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Jackson GR, Tuthill T, Asif S, DeWald D, Wessels M, McCormick JR, Mameri ES, Knapik DM, Familiari F, Hevesi M, Batra AK, Chahla J, Verma NN. Clinical outcomes, return to sport, and complications after isolated primary Latarjet versus Latarjet as a revision procedure: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2024; 110:103810. [PMID: 38159640 DOI: 10.1016/j.otsr.2023.103810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/23/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The purpose of this review was to compare clinical outcomes, return to sport (RTS), and complications in comparative studies examining patients undergoing primary Latarjet procedure versus Latarjet in the revision setting following soft tissue stabilization. METHODS A literature search was conducted using PubMed and Scopus databases using Preferred Reporting Items for Systematic Meta-Analyses guidelines. Inclusion criteria consisted of level I to III human clinical studies reporting clinical outcomes (Visual Analogue Pain Scale [VAS]), RTS metrics, and complications in patients following primary versus revision Latarjet procedures. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS A total of seven studies, consisting of 1170 patients (n=1179 shoulders) with a mean age of 26.4 years, consisting of 91.9% males (n=1083/1179 shoulders), were identified. Mean final follow-up was 46.4 (mean range, 7.3-72.2) months. A total of 748 primary and 431 revision Latarjet procedures were analyzed. Complications were reported in 9.6% (range, 0%-24.2%) of patients undergoing primary and 20.2% (range, 0%-40.7%) in patients undergoing revision procedures (p=0.22). There was no significant difference in the RTS rate between patients undergoing primary (87.3%; range, 83.8%-92.1%) versus Latarjet as a revision procedure (78.9%; range, 60%-100%) (p=0.08). Moreover, no significant difference in postoperative VAS was observed in patients undergoing primary versus Latarjet as a revision procedure (p=0.21). Recurrent shoulder subluxation was significantly greater in patients undergoing revision (12.0%; n=31/259 shoulders; range, 0%-20.7%) compared to primary procedures (3.3%; n=27/511 shoulders; range, 0%-9%) (p<0.001). DISCUSSION Patients undergoing primary and revision Latarjet demonstrated overall similar rates of complications and return to sport. Of clinical importance, Latarjet as a revision procedure possessed a risk of recurrent subluxation 3.6 times higher than primary Latarjet. While effective, patients should be counseled regarding the differing prognosis between Latarjet as a primary or revision procedure. LEVEL OF EVIDENCE III; Systematic review and meta-analysis.
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Affiliation(s)
- Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA.
| | - Trevor Tuthill
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Shaan Asif
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Daniel DeWald
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Morgan Wessels
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Johnathon R McCormick
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA; Instituto Brasil de Tecnologia da Saúde, 407 Visconde de Piraja St., 22410 Rio de Janeiro, RJ, Brazil; Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), 740 Botucatu St., 04023 São Paulo, SP, Brazil
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, 14532 South Outer Forty Drive, 63017 Chesterfield, MO, USA
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, V.le Europa (loc. Germaneto), 88100 Catanzaro, Italy
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, 55905 Rochester, MN, USA
| | - Anjay K Batra
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
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Arora M, Shukla T, Vala P. Managing severe bipolar bone loss in athletes: A comprehensive approach with open Latarjet and arthroscopic remplissage. J Orthop 2024; 51:91-97. [PMID: 38357440 PMCID: PMC10862392 DOI: 10.1016/j.jor.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
Background Severe bipolar bone loss (BBL) represents one of the toughest challenges when managing the instability of glenohumeral joints among athletes and more specifically the ones involved in overhead sports. It refers to the significant loss of the humeral head and the glenoid bone, with an increased risk of failure. The present study aimed to evaluate the functional outcomes of a combined open Latarjet and arthroscopic remplissage in such high-risk individuals. Methods A retrospective evaluation was carried out among athletes with antero-inferior loss of glenoid bone of more than 15 % and large off-track Hill-Sachs defect who underwent the Latarjet technique with iliac crest bone graft (ICBG) harvest used in combination with arthroscopic remplissage between 2021 and 2023. The University of California, Los Angeles (UCLA) score, constant-Murley score (CMS), and the range of motion (ROM; measured as forward flexion, external rotation, and abduction) were evaluated pre-operative and post-operative at the timepoint of 3-month, 6-month, and 1-year. Pre-operative magnetic resonance imaging scans (MRI) and computed tomography scans (CT) were obtained among the patients with severe glenohumeral BBL, and the glenoid track was calculated to identify on-track and off-track Hill-Sachs lesions. Post-operative MRI with filled Hill-Sachs defect post remplissage procedure and 3D CT scan was also done at 6-month to evaluate the union of the ICBG to the native glenoid bone. Results Overall, 11 patients underwent for the combined procedure for severe BBL. The UCLA score (31.18 ± 3.74), and the CMS (93.64 ± 8.38) at the time-point of 1-year post-operatively showed remarkable improvement in comparison with the preoperative scores (P < 0.0001); and the ROM including abduction, external rotation, and forward flexion were restored to near normality. All patients showed bony union at 6-month as confirmed by post-operative CT scan. No complications such as redislocation or subluxation were observed over 1-year. There were no neurological complications or complications related to graft (graft migration or graft breakage or resorption) as well. All the athletes returned to sports activities at an average duration of 6.8-month post-operatively, with 73 % returning to sports at the level of pre-injury. Conclusion The combined procedure of ICBG Latarjet and arthroscopic remplissage for the treatment of severe BBL in athletes achieved satisfactory outcomes over 1-year, with all athletes returning to sports activities.
