Arthroscopic Latarjet for Recurrent Shoulder Instability

Long head of biceps as an anterior dynamic sling for recurrent anterior shoulder dislocation

PURPOSE

To evaluate the functional outcomes of arthroscopic onlay dynamic anterior stabilization (DAS) using the long head of the biceps (LHB) tendon for treatment of anterior glenohumeral instability (AGI) with limited to subcritical glenoid bone loss (GBL).

METHODS

Twenty-five patients underwent arthroscopic DAS using LHB tendon between March 2022 and October 2022 for treatment of anterior glenohumeral instability (AGI) with limited to subcritical glenoid bone loss (GBL) were included in a prospective study with a minimum follow-up period of 2 years. The shoulder functional outcomes were assessed using the Rowe and the Quick Disabilities of Arm, Shoulder and Hand (Quick DASH) scores both preoperative and at 2 years follow-up. Magnetic resonance imaging (MRI) was done 6 months after surgery to evaluate LHB tendon healing to the anterior glenoid.

RESULTS

The study included 25 patients complaining of recurrent AGI. Twenty-one patients were males and four patients were females. The mean age of the patients at surgery was 22.75 ± 3.24 years. The mean duration between the first shoulder dislocation episode and surgery was 5.5 ± 2.13 months. The right shoulder was injured in 15 patients while the left shoulder was involved in 10 patients. The mean follow-up period was 24.25 ± 0.82 months. DAS using the long head of the biceps tendon resulted in a statistically significant improvement of the mean Rowe and the Quick DASH scores between preoperative and 2 years postoperative. Recurrent dislocation was reported in two (8%) patients during the follow-up period.

CONCLUSION

Arthroscopic onlay dynamic anterior stabilization using the long head of the biceps tendon is a safe and effective method for the treatment of recurrent anterior shoulder instability with GBL up to 25%.

LEVEL OF EVIDENCE

Level IV, case series study.

Arthroscopic shoulder instability surgery in patients under 25 years of age: the key role of soft tissue with both anterior and posterior axillary hammock tensioning

BACKGROUND

The arthroscopic treatment of shoulder instability is widely debated in the literature and includes very different surgical techniques. Imaging techniques do not allow an accurate assessment of soft tissue quality. The aim of the study is to demonstrate that correct patient selection and a surgical technique involving anterior and posterior capsular ligament repair with axillary retention may be the most crucial factors for successful arthroscopic treatment.

METHODS

Patients with recurrent shoulder instability who underwent arthroscopic stabilization between 2014 and 2015 and aged between 15 and 25 years, were included. The minimum follow-up was 5 years. Specific exclusion criteria were critical bone loss and patients with genetic connective tissue disorders. Demographics, instability characteristics, surgical procedures, recurrences, both dislocations and subluxations, and surgical revisions were evaluated. The surgical procedure, always performed by the same surgeon, involved the use of a minimum of 3 double-suture fixation devices and repair/tensioning of the axillary hammock. Statistical analysis was based on the non-parametric Kendall statistical model and proportions test, with p < 0.05.

RESULTS

The study population consisted of 44 patients. The first dislocation occurred in 61.4% of cases between the ages of 15 and 19. The number of dislocations prior to surgery was < 3 in 29.5%, between 3 and 9 episodes in 25%, and 10 or more episodes in 45.5%. Defined by patients who had no recurrent dislocations and those whose symptom of instability or subluxation did not require surgical revision, the surgical success rate was 90.9%. During the follow-up period, 4.5% of patients required surgical revision. Patients who required none or one reduction maneuver or had less than three dislocation episodes were statistically correlated with no recurrences after surgery. After the first dislocation, the 88.6% of patients had recurrency. Furthermore, if treated after only one episode, 75% of patients were affected by an isolated capsulolabral injury. Prompt stabilization surgery allows a simpler procedure, due to a reduced bone damage and associated injuries.

CONCLUSIONS

Even in a high-risk age group under 25 years, when the bone defect is subcritical, performing a standardised surgical technique including antero-posterior capsulolabral repair with axillary hammock retensioning demonstrates high success rates. Patients who correlate with the highest chance of success are those who have had less than three dislocation episodes and who have not undergone reduction manoeuvres, confirming the importance of soft tissue quality and thus of early treatment.

TRIAL REGISTRATION

Retrospectively registred.

