoulder Instability scores, were performed at a minimum 1- and 2-year follow-up, respectively. Postoperatively, 2 groups of patients were obtained: (1) patients with postoperative persistent OFF-HS; (2) patients with postoperative ON-HS. Clinical and imaging data were compared between the 2 groups. RESULTS A total of 51 patients (n = 51 shoulders), with a mean age of 29.8 ± 8.4 years (range, 15-50 years), met the inclusion criteria. Six shoulders (11.8%) still showed OFF-HS lesions despite Latarjet surgery. There were no postoperative dislocations, but 3 patients reported subluxations. The subluxation rate was significantly higher in the postoperative persistent OFF-HS group (2 [33%] vs 1 [2.2%]; P = .033). There was a wider preoperative HSI (29.8 ± 2.4 mm vs 22.9 ± 3.5 mm; P < .001) and a larger preoperative ΔHSI-GT (12.2 ± 3.8 mm vs 4.82 ± 3.2 mm; P < .001) in the persistent OFF-HS group. A receiver operating characteristic curve was performed based on preoperative ΔHSI-GT values. A preoperative ΔHSI-GT value ≥7.45 mm predicted a persistent OFF-HS after Latarjet surgery (sensitivity, 100%; specificity, 87%; positive predictive value, 50%; and negative predictive value, 100%). CONCLUSION Latarjet surgery converted many preoperative OFF-HS lesions into ON-HS lesions, but not all of them. Six patients (11.8%) retained an OFF-HS and had a statistically significantly higher failure rate after Latarjet surgery compared with those with postoperative ON-HS lesions. Because there were few postoperative OFF-HS lesions and few recurrences, findings are statistically fragile and should be confirmed with larger series.
Collapse
Affiliation(s)
- Claudio Calvo
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago De Chile, Chile
| | - Javier Calvo
- Hospital Universitario San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel Rojas
- Department of Orthopaedic Surgery, Hospital Regional de Talca, Universidad Católica del Maule, Talca, Chile
| | - María Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| |
Collapse
|
10
|
Intersurgeon and intrasurgeon variability in preoperative planning of anatomic total shoulder arthroplasty: a quantitative comparison of 49 cases planned by 9 surgeons. J Shoulder Elbow Surg 2020; 29:2610-2618. [PMID: 33190760 DOI: 10.1016/j.jse.2020.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/28/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative planning software is widely available for most anatomic total shoulder arthroplasty (ATSA) systems. It can be most useful in determining implant selection and placement with advanced glenoid wear. The purpose of this study was to quantify inter- and intrasurgeon variability in preoperative planning of a series of ATSA cases. METHODS Forty-nine computed tomography scans were planned for ATSA by 9 fellowship-trained shoulder surgeons using the ExactechGPS platform (Exactech Inc., Gainesville, FL, USA). Each case was planned a second time between 4 and 12 weeks later. Variability within and between surgeons was measured for implant type, size, version and inclination correction, and implant face position. Interclass correlation coefficients, Pearson, and Light's kappa coefficients were used for statistical analysis. RESULTS There was considerable variation in the frequency of augment use between surgeons and between rounds for the same surgeon. Thresholds for augment use also varied between surgeons. Interclass correlation coefficients for intersurgeon variability were 0.37 for version, 0.80 for inclination, 0.36 for implant type, and 0.36 for implant size. Pearson coefficients for intrasurgeon variability were 0.17 for version and 0.53 for inclination. Light's kappa coefficient for implant type was 0.64. CONCLUSIONS This study demonstrates substantial inter- and intrasurgeon variability in preoperative planning of ATSA. Although the magnitude of differences in correction was small, surgeons differed significantly in the use of augments to achieve the resultant plan. Surgeons differed from each other on thresholds for augment use and maximum allowable residual retroversion. This suggests that there may a range of acceptable corrections for each shoulder rather than a single optimal plan.