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Affiliation(s)
- Manit Arora
- Department of Orthopaedic, Fortis Hospital, Mohali, 160062, India
| | - Tapish Shukla
- Department of Orthopaedic, Fortis Hospital, Mohali, 160062, India
| | - Pratik Vala
- Department of Orthopaedic, Fortis Hospital, Mohali, 160062, India
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Pasqualini I, Tanoira I, Hurley ET, Ranalletta M, Rossi LA. Clinical Significance Thresholds in Primary and Revision Latarjet Procedures With Comparable Outcome Achievements. Am J Sports Med 2024:3635465241241538. [PMID: 38590171 DOI: 10.1177/03635465241241538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Given the variability across populations and settings, defining the MCID and the PASS for the Rowe and ASOSS scores and patients undergoing primary and revision Latarjet it is essential to have accurate benchmarks relevant to these groups when interpreting clinical results. PURPOSE To determine the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds for the visual analog scale (VAS) for pain during sports, Athletic Shoulder Outcome Scoring System (ASOSS), and Rowe scores after primary and revision Latarjet procedures for treatment of shoulder instability. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Between January 2018 and January 2020, a retrospective review of 149 patients undergoing primary Latarjet (n = 82) and revision Latarjet (n = 67) to treat shoulder instability was performed in a single institution. Patient-reported outcome measures were collected preoperatively and 1 year postoperatively. The delta was defined as the change between the pre- and postoperative scores. Distribution-based and anchored-based approaches were used to estimate the MCID and the PASS, respectively. The optimal cutoff point and the percentage of patients achieving those thresholds were also calculated. RESULTS The distribution-based MCIDs after primary Latarjet were 1.1, 7.5, and 9.6 for the VAS, Rowe, and ASOSS scores, respectively. The rates of patients who achieved the MCID thresholds were 93.9%, 98.7%, and 100% for the VAS, Rowe, and ASOSS scores, respectively. The PASS thresholds after primary Latarjet were ≤1, ≥90, and ≥85 for the VAS, Rowe, and ASOSS scores, respectively. The percentages of patients who achieved PASS thresholds were 82.9%, 89%, and 86.5% for the VAS, Rowe, and ASOSS scores, respectively. The distribution-based MCIDs after revision Latarjet were 0.6, 6.2, and 3.4 for the VAS, Rowe, and ASOSS scores, respectively. The rates of patients who achieved MCID thresholds were 89.3%, 100%, and 100% for the VAS, Rowe, and ASOSS scores, respectively. The PASS thresholds were ≤3, ≥87, and ≥86 after revision Latarjet for the VAS, Rowe, and ASOSS scores, respectively. The rates of patients who achieved the PASS thresholds were 88%, 88%, and 91% for the VAS, Rowe, and ASOSS, respectively. CONCLUSION This study identified useful values for the MCID and PASS thresholds in VAS, Rowe, and ASOSS scores after primary and revision Latarjet procedures for treating shoulder instability. Most patients achieved MCID and PASS benchmarks, indicating successful primary and revision Latarjet procedure outcomes. These metrics can serve as valuable parameters when analyzing parameters in future studies and have the potential to enhance patient care by optimizing treatment strategies and surgical decision making.
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Affiliation(s)
- Ignacio Pasqualini
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Eoghan T Hurley
- Department of Orthopedic Surgery, Division of Hand and Upper Extremity, Duke University, Durham, North Carolina, USA
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Gao A, Song Q, Shao Z, Pan H, Cui G. Inlay structure can improve bone graft stability in the Bristow procedure. J Shoulder Elbow Surg 2024; 33:781-791. [PMID: 37778656 DOI: 10.1016/j.jse.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/09/2023] [Accepted: 08/27/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Compared with the Latarjet procedure, the Bristow procedure has a lower screw-related complication rate but poor bone healing. A modified Inlay Bristow procedure has been reported to significantly improve the bone healing rate, but the biomechanical mechanism is unclear. The aim of this study was to evaluate the biomechanical stability of the bone graft between a modified Inlay Bristow procedure and the classic Bristow procedure. METHODS Sixteen left scapula models (Sawbones, Composite Scapula, and fourth generation) were randomly divided into 2 groups (8:8). The bone graft in the first group was fixed with a 3.5 mm screw using the Inlay structure. The bone graft in the second group was fixed with a 3.5 mm screw via the traditional method. The maximum cyclic displacement, ultimate failure load and stiffness were evaluated biomechanically. The failure type was recorded for each model. RESULTS Cyclic loading tests demonstrated that the maximum cyclic displacement of the Inlay procedure was significantly smaller (P = .001) than that of the classic procedure. The Inlay Bristow technique resulted in a significantly higher (P = .024) ultimate failure load than the classic Bristow technique. The stiffness of the classic group was 19.17 ± 4.01 N/mm and that of the inlay group was 22.34 ± 5.35 N/mm (P = .232). Failure was mainly due to bone graft fractures through the drill hole or glenoid bone fractures. CONCLUSION Inlay Bristow fixation of the bone graft in a Sawbones model provides significantly stronger fixation and better time point zero stability than classic Bristow fixation, suggesting a higher likelihood of graft union.