Latarjet procedure versus iliac crest autograft transfer for anterior shoulder instability: a systematic review and meta-analysis of comparative studies

BACKGROUND

Anterior shoulder instability with glenoid bone loss presents a challenge in orthopedic surgery. The Latarjet and iliac crest bone graft transfer (ICBGT) procedures are commonly employed for its management, but direct comparative evidence is insufficient.

METHODS

Following PRISMA guidelines, a comprehensive search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted. Randomized controlled trials (RCTs) and cohort studies directly comparing the Latarjet and ICBGT procedures were included. Primary outcomes included postoperative recurrent instability, apprehension test, and complications, while secondary outcomes comprised Rowe score, Subjective Shoulder Value (SSV), pain level assessed by visual analogue scale (VAS), range of motion (ROM), and radiologic outcomes. Quality assessment was performed using RoB2 and MINORS tools. The weighted mean difference (WMD) for continuous variables and odds ratio (OR) for dichotomous variables were calculated, along with 95% confidence intervals (CIs). Meta-analysis was performed using RevMan 5.4.1 software.

RESULTS

A total of 6 studies with 409 patients were included. There was no significant difference in postoperative recurrent instability (OR, 1.33; 95% CI, 0.44 to 4.03; P = 0.61), positive apprehension test (OR, 0.78; 95% CI, 0.20 to 3.10; P = 0.73), revision surgery (OR, 2.06; 95% CI, 0.74 to 5.71; P = 0.16), mild complications (OR, 0.49; 95% CI, 0.23 to 1.06; 0.07), SSV (WMD, -1.94; 95% CI, -3.94 to 0.06; P = 0.06) or VAS score (WMD, 0.15; 95% CI, -0.17 to 0.47; P = 0.36) between the two procedures. The ICBGT group exhibited statistically superior Rowe scores (WMD, -3.10; 95% CI, -5.10 to -1.10; P = 0.002), as well as improved external (WMD, -5.32; 95% CI, -7.30 to -3.30; P < 0.001) and internal rotation (WMD, -5.11; 95% CI, -6.76 to -3.45; P < 0.001). However, these differences did not surpass the minimal clinically important difference (MCID). Radiological evaluations showed that the ICBGT procedure had statistically better outcomes in immediate glenoid augmentation, preservation and reduced fatty degeneration of the subscapularis (SSC) tendon, and graft remodeling at short-term follow-up.

CONCLUSIONS

The ICBGT procedure showed statistically superior Rowe scores and range of motion, but these differences may not be clinically significant. Both procedures had comparable outcomes in recurrent instability, apprehension test results, revision surgery, mild complications, SSV, and pain levels. ICBGT appears to offer advantages in glenoid augmentation and SSC preservation at short-term follow-up.

PROSPERO REGISTRATION ID

CRD42024586157.

Utilization of a stepwise model to assess pivotal information for patient decision-making regarding open vs. arthroscopic Latarjet procedure

BACKGROUND

The popularity of arthroscopic Latarjet has increased significantly in recent years due to its perceived advantages. The latter include a smaller surgical incision, faster recovery, quicker return to sports, and ability to treat concomitant intra-articular pathology. Nevertheless, the arthroscopic technique is more technically challenging, has a more significant learning curve, longer operating time, and is less cost-effective. The study aimed to identify the various factors influencing patient decision-making between undergoing arthroscopic or open Latarjet using a stepwise questionnaire model.

METHODS

All patients with a primary, whether arthroscopic or open Latarjet procedure were subjected to a stepwise interviewing process and were asked to select between arthroscopic and open approaches at each step.

RESULTS

Fifty patients with a mean age of 28.8 ± 8.8 year old participated in the study. Twenty (40%) consistently selected an arthroscopic approach after analysis of the incision's aspect, whereas 34 (68%) had a final decision different from their initial choice. In addition, out of the 15 patients who chose arthroscopy or were undetermined after presentation of the incisional aspect, 9 (60%) changed their decision to open surgery after presentation of the pros and cons of each approach. Twenty-three (46%) patients were unable to choose and left the choice to their surgeon. The faith in their surgeon and recovery were identified as the 2 most important factors influencing patients' final decisions.