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Taverna E, Longo UG, Guarrella V, Garavaglia G, Perfetti C, Sconfienza LM, Broffoni L, Denaro V. A new mini-open technique of arthroscopically assisted Latarjet. BMC Musculoskelet Disord 2020; 21:285. [PMID: 32380996 PMCID: PMC7206729 DOI: 10.1186/s12891-020-03307-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/22/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim is to describe a new arthroscopically assisted Latarjet technique. METHODS We evaluated the clinical and radiological findings of 60 patients with chronic recurrent anterior gleno-humeral instability who underwent, between September 2013 and November 2014, an arthroscopically-assisted Latarjet procedure with double round endobutton fixation. Inclusion criteria were: chronic anterior recurrent instability, Instability Severity Index Score (ISIS) greater than three points, a glenoid bone defect > 15% or a Hill Sachs lesion with concomitant glenoid bone defect > 10%. During surgery the joint capsule and the anterior glenoid labrum were detached. Two drill tunnels perpendicular to the neck of the glenoid were made through a guide. An accessible pilot hole through the glenoid was created to allows the passage of guidewires for coracoid guidance and final fixation onto the anterior glenoid. Through a restricted deltopectoral access a coracoid osteotomy was made. Finally, the graft was prepared, inserted and secured using half-stitches. RESULTS The mean follow-up was 32.5 months (range 24-32 months). At a mean follow-up, 56 of the 60 subjects claimed a stable shoulder without postoperative complaints, two (3.3%) had an anterior dislocation after new traumatic injury, and two (3.3%) complained of subjective instability. At the latest follow-up, four subjects complained of painful recurrent anterior instability during abduction-external rotation with apprehension. At 1 year, the graft had migrated in one patient (1.7%) and judged not healed and high positioned in another patient (1.7%). Moreover, a glenoid bony gain of 26.3% was recorded. At the latest follow-up, three patients had grade 1 according to Samilson and Prieto classification asymptomatic degenerative changes. Nerve injuries and infections were not detected. None of the 60 patients underwent revision surgery. Healing rate of the graft was 96.7%. CONCLUSIONS This technique of arthroscopically assisted Latarjet combines mini-open and arthroscopic approach for improving the precision of the bony tunnels in the glenoid and coracoid placement, minimizing any potential risk of neurologic complications. It can be an option in subjects with anterior gleno-humeral instability and glenoid bone defect. Further studies should be performed to confirm our preliminary results. TRIAL REGISTRATION Trial registration number 61/int/2017 Name of registry: ORS Date of registration 11.5.2017 Date of enrolment of the first participant to the trial: September 2013 'retrospectively registered' LEVEL OF EVIDENCE: IV.
Collapse
Affiliation(s)
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.
| | | | - Guido Garavaglia
- Servizio di Chirurgia dell'Arto Superiore, OBV, Mendrisio, Switzerland
| | | | | | - Laura Broffoni
- Servizio di Chirurgia dell'Arto Superiore, OBV, Mendrisio, Switzerland
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| |
Collapse
|
13
|
Taverna E, Garavaglia G, Perfetti C, Ufenast H, Sconfienza LM, Guarrella V. An arthroscopic bone block procedure is effective in restoring stability, allowing return to sports in cases of glenohumeral instability with glenoid bone deficiency. Knee Surg Sports Traumatol Arthrosc 2018; 26:3780-3787. [PMID: 29623353 DOI: 10.1007/s00167-018-4921-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 03/28/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE A group of patients affected by bone loss in the context of recurrent anterior shoulder instability were treated arthroscopically with a modified Eden-Hybinette technique since 2005. The last modification was made in 2013, consisting of fixation using a pair of specifically designed double round Endobuttons, which secure the bone graft to the glenoid rim placed through a guide. This report describes patients operated on after this last modification. No reports have described the results of this technique, and the purpose of this study was to assess early clinical and radiological results of an arthroscopic bone block procedure with double round Endobutton fixation. We hypothesized that this technique would restore shoulder stability in patients with anteroinferior glenohumeral instability with glenoid bone deficit, with excellent clinical and radiological results. METHODS The clinical and radiological efficacy of this procedure was retrospectively evaluated in 26 patients with an average follow-up of 29.6 months (range 24-33 months). RESULTS At minimum 2-year follow-up, we had no recurrent anterior dislocations, excellent clinical results [average Walch-Duplay score 93.2, (SD 7.8); average Rowe score, 96.4 (SD 6.5); average SSV, 87.4 (SD 12.1); satisfaction rate, 88.5%; average loss of external rotation, 4.4° (SD 8.7°)] optimal graft positioning, and a healing rate of 92.3% on computed tomography scan. CONCLUSIONS Arthroscopic bone block grafting combined with a standard Bankart repair restored shoulder stability in patients with anteroinferior glenohumeral instability with glenoid bone deficit, with excellent clinical and radiological results. This procedure did not substantially limit external rotation, allowing a high rate of return to sports even among competitive, overhead, and "at risk" athletes.