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Affiliation(s)
- Aofei Gao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China; The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Qingfa Song
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Zhenxing Shao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
| | - Haile Pan
- The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
| | - Guoqing Cui
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
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Nolte AK, Bayer T, Jäger S, Raiss P, Wegmann K, Kretzer JP, Bülhoff M, Renkawitz T, Panzram B. Primary bone graft stability after Latarjet surgery: biomechanical evaluation of a fixation technique with metal-free all-suture cerclage vs. cortical screws. J Shoulder Elbow Surg 2024; 33:e175-e184. [PMID: 37652214 DOI: 10.1016/j.jse.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND To reduce hardware-related complications in coracoid graft fixation to the anterior aspect of the glenoid, a metal-free Latarjet technique was recently introduced. The aim of this study was to compare the primary stability of a classic Latarjet procedure with 2 metal screws to a novel metal-free, all-suture cerclage method. It is hypothesized that fixation of the coracoid graft with 2 malleolar screws will provide higher primary stability compared with an all-suture cerclage technique. METHODS This biomechanical in vitro study was conducted on 12 fresh-frozen cadaveric shoulders (6 matched pairs) with a mean donor age of 80 years (range, 67-89 years). Coracoid graft fixation was performed using a recently introduced all-suture cerclage technique (group A) or a classic Latarjet technique with two 4.5-mm malleolar screws (group B). The conjoint tendon was loaded with a static force of 10 N to simulate the sling effect. Graft loading with a probe head consisted of 6 ascending load levels (10-50 N, 10-100 N, 10-150 N, 10-200 N, 10-250 N, and 10-300 N) with 100 cycles each at 1 Hz. Relative motion of the bone graft to the glenoid was measured using an optic 3-dimensional system. RESULTS While loading the conjoint tendon with 10 N, no difference in mean displacement of the bone-graft was found between both groups (P = .144). During cyclic loading, a significant difference in relative displacement for both groups was already detected in load level 1 (group A: 2398.8 μm vs. group B: 125.7 μm; P = .024), and this trend continued with the following load levels (P < .05). DISCUSSION AND CONCLUSION The study demonstrated that the innovative metal-free, all-suture cerclage fixation technique results in higher micromotion than the classic coracoid graft fixation with 2 malleolar screws. According to the present biomechanical investigation, shoulders treated with a metal-free all-suture cerclage technique might need adapted rehabilitation protocols to protect the construct and allow for graft healing.
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Affiliation(s)
- Anna-Katharina Nolte
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany.
| | - Tobias Bayer
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jäger
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany; Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Patric Raiss
- Orthopädische Chirurgie München, Munich, Germany
| | | | - J Philippe Kretzer
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany; Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Bülhoff
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Panzram
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wang L, He S, Wu X, Lv X, Wang T, Tan H. Efficacy and safety of the Latarjet procedure for the treatment of athletes with glenoid bone defects ≥ 20%: a single-arm meta-analysis. J Orthop Surg Res 2024; 19:159. [PMID: 38429849 PMCID: PMC10908040 DOI: 10.1186/s13018-024-04641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The shoulder joint is the most commonly dislocated joint in the human body, and the recurrence rate exceeds 50% after nonsurgical treatment. Although surgical treatment reduces the recurrence rate, there is controversy regarding the optimal surgical approach. Previous studies suggest that the Latarjet procedure yields favourable outcomes for specific populations at risk of recurrence, such as competitive athletes with significant glenoid defects. However, most of the existing related research consists of nonrandomized controlled trials with small sample sizes, and there is a lack of strong evidence regarding the efficacy and safety of the Latarjet procedure. METHODS The PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched. Athletes with ≥ 20% glenoid defects were selected for inclusion. The following data were extracted: general patient information, instability rates, return to sports (RTS) rates, imaging features (graft positioning rate and graft healing rate), functional assessments [Rowe score, Athletic Shoulder Outcome Scoring System(ASOSS), visual analogue scale (VAS), forward flexion function, and external rotation function], and complications. RESULTS After excluding suspected duplicate cases, a total of 5 studies were included in this meta-analysis. The studies involved a total of 255 patients, including 237 males (93%) and 18 females (7%). The average age at the time of surgery was 25.4 ± 8.5 years. All the studies had a minimum follow-up period of 2 years, with an average follow-up time of 48.7 ± 18.9 months. The pooled rate of return to sport (RTS) was 94.3% (95% CI: 87.3%, 98.8%), and 86.1% (95% CI: 78.2%, 92.5%) of patients returned to their preoperative level of activity. The pooled redislocation rate was 1.1% (95% CI: 0%, 3.8%). Regarding the imaging results, the combined graft retention rate was 92.1% (95% CI: 88.1%, 95.5%), and the graft healing rate was 92.1% (95% CI: 88%, 95.4%). Postoperative functional evaluation revealed that the combined Rowe score, ASOSS score, and VAS score were 93.7 ± 6.5 points, 88.5 ± 4.4 points, and 1.1 ± 10 points, respectively. The forward flexion and external rotation angles were 170.9 ± 6.9 degrees and 65.6 ± 4.5 degrees, respectively. After excluding one study with unclear complications, the combined complication rate was 9.4% (95% CI: 1.0%, 23.6%). CONCLUSION For athletes with shoulder instability and a total of ≥ 20% glenoid bone defects, the Latarjet procedure can achieve excellent functional outcomes, with the majority of patients returning to preoperative levels of sports activity. This procedure also leads to a low recurrence rate. Therefore, the Latarjet procedure has been proven to be a safe and effective treatment.
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Affiliation(s)
- Ling Wang
- People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, 650100, China
| | - ShengRong He
- The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital/Yunnan Cancer Center), Kunming, 650100, China
| | - Xia Wu
- The Third People's Hospital of Kunming, Kunming, 650041, China
| | - XiaoYu Lv
- People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, 650100, China
| | - Tao Wang
- People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, 650100, China
| | - HongBo Tan
- People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, 650100, China.