CONCLUSIONS

The minimally invasive nature of arthroscopic incisions was not considered to be more cosmetically appealing than that of a single open incision. The advantages of the arthroscopic procedure may not be as valued by patients as by surgeons. Patients were more interested in the equivalent short- and mid-term outcomes of both approaches and the shorter surgical duration of the open option. It is crucial to adequately inform patients during preoperative counseling to achieve the best consensus.

Current Evidence and Techniques for Arthroscopic Bone Augmentation

The indications for bone block augmentation of the glenoid following recurrent anterior shoulder instability are expanding. Arthroscopic anatomic glenoid reconstruction (AAGR) is an evolving technique with similar clinical results to the Latarjet procedure and other open bone block procedures. Multiple types of bone grafts and fixation techniques have been described, with varying results on bony integration, resorption, articular congruity, and recurrence rates. This review focuses on biomechanics, patient workup, indications, current evidence, and the authors' preferred surgical technique for AAGR.

Clinical Outcomes and Return to Sports After Arthroscopic Repair of Humeral Avulsion of the Glenohumeral Ligament: A Meta-Analysis

This study aimed to evaluate the clinical outcomes and the frequency of return to sport after the arthroscopic repair of a humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion. Web of Science, Scopus, and Medline via PubMed and OVID were searched to identify the relevant citations. Screening and data extraction were performed independently. The Comprehensive Meta-Analysis software was used for all statistical analyses (CMA; USA version 3.3.070). A total of 18 articles (n = 832 patients; of whom, 379 patients had HAGL) were included. The fixed-effect estimate showed that the percentage of patients who returned to their sports was 89.1% (95% CI = 85% to 92.2%). The mean duration to return was estimated to be 6.65 months (95% CI = 5.10 to 8.20). Postoperatively, the mean Western Ontario Shoulder Instability Index (WOSI), Oxford Shoulder Instability Score (OSIS), and Subjective Shoulder Value (SSV) scores were 88.60 (95% CI = 86.18 to 90.98), 15.02 (95% CI = 7.42 to 22.63), and 86.90 (95% CI = 80.79 to 93.00), respectively. The Rowe score improved significantly postoperatively with a mean difference (MD) of 54.47 (95% CI = 39.28 to 69.66). The University of California - Los Angeles (UCLA) shoulder score increased significantly post-arthroscopic repair (MD = 10.91, 95% CI = 10.07 to 11.76). The current evidence suggests that arthroscopic repair of HAGL lesions is associated with a high percentage of return to sports and improved Rowe score, WOSI, UCLA shoulder score, OSIS scale, and SSV score. The quality of the included studies is moderate; however, these findings are promising and call for further multicenter, prospective studies.

Latarjet procedure for failed Bankart repair provides better stability and return to sports, but worse postoperative pain and external rotation limitations with more complications, compared to revision Bankart repair: a systematic review and meta-analysis

PURPOSE

This study aimed to compare the clinical results of revision Bankart repair versus the Latarjet procedure for failed Bankart repair.

METHODS

A literature search was performed in databases, such as Pubmed, Embase, and Scopus Library. The studies were appraised using the Methodological Index for Non-randomized Studies tool. Studies for failed Bankart repair with revision Bankart repair or Latarjet procedure were included. The pain VAS, ROWE score, rate of return to sports and preinjury level of sports, recurrent instability, range of motion, and complications were compared. Additionally, the pain VAS, ROWE score, forward flexion, and external rotation at side were subjected to a meta-analysis.

RESULTS

Twenty-four articles were included in the systematic review. The functional outcomes in terms of the ROWE score, recurrent instability, return to sports, and the preinjury level of sports was better in the Latarjet procedure group than those in the revision Bankart repair group (ROWE score, 91 vs. 86.7; recurrent instability rate, 3.5% vs. 14.4%; return to sports rate, 100% vs. 87.9%; return to preinjury level of sports rate, 89.9% vs. 74.9%; all P < 0.001). However, the results of postoperative pain and the postoperative limitation of external rotation at side were worse in the Latarjet procedure group than those in the revision Bankart repair group (pain VAS, 1.4 vs. 0.8; postoperative external rotation at side, 38° vs. 60°; all P < 0.001). In addition, the majority of the complications occurred in the Latarjet procedure group. In the meta-analysis, the postoperative ROWE score was significantly higher in the Latarjet procedure group than that in the revision Bankart group (revision Bankart repair: 95% CI 88.9-80.9, I² = 65.70; Latarjet procedure: 95% CI 95.8-88.1, I² = 93.37; P = 0.014). However, the pain VAS, forward flexion, and external rotation at side did not reach the significant level in the meta-analysis.