Collapse
Affiliation(s)
| | - Guido Garavaglia
- Servizio di Chirurgia dell'Arto Superiore, OBV, Mendrisio, Switzerland
| | | | | | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | |
Collapse
|
14
|
Ernstbrunner L, Gerber C. Editorial Commentary: Computed Tomography-based Analysis of the Arthroscopic Latarjet Procedure Suggests Graft Positioning Is More Variable than Expected. Arthroscopy 2018; 34:2041-2044. [PMID: 29976423 DOI: 10.1016/j.arthro.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 05/13/2018] [Accepted: 05/15/2018] [Indexed: 02/02/2023]
Abstract
The Latarjet operation is one of the most successful techniques for the treatment of recurrent anterior shoulder instability, which has recently been translated into the arthroscopic field. Several studies suggest that its arthroscopic variant is safe and reproducible and report promising short-term and mid-term results. Some authors claim that, in addition to less soft tissue damage, positioning of the coracoid graft is more accurate during arthroscopic control. There is currently no evidence of superiority of the arthroscopic or the open technique. As with the open procedure, the arthroscopic Latarjet operation requires a substantial learning curve; therefore the arthroscopic technique should be reserved for experienced arthroscopists treating a large number of shoulder instabilities.
Collapse
|
15
|
Neyton L, Barth J, Nourissat G, Métais P, Boileau P, Walch G, Lafosse L. Arthroscopic Latarjet Techniques: Graft and Fixation Positioning Assessed With 2-Dimensional Computed Tomography Is Not Equivalent With Standard Open Technique. Arthroscopy 2018; 34:2032-2040. [PMID: 29789246 DOI: 10.1016/j.arthro.2018.01.054] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze graft and fixation (screw and EndoButton) positioning after the arthroscopic Latarjet technique with 2-dimensional computed tomography (CT) and to compare it with the open technique. METHODS We performed a retrospective multicenter study (March 2013 to June 2014). The inclusion criteria included patients with recurrent anterior instability treated with the Latarjet procedure. The exclusion criterion was the absence of a postoperative CT scan. The positions of the hardware, the positions of the grafts in the axial and sagittal planes, and the dispersion of values (variability) were compared. RESULTS The study included 208 patients (79 treated with open technique, 87 treated with arthroscopic Latarjet technique with screw fixation [arthro-screw], and 42 treated with arthroscopic Latarjet technique with EndoButton fixation [arthro-EndoButton]). The angulation of the screws was different in the open group versus the arthro-screw group (superior, 10.3° ± 0.7° vs 16.9° ± 1.0° [P < .001]; inferior, 10.3° ± 0.8° vs 15.7° ± 0.9° [P < .0001]). The angulation of the EndoButtons was 5.7° ± 0.5°; this was different from that of open inferior screws (P = .003). In the axial plane (level of equator), the arthroscopic techniques resulted in lateral positions (arthro-screw, 1.5 ± 0.3 mm lateral [P < .001]; arthro-EndoButton, 0 ± 0.3 mm lateral [P < .0001]) versus the open technique (0.9 ± 0.2 mm medial). At the level of 25% of the glenoid height, the arthroscopic techniques resulted in lateral positions (arthro-screw, 0.3 ± 0.3 mm lateral [P < .001]); (arthro-EndoButton, 0.7 ± 0.3 mm lateral [P < .0001]) versus the open technique (1.0 ± 0.2 mm medial). Higher variability was observed in the arthro-screw group. In the sagittal plane, the arthro-screw technique resulted in higher positions (55% ± 3% of graft below equator) and the arthro-EndoButton technique resulted in lower positions (82% ± 3%, P < .0001) versus the open technique (71% ± 2%). Variability was not different. CONCLUSIONS This study shows that the position of the fixation devices and position of the bone graft with the arthroscopic techniques are statistically significantly different from those with the open technique with 2-dimensional CT assessment. In the sagittal plane, the arthro-screw technique provides the highest positions, and the arthro-EndoButton technique, the lowest. Overall, the mean position of the bone block with the open Latarjet technique in the axial plane is slightly medial to the joint line, as recommended. Conversely, with the arthroscopic techniques, the bone grafts are more lateral with a slight overhang. The main differences are observed in the dispersion of the values (more extreme positions) with the arthro-screw technique, given the acknowledged limitations. Despite the statistical significance, the clinical significance of these differences is yet unknown. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Lionel Neyton
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France; Centre Orthopédique Santy, Lyon, France.