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Park J, Kim DS, Huh H, Cho WG, Kim H, Lee DW. In Vivo 3-Dimensional Dynamic Evaluation of Shoulder Kinematics After the Latarjet Procedure: Comparison With the Contralateral Healthy Shoulder. Orthop J Sports Med 2024; 12:23259671241226909. [PMID: 38486807 PMCID: PMC10938626 DOI: 10.1177/23259671241226909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 03/17/2024] Open
Abstract
Background Researchers have attempted to understand the underlying mechanism of the Latarjet procedure; however, its effects on shoulder kinematics have not been well studied. Purpose/Hypothesis The purpose was to analyze shoulder kinematics after the Latarjet procedure. It was hypothesized that the nonanatomic transfer of the coracoid process during the procedure would affect normal shoulder kinematics. Study Design Controlled laboratory study. Methods The study included 10 patients (age range, 20-52 years) who underwent the modified Latarjet procedure between June 2016 and November 2021. Computed tomography and fluoroscopy were conducted on both shoulder joints of all patients, and 3-dimensional models were reconstructed. The 3-dimensional coordinates were encoded on the reconstructed models, and shoulder kinematics were analyzed through a 3-dimensional-2-dimensional model-image registration technique. Scapular rotation parameters (scapular upward rotation, posterior tilt, external rotation, and scapulohumeral rhythm) were compared between the Latarjet and the nonsurgical contralateral sides during humeral abduction, as was anteroposterior (AP) translation relative to the glenoid center during active humeral external rotation. Results The Latarjet side displayed significantly higher values of scapular upward rotation at higher degrees of humeral elevation (130°, 140°, and 150°) compared with the nonsurgical side (P = .027). Posterior tilt, external rotation, and scapulohumeral rhythm were not significantly different between sides. AP translation at maximal humeral rotation was not significantly different between sides (Latarjet, -0.06 ± 5.73 mm vs nonsurgical, 5.33 ± 1.60 mm; P = .28). Interestingly, on the Latarjet side, AP translation increased until 40° of humeral rotation (4.27 ± 4.64 mm) but began to decrease from 50° of humeral rotation. Conclusion The Latarjet side demonstrated significant changes in scapular upward rotation during higher degrees of humeral elevation compared with the contralateral shoulder. Posterior movement of the humeral head at >50° of humeral rotation could be the desired effect of anterior stabilization; however, researchers should evaluate long-term complications such as osteoarthritis. Clinical Relevance Analysis of shoulder kinematics after the Latarjet procedure could provide information regarding long-term outcomes and whether the procedure would affect the daily activities of patients.
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Affiliation(s)
- Jisu Park
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Republic of Korea
| | - Doo Sup Kim
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Republic of Korea
| | - Hyungkyu Huh
- Daegu-Gyeongbuk Medical Innovation Foundation, Dae-gu, Republic of Korea
| | - Won Gil Cho
- Department of Anatomy, Wonju College of Medicine, Yonsei University, Gangwon-do, Republic of Korea
| | - HyunWoo Kim
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Republic of Korea
| | - Dong-Woo Lee
- Department of Orthopaedics, Hanil General Hospital, Seoul, Republic of Korea
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Marigi EM, Lamba A, Boos A, Wang A, Okoroha KR, Barlow JD, Krych AJ, Camp CL. Outcomes of Shoulder Instability Surgery in Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 5 Years' Mean Follow-up. Am J Sports Med 2024; 52:586-593. [PMID: 38305257 DOI: 10.1177/03635465231218262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Wrestling is a physically demanding sport with young athletes prone to traumatic shoulder instability and a paucity of data evaluating the results of shoulder instability surgery (SIS). PURPOSE To assess reoperation rates, patient-reported outcomes, and return to wrestling (RTW) after SIS in a cohort of competitive wrestlers. STUDY DESIGN Case series; Level of evidence, 3. METHODS All competitive wrestlers with a history of shoulder instability and subsequent surgery at a single institution between 1996 and 2020 were identified. All directions of shoulder instability (anterior shoulder instability [ASI], posterior shoulder instability [PSI], and traumatic multidirectional shoulder instability [TMDI]) were analyzed. Exclusions included revision SIS and <2 years of follow-up. Athletes were contacted for determination of complications, RTW, and Western Ontario Shoulder Instability Index scores. RESULTS Ultimately, 104 wrestlers were included with a mean age at initial instability of 16.9 years (range, 12.0-22.7 years), mean age at surgery of 18.9 years (range, 14.0-29.0 years), and a mean follow-up of 5.2 years (range, 2.0-22.0 years). A total of 58 (55.8%) wrestlers were evaluated after a single shoulder instability event, while 46 (44.2%) sustained multiple events before evaluation. ASI was the most common direction (n = 79; 76.0%), followed by PSI (n = 14; 13.5%) and TMDI (n = 11; 10.6%). Surgical treatment was most commonly an arthroscopic soft tissue stabilization (n = 88; 84.6%), with open soft tissue repair (n = 13; 12.5%) and open bony augmentation (n = 3; 2.9%) performed less frequently. RTW occurred in 57.3% of wrestlers at a mean of 9.8 months. Recurrent instability was the most common complication, occurring in 18 (17.3%) wrestlers. Revision SIS was performed in 15 (14.4%) wrestlers. Across the entire cohort, survivorship rates free from recurrent instability and revision surgery were 90.4% and 92.5% at 2 years, 71.9% and 70.7% at 5 years, and 71.9% and 66.5% at 10 years, respectively. Preoperative recurrent instability was an independent risk factor for postoperative recurrent instability (hazard ratio, 3.8; 95% CI, 1.33-11.03; P = .012). CONCLUSION Competitive wrestlers with multiple dislocations before initial clinical evaluation were 3.8 times more likely to experience postoperative recurrent instability. Patients should be counseled that despite SIS, only 57.3% returned to wrestling after surgery.