CONCLUSION

Compared with revision Bankart repair, the Latarjet procedure for failed Bankart repair showed better ROWE scores, stability, and return to sports or preinjury level of sports; however, the postoperative pain and the limitation of external rotation at side were worse with more complications.

IRB NO

KUMC 2022-01-024.

LEVEL OF EVIDENCE

Level IV.

Complications Related to Latarjet Shoulder Stabilization: A Systematic Review

BACKGROUND

In cases of recurrent anterior shoulder instability with a glenoid defect, Latarjet procedures are widely used for stabilization. Although complications with this procedure have been reported, few studies have comprehensively analyzed issues related to the Latarjet procedure.

PURPOSE

To identify the overall complication rate of the Latarjet procedure used for anterior shoulder instability and to compare the rate of complications between arthroscopic and open approaches.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed by using the PubMed, EMBASE, Scopus, and Cochrane Library databases. Data on complications were extracted and classified as intraoperative, postoperative, or instability-related for further analysis. Quality assessments were performed with criteria from the Methodological Index for Nonrandomized Studies (MINORS). A quantitative synthesis of data was conducted to compare the complication rates between arthroscopic and open approaches.

RESULTS

A total of 35 articles were included in this analysis. The MINORS score was 11.89. A total 2560 Latarjet procedures (2532 patients) were included. The overall complication rate was 16.1% (n = 412). The intraoperative complication rate was 3.4% (n = 87) and included a 1.9% (n = 48) incidence of nerve injuries and a 1.0% (n = 25) incidence of iatrogenic fractures. Screw problems, vascular injuries, and conversion arthroscopic to open surgery each occurred at a rate of <1%. The postoperative complication rate was 6.5% (n = 166), and the most common complication was nonunion (1.3%; n = 33). The instability-related complication rate was 6.2% (n = 159) and included a 1.5% (n = 38) rate of redislocation, a 2.9% (n = 75) rate of positive apprehension test, and a 1.0% (n = 26) rate of instability. Overall, 2.6% (n = 66) of patients required an unplanned secondary operation after the initial surgery. The arthroscopic approach was associated with a higher rate of intraoperative complications compared with the open approach (5.0% vs 2.9%; P =.020) and a lower rate of instability-related complications (3.1% vs 7.2%; P < .001).

CONCLUSION

The Latarjet procedure for anterior shoulder instability results in an overall complication rate of 16.1% and a reoperation rate of 2.6%. However, serious complications at short-term follow-up appear rare. When the arthroscopic approach was used, the rate of intraoperative complications was higher, although instability-related complications were lower when compared with the open approach.

Satisfactory Functional Results and Complication Rates After Anterior Glenoid Bone Block Reconstruction in Recurrent Shoulder Dislocation: A Mean 4-Year Follow-up Comparative Study

BACKGROUND

Anterior recurrent instability of the glenohumeral joint is a common clinical problem among the young population. Glenoid reconstruction with bone graft has become the treatment of choice, particularly in significant deficiency (˃ 20%). This study aims to assess the functional results of glenoid reconstruction using Latarjet and iliac bone graft in management of glenoid insufficiency associated with recurrent anterior dislocation of the glenohumeral joint.

METHODS

Patients suffering from anterior shoulder instability with glenoid defect > 20% were included in this study between 2016 and 2021. University of California at Los Angeles (UCLA) shoulder scale and Constant score were used to assess the functional improvement. Preoperative and final postoperative continuous outcomes were compared with one-tailed paired t-test and the outcomes across groups were compared using two-tailed independent t-test. P-value of < 0.05 was considered statistically significant for both tests.