| | | | | | - Pierre Métais
- Hôpital Privé La Châtaigneraie - ELSAN, Beaumont, France
| | | | - Gilles Walch
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France; Centre Orthopédique Santy, Lyon, France
| | | |
Collapse
|
16
|
Collin P, Lädermann A. Dynamic Anterior Stabilization Using the Long Head of the Biceps for Anteroinferior Glenohumeral Instability. Arthrosc Tech 2017; 7:e39-e44. [PMID: 29552467 PMCID: PMC5852254 DOI: 10.1016/j.eats.2017.08.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/11/2017] [Indexed: 02/03/2023] Open
Abstract
Anteroinferior glenohumeral instability can be treated by variants of the Bankart repair, remplissage, and the Latarjet procedure, although all options remain associated with complications, including recurrence, stiffness, persistent pain, apprehension, and dislocation arthropathy. The authors therefore thought of a concept of dynamic anterior stabilization to treat anteroinferior glenohumeral instability by transferring the long head of the biceps within a subscapularis split to the anterior glenoid margin, thereby creating a "sling effect" by using a conservative technique. A standard Bankart repair is then to re-establish the labral damper effect. The main benefit of the dynamic anterior stabilization procedure is that it grants the "sling effect," but is easier and safer than arthroscopic Latarjet. It does not require screws nor traction of the coracoid process, and should therefore reduce the risks of neurologic damage. Furthermore, the procedure can be performed with only 3 small incisions, because it does not require coracoid transfer, which eliminates risks of nerve dissection, graft overhang, and cortical resorption, hence reducing the probability for dislocation arthroplasty. Lastly, the pectoralis minor remains intact, which would avoid scapular dyskinesis.
Collapse
Affiliation(s)
- Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland,Faculty of Medicine, University of Geneva, Geneva, Switzerland,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland,Address correspondence to Alexandre Lädermann, M.D., Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Avenue. J-D Maillard 3, CH-1217 Meyrin, Switzerland.Division of Orthopaedics and Trauma SurgeryLa Tour HospitalAvenue. J-D Maillard 3CH-1217 MeyrinSwitzerland
| |
Collapse
|
17
|
Zhang H, Gong J, Xie M, Tang K. Individualized coracoid osteotomy and 3D congruent arc reconstruction of glenoid for the treatment of recurrent anterior shoulder dislocation. J Orthop Surg Res 2017; 12:193. [PMID: 29246239 PMCID: PMC5732511 DOI: 10.1186/s13018-017-0687-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/16/2017] [Indexed: 01/26/2023] Open
Abstract
Background The present study investigated individualized coracoid osteotomy for 3D congruent arc glenoid reconstruction and evaluated the clinical outcomes in recurrent anterior shoulder dislocation. Methods From January 2005 to July 2015, 78 patients with glenoid defect underwent coracoid and conjoint tendon transposition. The patients were divided into the individualized group (n = 34) and the non-individualized group (n = 44). All patients had CT data to reconstruct the shoulder model using Mimics software. In the individualized group, the individual coracoid osteotomy and bone fixation position parameters were measured from preoperative planification through simulating a 3D congruent arc glenoid reconstruction model. The non-individualized group underwent classic Bristow-Latarjet (B-L) procedure. The postoperative evaluation parameters included 3D congruent arc index, coracoid bone position, shoulder osteoarthritis index (Samilson-Prieto) and shoulder function score (Rowe, Constant-Murley score). Results The mean follow-up time was 51.0 months (ranging from 24 to 146). The individualized group got 3D congruent arc reconstruction of the glenoid by postoperative CT scanning. Bone position was more precise in the individual group than that in the B-L group. There was a lower incidence of shoulder osteoarthritis (Samilson-Prieto) in the individual group compared with that in the B-L group: 0 vs 13.6% (mild 6/44, P = 0.027), respectively. No significant difference was observed between the individual and B-L groups in rate of re-dislocation: 0 vs 4.5% (2/44, P = 0.315), respectively. The postoperative Rowe and Constant score was significantly improved but was not significantly different between the two groups. Conclusion The individual procedure achieved 3D congruent arc glenoid reconstruction. The clinical effects in patients with medium glenoid defect were good, especially the low incidence of shoulder osteoarthritis in middle-term follow-up. Electronic supplementary material The online version of this article (10.1186/s13018-017-0687-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hongxin Zhang
- Department of Orthopaedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | - Jicheng Gong
- Department of Orthopaedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | - Meiming Xie
- Department of Orthopaedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | - Kanglai Tang
- Department of Orthopaedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China.