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Affiliation(s)
- Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Boos
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Allen Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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10
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Paul K, Elphingstone JW, Williams M, Manfredi JN, Jardaly A, Schick S, Floyd S, Brabston EW, Momaya AM, Ponce BA. Suspensory fixation for bone transfer procedures in shoulder instability is superior to screws in an angled construct: a biomechanical analysis. JSES Int 2024; 8:250-256. [PMID: 38464447 PMCID: PMC10920126 DOI: 10.1016/j.jseint.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background The Latarjet procedure is a common bony augmentation procedure for anterior shoulder instability. Historically, screw fixation is used to secure the coracoid graft to the anterior glenoid surface; however, malpositioning of the graft leads to oblique screw insertion that contributes to complications. Suture buttons (SBs) are a more recent fixation technique that have not been studied alongside standard screw fixation in the context of biomechanical models of angulated fixation. This study aims to compare the biomechanical strength of single and double, screw and SB fixation at various levels of angulation. Methods Testing was performed using polyurethane models from Sawbones. The graft piece was secured with screw fixation (Arthrex, Naples, FL, USA) or suspensory button (ABS Tightrope, Arthrex, Naples, FL, USA). Single or double constructs of screws and SBs were affixed at 0°, 15°, and 30° angles to the face of the glenoid component. An aluminum testing jig held the samples securely while a materials testing system applied loads. Five constructs were used for each condition and assessed load to failure testing. Results For single fixation constructs, suspensory buttons were 60% stronger than screws at 0° (P < .001), and 52% stronger at 15° (P = .004); however, at 30°, both were comparable (P = .180). Interestingly, single suspensory button at 15° was equivalent to a single screw at 0° (P = .310). For double fixation, suspensory buttons (DT) were 32% stronger than screws at 0° (P < .001) and 35% stronger than screws at 15° (P < .001). Both double fixation methods were comparable at 30° (P = .061). Suspensory buttons at 15° and 30° were equivalent to double screws at 0 (P = .280) and 15° (P = .772), respectively. Conclusion These measurements indicate that the suspensory button has a significantly higher load to failure capacity over the screw fixation technique, perpendicularly and with up to 15° of angulation. These analyses also indicate that the suspensory button fixation offers superior strength even when positioned more obliquely than the screw fixation. Therefore, suspensory button fixation may confer more strength while offering greater margin for error when positioning the graft.
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Affiliation(s)
- Kyle Paul
- Department of Orthopedic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Joseph W. Elphingstone
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marshall Williams
- Department of Orthopedic Surgery, The Hughston Clinic, Columbus, GA, USA
| | - John N. Manfredi
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Achraf Jardaly
- Department of Orthopedic Surgery, The Hughston Clinic, Columbus, GA, USA
| | - Samuel Schick
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Susan Floyd
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eugene W. Brabston
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amit M. Momaya
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent A. Ponce
- Department of Orthopedic Surgery, The Hughston Clinic, Columbus, GA, USA
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Liow RYL, Adam J, Holland P, Bhatti A. Bulk osteochondral allograft for massive Hill-Sachs defect combined with Latarjet procedure for bipolar bone loss in anterior instability. Shoulder Elbow 2024; 16:106-113. [PMID: 38435034 PMCID: PMC10902417 DOI: 10.1177/17585732221146177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/20/2022] [Accepted: 11/28/2022] [Indexed: 03/05/2024]
Abstract
A proportion of patients with anterior glenohumeral instability present with bipolar bone loss comprising large Hill-Sachs lesions and substantial glenoid defect. These are surgically difficult cases to treat. We describe a novel surgical procedure of bulk size-matched osteochondral allograft reconstruction for massive Hill-Sachs lesions combined with the Latarjet procedure for these challenging cases.
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Affiliation(s)
- Raymond Y L Liow
- Department of Trauma and Orthopaedics, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - John Adam
- Department of Trauma and Orthopaedics, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Philip Holland
- Department of Trauma and Orthopaedics, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Amjad Bhatti
- County Durham and Darlington NHS Foundation Trust, Durham, UK
LEVEL OF EVIDENCE: IV (Technical Note)
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12
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Hurley ET, Lunn K, Bethell M, Levin J, Pasqualini I, Frangiamore S, Anakwenze O, Klifto CS. Return to play following operative management of anterior shoulder instability in overhead athletes-A systematic review. Shoulder Elbow 2024; 16:15-23. [PMID: 38435042 PMCID: PMC10902415 DOI: 10.1177/17585732231205175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 03/05/2024]
Abstract
Background The purpose of this study was to systematically review the rate and timing of return to play in overhead athletes following operative management of anterior shoulder instability. Methods A systematic literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to play among overhead athletes following arthroscopic Bankart repair, open Latarjet procedure or Remplissage procedure. Results There are 23 studies included with 961 patients. Among those undergoing arthroscopic Bankart repair, the rate of return to play was 86.2%, with 70.6% returning to the same level of play and the mean time to return to play was 7.1 months. Among those undergoing an open Latarjet procedure, the rate of return to play was 80.9%, with 77.7% returning to the same level of play and the mean time to return to play was 5.1 months. Among those undergoing a Remplissage procedure, the rate of return to play was 70.6%, with 70.0% returning to the same level of play or mean time to return to play. Discussion Overall, there were high rates of return to play following operative management of anterior shoulder instability in overhead athletes.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Kiera Lunn
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Jay Levin
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | | | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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13
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Soeding P, Morris A, Soeding A, Hoy G. Effect of intravenous magnesium on post-operative pain following Latarjet shoulder reconstruction. Shoulder Elbow 2024; 16:46-52. [PMID: 38435030 PMCID: PMC10902413 DOI: 10.1177/17585732231158805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 01/24/2023] [Accepted: 02/04/2023] [Indexed: 03/05/2024]
Abstract
Background Single injection ropivacaine interscalene anesthesia (ISA) is frequently used in Latarjet reconstruction to enhance post-operative analgesia. A potential limitation is the occurrence of severe rebound pain on block resolution. We investigated the effect of intravenous magnesium on post-operative pain, particularly at the transition of block resolution to multimodal analgesia. Methods Elective patients (n = 40) having Latarjet open shoulder reconstruction were randomised to receive either intravenous magnesium sulphate 50 mg/kg (M) or normal saline (S) before induction. Post-operatively, a standardised analgesic regimen was used, and post-operative pain was recorded using a verbal numerical rating assessment (VNRA) score. Requirement for injected opioid analgesia was recorded. Results ISA provided longstanding analgesia in all patients with block duration slightly prolonged in the magnesium group (16.7(1.0) (S), 17.8(1.3) h (M), p = 0.049). Magnesium resulted in less rebound pain following ISA resolution (VNRA 4.0 (0.6) M, 6.2 (0.8) S, p = 0.03) and lower pain intensity at 24 h. Four patients had nausea and two required rescue opioid injection. Conclusion Magnesium before Latarjet surgery results in less rebound pain following ropivacaine block and improves post-operative analgesia. Magnesium may be indicated in major upper limb surgery, where significant pain intensity is anticipated. Level of evidence Treatment study; Randomised blinded; Level 2.