RESULTS

This trial included 50 patients; twenty-five underwent mini-open Latarjet, and 25 underwent arthroscopic tricortical iliac bone grafting (ICBG). The mean follow-up durations were 50.1 ± 5.9 months for Laterjet and 51.6 ± 6.8 months for ICBG. Both techniques showed statistically significant improvement in the final UCLA (31.1± 2.1 in Laterjet, and 30.2± 2.2 in ICBG) and Constant (90.2± 4.6 in Laterjet, and 89± 5.01 in ICBG) scores. There was no statistically significant difference regarding mean age, sex, side of injury, mechanism of injury, follow-up period, and clinical outcome between both surgical treatments. At the end of the study, both groups demonstrated statistically significant improvement in the range of motion (p˂ 0.00001). Only one, non-adherent patient in Laterjet group had post-operative dislocation. In ICBG group, two patients had partial bone graft resorption, 3 graft site morbidities, and 1 hardware prominence.

CONCLUSION

Both Laterjet and iliac bone graft procedures had satisfactory functional results in reconstruction of glenoid defect > 20% in unstable shoulders with a mean 4-year follow-up. No statistically significant difference was reported in the last postoperative Constant and UCLA scores between both techniques, but Latarjet procedure had fewer complications (4%) than iliac bone grafting (24%).

LEVEL OF EVIDENCE

prospective non-randomized comparative study; level Ⅱ.

Arthroscopic Autologous Scapular Spine Bone Graft Combined With Bankart Repair for Anterior Shoulder Instability With Subcritical (10%-15%) Glenoid Bone Loss

PURPOSE

The purpose of our study is to prove that the autologous scapular spine bone graft is an alternative for the treatment of anterior shoulder instability and the clinical and radiological results are promising.

METHOD

From July 2016 to August 2018, patients who were diagnosed as having anterior shoulder instability with subcritical (10%-15%) glenoid bone loss were treated by arthroscopic repair with autologous scapular spine bone graft. The inclusion criteria were (1) anterior shoulder instability underwent arthroscopic autologous scapular spine bone graft; (2) glenoid bone loss was within 10% to 15% (measured by Sugaya's method); (3) three complete sets of computed tomography (CT) scans (preoperative, 1 week after surgery, and 1 year after surgery) available; and (4) clinical follow-up time was at least 2 years. The exclusion criteria were (1) concomitant rotator cuff tear; (2) concomitant remplissage or SLAP repair; (3) previous surgery of the affected shoulder; (4) open surgery; and (5) incomplete radiological or clinical follow-up. The preoperative and postoperative Constant-Murley score, dietary approaches to stop hypertension (DASH) score, visual analog scale (VAS) score, and range of motion (ROM) were recorded. CT scans with 3-dimensional reconstruction were obtained at the first week after operation and at 1 year after operation; the graft resorption rate was consequently calculated.

RESULTS

Twenty-seven patients were qualified and enrolled in the study. No severe complication was recorded during follow-up. No redislocation or subluxation was found, and the apprehension tests were all negative. At the last follow-up, the mean Constant-Murley score was 89.74 ± 3.71, the mean DASH score was 9.77 ± 5.31, the mean VAS score was 0.74 ± 0.64, which are all improved significantly compared with preoperative scores (P = .00,.00,.00, respectively). At the last follow-up, the ROM including anterior flexion, external rotation by side, and the internal rotation were well restored without significant difference compared with the contralateral shoulder (P =.48, .08, .47, respectively). At 1 year after operation, the resorption rate of the bone graft was 19.4%.

CONCLUSION

This study found that anterior shoulder instability with subcritical (10%-15%) glenoid bone loss treated with arthroscopic autologous scapular spine bone graft with suture anchor fixation is safe and could achieve satisfactory result at short-term follow-up.

LEVEL OF EVIDENCE

Therapeutic case series.

Outcomes of the Latarjet Procedure Versus Free Bone Block Procedures for Anterior Shoulder Instability: A Systematic Review and Meta-analysis

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.

Effectiveness of Latarjet for anterior shoulder instability in patients with seizure disorder

Background

A paucity of literature exists on the outcomes after Latarjet for anterior shoulder instability in patients with seizure disorders (SDs). The purpose of this study was to determine the effectiveness of the Latarjet procedure for anterior shoulder instability in patients with SDs.

Methods

A retrospective review of patients undergoing Latarjet from 2013 to 2017 for anterior shoulder instability with minimum 2 years of clinical follow-up was performed. Patients were divided into two groups: patients diagnosed with SD, and patients without a history of seizure (control). Demographics, indications, SD details, and postoperative outcomes were collected. The incidence of complications, recurrent instability, revision surgery, and repeat seizure(s) were also examined.