| |
Collapse
|
18
|
Lädermann A. Editorial Commentary: Arthroscopic Latarjet Shoulder Stabilization: Where Are We? Where Are We Going? Arthroscopy 2017; 33:2136-2138. [PMID: 29198351 DOI: 10.1016/j.arthro.2017.08.277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 02/02/2023]
Abstract
Arthroscopic Latarjet procedure has shown satisfactory clinical outcomes in the treatment of anteroinferior shoulder instability. Although as of today there is no proven advantage of the arthroscopic procedure over an open one, it is too early to give up. At the same time, crucial to understand the causes of failure, to find the solutions to every single difficulty to simplify this surgery and to make it as accessible as possible.
Collapse
|
19
|
Barth J, Boutsiadis A, Neyton L, Lafosse L, Walch G. Can a Drill Guide Improve the Coracoid Graft Placement During the Latarjet Procedure? A Prospective Comparative Study With the Freehand Technique. Orthop J Sports Med 2017; 5:2325967117734218. [PMID: 29094054 PMCID: PMC5652655 DOI: 10.1177/2325967117734218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background One of the factors that can affect the success of the Latarjet procedure is accurate coracoid graft (CG) placement. Hypothesis The use of a guide can improve placement of the CG and screw positioning in the sagittal and axial planes as compared with the classic open ("freehand") technique. Study Design Cohort study; Level of evidence, 2. Methods A total of 49 patients who underwent a Latarjet procedure for the treatment of recurrent anterior shoulder instability were prospectively included; the procedure was performed with the freehand technique in 22 patients (group 1) and with use of a parallel drill guide during screw placement in 27 patients (group 2). All patients underwent a postoperative computed tomography scan with the same established protocol. The scans were used to evaluate and compare the position of the CG in the sagittal and axial planes, the direction of the screws (α angle), and overall contact of the graft with the anterior surface of the glenoid after the 2 surgical techniques. Results The CG was placed >60% below the native glenoid equator in 23 patients (85.2%) in group 2, compared with 14 patients (63.6%) in group 1 (P = .004). In the axial plane, the position of the CG in group 2 patients was more accurate (85.2% and 88.9% flush) at the inferior and middle quartiles of the glenoid surface (P = .012 and .009), respectively. Moreover, with the freehand technique (group 1), the graft was in a more lateral position in the inferior and middle quartiles (P = .012 and .009, respectively). No differences were found between groups 1 and 2 regarding the mean α angle of the superior (9° ± 4.14° vs 11° ± 6.3°, P = .232) and inferior (9.5° ± 6° vs 10° ± 7.5°, P = .629) screws. However, the mean contact angle (angle between the posterior coracoid and the anterior glenoid surface) with the freehand technique (3.8° ± 6.8°) was better than that of the guide (8.55° ± 8°) (P = .05). Conclusion Compared with the classic freehand operative technique, the parallel drill guide can ensure more accurate placement of the CG in the axial and sagittal planes, although with inferior bone contact.
Collapse
Affiliation(s)
| | | | - Lionel Neyton
- Générale de Santé, Hôpital privé Jean Mermoz; Centre Orthopédique Santy, Lyon, France
| | | | - Gilles Walch
- Générale de Santé, Hôpital privé Jean Mermoz; Centre Orthopédique Santy, Lyon, France
| |
Collapse
|