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Affiliation(s)
- Paul Soeding
- FANZCA Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Pharmacology and Therapeutics, The University of Melbourne, Victoria, Australia
| | - Alex Morris
- The University of Melbourne, Victoria, Australia
- Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Adam Soeding
- Department of Preventative Medicine, The Alfred Centre Monash University, Prahran, Australia
| | - Gregory Hoy
- Melbourne Orthopaedic Group, Monash University Department of Surgery, Windsor, Australia
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Alnusif N, Lari A, AlQahtani S, Athwal GS. Strength after the arthroscopic Latarjet procedure: Are shoulder internal rotation, elbow flexion & supination strength decreased? Shoulder Elbow 2024; 16:53-58. [PMID: 38435038 PMCID: PMC10902414 DOI: 10.1177/17585732231165227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/08/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2024]
Abstract
Background The Latarjet procedure is an effective shoulder stabilizing surgery, however, the procedure results in an alteration of anatomy that may result in shoulder and elbow weakness. Thus, the purpose of this study was to assess post-operative shoulder and elbow strength after the Latarjet procedure. We hypothesized that shoulder and elbow strength are not affected after the procedure. Methods The study group consisted of patients that had undergone the arthroscopic Latarjet procedure. An isokinetic dynamometer was used to evaluate the strength of bilateral shoulder internal rotation, elbow flexion, forearm supination using peak torque (N/m), as well as grip strength (kilograms). Shoulder range of motion and the potential effects of hand dominance were further analysed. Results Nineteen patients with a mean age of 29 years and an average follow up of 47 months were included. Shoulder internal rotation strength, elbow flexion and forearm supination strength and grip strength were not significantly different when compared to the non-operative side (p > 0.13). The range of shoulder external rotation was significantly reduced (p < 0.001) on the Latarjet side. Conclusion The results from this study demonstrate no statistically significant differences in the strength of shoulder internal rotation, elbow flexion, forearm supination or grip strength despite the surgical alterations to the subscapularis and conjoint tendon.
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Affiliation(s)
- Naser Alnusif
- St Joseph's Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
- Department of Orthopedic Surgery, AlRazi Orthopedic Hospital, Kuwait City, Kuwait
| | - Ali Lari
- Department of Orthopedic Surgery, AlRazi Orthopedic Hospital, Kuwait City, Kuwait
| | - Saad AlQahtani
- Department of Orthopedic Surgery, King Fahad Hospital of the University, Imam AbdulRahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - George S Athwal
- St Joseph's Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
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Baur A, Satalich J, O'Connell R, Vap A. Surgical management of recurrent instability following Latarjet procedure - A systematic review of salvage procedures. Shoulder Elbow 2024; 16:24-32. [PMID: 38435040 PMCID: PMC10902410 DOI: 10.1177/17585732231226123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 03/05/2024]
Abstract
Background Failed Latarjet procedures pose a surgical challenge due to complex anatomical issues. This systematic review investigates salvage techniques for recurrent instability following a Latarjet procedure. Methods A search was conducted on MEDLINE and PubMed Central following the methodology registered to International Prospective Register of Systematic Reviews. Inclusion criteria focused on identifying revision procedures following a Latarjet procedure. Exclusion criteria filtered out irrelevant studies, such as those focused on Bankart procedures. After a multistage selection process, 10 eligible studies were included for data extraction. Results The most frequently utilized technique for salvage was variations of the Eden-Hybinette procedure. Complications associated with these salvage procedures include graft-related problems and donor site morbidity. Patients reported significant improvements in multiple patient-reported outcome scores, and multiple studies indicated high rates of return to sports activities. However, it is noteworthy that there remains an average recurrence rate of 7%. Discussion The review emphasizes the limited therapeutic options available largely due to shoulder anatomy alterations. Despite promising trends in patient-reported outcomes, recurrence remains possible post-salvage surgeries. Conclusion Addressing recurrent instability after a Latarjet procedure continues to be a unique surgical challenge. However, this systematic review highlights encouraging indications, with positive trends evident in patient-reported outcomes.