Results

A total of 53 patients were identified, including 10 shoulders in 9 patients with an SD (88.9% male; mean age, 29.2 years [range, 20-37]), and 44 shoulders in 44 non-SD patients (86.4% male; mean age, 30.3 years [range, 18-52]). The mean follow-up time was 3.4 (range, 2.2-4.8) and 3.8 (range, 2.1-5.6) years in the SD and control group, respectively. During the follow-up period, 4 of 9 (44.4%) patients with an SD (50% shoulders) had a recurrent seizure postoperatively. Of those 4 patients, three sustained a recurrent dislocation of the operative shoulder(s) resulting from a postoperative seizure, including one who dislocated bilateral shoulders from a single seizure event after bilateral Latarjet procedures. There was no recurrent instability in patients who did not sustain a seizure in the postoperative period. Having a seizure in the postoperative period significantly increased the risk of recurrent dislocation (OR = 39.9, P = 0.04).

Conclusions

Latarjet is a successful operation for recurrent anterior shoulder instability in patients without an SD. While it can still be successful in patients with SD, adequate control of seizures postoperatively is paramount to prevent recurrent instability episodes. Patients with an SD can be advised that if their seizures can remain controlled, they have a high likelihood of clinical success equal to that of patients without an SD.

Posterior shoulder instability: a systematic review

INTRODUCTION

This review aims to provide information on outcomes of surgical procedures for soft tissue or bony glenoid and/or humeral abnormalities in case of posterior shoulder instability.

SOURCE OF DATA

A systematic review of the literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, Ovid and Google Scholar databases using various combinations of the keywords 'shoulder', 'posterior instability', 'dislocation', 'reversed bony bankart', 'reversed Hill Sachs', and 'capsulolabral' was performed.

AREAS OF AGREEMENT

A total of 847 shoulders in 810 patients were included. A redislocation event occurred in 33 (8.7%) of 411 shoulders with soft tissue abnormalities and in 12 (9.1%) of 132 shoulders with bony abnormalities of the glenoid, humeral head or both.

AREAS OF CONTROVERSY

The optimal treatment modalities for posterior shoulder dislocation remain to be defined.

GROWING POINTS

Operative stabilization for posterior shoulder instability should be lesion-specific and should correct all components of the posterior instability.

AREAS TIMELY FOR DEVELOPING RESEARCH

Future prospective studies should aim to establish the optimal treatment modalities for posterior shoulder instability.

A new mini-open technique of arthroscopically assisted Latarjet

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.

Epidemiology of Paediatric Shoulder Dislocation: A Nationwide Study in Italy from 2001 to 2014

Limited knowledge is accessible concerning the tendencies of hospitalization for skeletally immature patients with episodes of shoulder dislocation. Our research aim was to evaluate annual hospitalizations for shoulder dislocation in paediatric patients in Italy from 2001 to 2014, on the basis of the official data source as hospitalization reports. The second purpose was to investigate geographical diversification in hospitalization for shoulder dislocation in regions of Italy. The last aim was to make statistical predictions of the number of shoulder dislocation hospitalization volumes and rates in skeletally immature patients based on data from 2001 to 2014. An examination of the National Hospital Discharge records (SDO) kept at the Italian Ministry of Health regarding the 14 years of our study (2001 through 2014) was conducted. These data are anonymous and include patient's age, gender, domicile, region and time of hospitalization, and the kind of reimbursement (public or private). In the 14-year study time, 344 hospitalizations for shoulder dislocation of patients aged 0-14 years took place in Italy. The male/female hospitalization ratio varied from a maximum of 3.0 (2001) to a minimum of 1.1 (2013), with a mean average ratio in the 2001-2014 timespan of 2.0. Almost half of the hospitalizations (49.1%) were performed in the South. The mean incidence of hospitalizations in Italy for shoulder dislocation in patients with less than 14 years was 0.3 for every 100,000 inhabitants in the same class of age. The most common treatment was a closed reduction (60.8%), followed by open stabilization (16.6%) and arthroscopic procedures (13.7%). The present registry study shows a low incidence of hospitalization for shoulder dislocation in young patients. The most common treatment for a shoulder dislocation in paediatric patients is a closed shoulder reduction. Regions from the south and the centre of Italy are marked by an inferior number of operations and a higher number of hospitalization for closed shoulder reduction.