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Affiliation(s)
- Alexander Baur
- Liberty University College of Osteopathic Medicine, Lynchburg, VA, USA
| | - James Satalich
- PGY-5, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Robert O'Connell
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Alexander Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Dalmas Y, Thélu CE, Laumonerie P, Mathieu E, Robert S, Mansat P, Bonnevialle N. The arthroscopic double-button Latarjet does not modify the static posterior translation of the humeral head. Orthop Traumatol Surg Res 2024; 110:103662. [PMID: 37460084 DOI: 10.1016/j.otsr.2023.103662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/16/2023] [Accepted: 05/10/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION The Latarjet procedure treats anterior instability of the shoulder and is based on a triple anterior lock, where the conjoint tendon straps the lower third of the subscapularis muscle. Excessive posterior translation of the humeral head is a known risk factor for shoulder osteoarthritis. No in vivo study has investigated the effect of the bone block on the posterior static translation of the humeral epiphysis. The purpose of this study was to evaluate the effect of the bone block on the static posterior translation of the humeral head. The hypothesis was that this procedure increased this translation. MATERIALS AND METHODS This retrospective study included patients treated arthroscopically for anterior shoulder instability by a double-button Latarjet. An independent examiner analyzed the CT scans preoperatively, at 15 days, and at least 6 months postoperatively according to a standardized protocol. The analysis focused on the position of the bone block in the axial and coronal planes relative to the glenoid. The posterior translation was automatically calculated using the Blueprint© planning software. RESULTS Thirty-five patients were included with a mean age of 25 years (16-43), according to a 4M/1F sex ratio. The graft was perfectly flush to the subchondral bone in 63% (n=22) of cases and subequatorial in 91% (n=32). Preoperative posterior humeral translation was 52%. The mean immediate postoperative posterior humeral translation was 56%, and 57% at more than 6 months. The change in mean posterior humeral translation between preoperative/6 months was +0.94% [-20%; +12%] (p=0.29) and immediate postoperative/6 months +0.34% [-18%; +15%] (p=0.84). Gender, hypermobility and the axial position of the bone block did not influence the change in posterior humeral translation. The equatorial position of the bone block appeared to increase posterior humeral translation by +10%±5.2% [-0.427; 20.823] (p=0.07). CONCLUSION This work refutes our initial hypothesis. The change in static posterior humeral translation after arthroscopic Latarjet bone block remains stable at more than 6 months of follow-up. This procedure does not alter the anatomical position of the humeral head in relation to the glenoid. On the other hand, a more cranial positioning of the bone block could have an influence. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yoann Dalmas
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France.
| | - Charles-Edouard Thélu
- Clinique du sport et de chirurgie orthopédique, 199, rue de la Rianderie, 59700 Marcq-en-Barœul, France
| | - Pierre Laumonerie
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France
| | - Emilie Mathieu
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France
| | - Suzanne Robert
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France
| | - Pierre Mansat
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France; Laboratoire de biomécanique, IMFT-UMR-CNRS 5502, hôpital Pierre Paul Riquet, Toulouse, France
| | - Nicolas Bonnevialle
- Département de chirurgie orthopédique et traumatologique du CHU de Toulouse, hôpital Pierre Paul Riquet, université de Toulouse III, Toulouse, France; Laboratoire de biomécanique, IMFT-UMR-CNRS 5502, hôpital Pierre Paul Riquet, Toulouse, France
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Paul RW, Perez AR, Windsor JT, Osman A, Romeo AA, Erickson BJ. Analysis of reasons for failure to return to sport after Latarjet surgery: a systematic review. J Shoulder Elbow Surg 2024:S1058-2746(23)00888-1. [PMID: 38182027 DOI: 10.1016/j.jse.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/25/2023] [Accepted: 11/12/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND The purpose of this study was to perform a systematic review of the literature to identify Shoulder Instability Return to Sport after Injury (SIRSI) scores in athletes who underwent open Latarjet surgery, determine the reasons why athletes failed to return to play (RTP) after Latarjet surgery, and compare SIRSI scores of those who did vs. did not RTP. METHODS According to PRISMA guidelines, the PubMed, SportDiscus, and Ovid MEDLINE databases were queried to identify studies evaluating return to sport after Latarjet surgery. Study quality was assessed using the MINORS criteria. Studies were included if RTP after Latarjet surgery and a psychological factor were evaluated, with potential psychological factors including readiness to RTP and reasons for failure to RTP. RESULTS Fourteen studies, 10 of level III evidence and 4 of level IV evidence, with 1034 patients were included. A total of 978 athletes were eligible to RTP. Of these, 792 (79%) successfully returned to play and 447 (56.4%) returned to play at their previous level of play. Mean RTP time was 6.2 months. Postoperative SIRSI scores averaged 71.2 ± 8.8 at a mean of 21 months' follow-up. Postoperative SIRSI scores for those able to RTP was 73.2, whereas athletes unable to RTP scored an average of 41.5. Mean postoperative SIRSI scores for those in contact sports was 71.4, whereas those in noncontact sports was 86.5. There were 31 athletes with a documented reason why they did not RTP, with postoperative shoulder injury being the most common reason (54.5%). Fear of reinjury and feeling "not psychologically confident" each represented 6.5% of the total. CONCLUSION Athletes who RTP have higher average SIRSI scores than those who are unable to RTP. Of the athletes who documented why they did not RTP, more than half cited a shoulder injury as their reason for not returning to play, whereas fear of reinjury and lack of psychological readiness were other common reasons.
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Affiliation(s)
- Ryan W Paul
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA; Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Andres R Perez
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA; University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Alim Osman
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Anthony A Romeo
- Division of Sports Medicine, Duly Health and Care, Chicago, IL, USA
| | - Brandon J Erickson
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, New York, NY, USA; Department of Orthopedic Surgery, New York University Langone, New York, NY, USA.
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Limam K, Barret H, Girard M, Letartre R, Mansat P, Bonnevialle N. Latarjet in women for anterior shoulder instability: a case series analysis. Eur J Orthop Surg Traumatol 2024; 34:633-639. [PMID: 37668751 DOI: 10.1007/s00590-023-03703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE The Latarjet procedure is traditionally used to treat chronic anterior shoulder instability associated with glenoid bone loss. However, few series have analyzed outcomes in a female-only population. The objective of this study was to evaluate the clinical and radiological outcomes of a Latarjet bone block in this specific population. METHODS This single-center retrospective study included 15 women (mean age 35 ± 11.3; 19-60) reviewed with a minimum follow-up of 2 years. The procedure was performed using the open bone block screw technique (n = 7) or by arthroscopy with cortical button (n = 8). Clinical evaluation was based on active range of motion measurements, Rowe and Walch-Duplay scores, and subjective shoulder value (SSV). Radiographic analysis explored bone block healing at the last follow-up. RESULTS At a mean follow-up of 48 months (32-86), no recurrence was reported. The mean Rowe score was 91 points (70-100), Walch-Duplay 90 points (60-100), and SSV 87% (70-100). The active mobilities reached 169° (± 9°) in elevation, 57° (± 15°) in external rotation at side, and 89° (± 6°) in abduction. The return-to-sport rate was 91%. Five patients experienced persistent anterior pain, with screws requiring hardware removal in 2 (p = 0.02). Radiological assessment detected one case of nonunion (7%). CONCLUSION Women treated with the Latarjet procedure experienced satisfactory midterm clinical outcomes. The arthroscopic technique using cortical button fixation seems to avoid residual anterior pain requiring hardware removal.
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Affiliation(s)
- Kenza Limam
- Service de Chirurgie Orthopédique et du Sport, Hôpital Pierre Paul Riquet, CHU de Toulouse, Place du Dr Baylac, 31059, Toulouse, France
- Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Hugo Barret
- Service de Chirurgie Orthopédique et du Sport, Hôpital Pierre Paul Riquet, CHU de Toulouse, Place du Dr Baylac, 31059, Toulouse, France
- Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Mathieu Girard
- Service de Chirurgie Orthopédique et du Sport, Hôpital Pierre Paul Riquet, CHU de Toulouse, Place du Dr Baylac, 31059, Toulouse, France
- Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France
| | | | - Pierre Mansat
- Service de Chirurgie Orthopédique et du Sport, Hôpital Pierre Paul Riquet, CHU de Toulouse, Place du Dr Baylac, 31059, Toulouse, France
- Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Nicolas Bonnevialle
- Service de Chirurgie Orthopédique et du Sport, Hôpital Pierre Paul Riquet, CHU de Toulouse, Place du Dr Baylac, 31059, Toulouse, France.
- Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France.
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Coifman I, Valencia M, Ariza A, Clascá F, Calvo E. [Translated article] Latarjet procedure for shoulder instability: Implications in the innervation of the subscapularis muscle. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T1-T8. [PMID: 37981199 DOI: 10.1016/j.recot.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/01/2023] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION Our aim was to describe whether Latarjet's technique affects subscapularis muscle innervation. MATERIALS AND METHODS We studied 12 embalmed shoulders. Subscapularis muscle innervation pattern was registered. Dimensions of the subscapularis at the glenohumeral joint line and the nerves entry point were measured. Horizontal distances from the nerves to the glenohumeral joint line as well as vertical ones to the split were measured before and after Latarjet procedure. A safe zone for the split was designed to avoid damage to subscapularis innervation. RESULTS Subscapularis muscle is innervated by three principal branches: upper, middle, and inferior subscapularis nerves. No statistical differences were found between innervation distances before and after Latarjet procedure. To perform subscapularis split along the muscle safe zone, two thirds' proportions throughout all the split must be maintained. CONCLUSIONS Subscapularis muscle has a triple innervation and was not altered after Latarjet procedure. Therefore, Latarjet technique seems to respect subscapularis muscle innervation if its split is placed through the subscapularis muscle safe zone.
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Affiliation(s)
- I Coifman
- Unidad de Cirugía Reconstructiva de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
| | - M Valencia
- Unidad de Cirugía Reconstructiva de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - A Ariza
- Unidad de Cirugía Reconstructiva de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - F Clascá
- Departamento de Anatomía, Histología y Neurociencia, Facultad de Medicina de la Universidad Autónoma, Madrid, Spain
| | - E Calvo
- Unidad de Cirugía Reconstructiva de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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20
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Coifman I, Valencia M, Ariza A, Clascá F, Calvo E. Latarjet procedure for shoulder instability: Implications in the innervation of the subscapularis muscle. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:1-8. [PMID: 36642371 DOI: 10.1016/j.recot.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Our aim was to describe whether Latarjet's technique affects subscapularis muscle innervation. MATERIALS AND METHODS We studied 12 embalmed shoulders. Subscapularis muscle innervation pattern was registered. Dimensions of the subscapularis at the glenohumeral joint line and the nerves entry point were measured. Horizontal distances from the nerves to the glenohumeral joint line as well as vertical ones to the split were measured before and after Latarjet procedure. A safe zone for the split was designed to avoid damage to subscapularis innervation. RESULTS Subscapularis muscle is innervated by three principal branches: upper, middle, and inferior subscapularis nerves. No statistical differences were found between innervation distances before and after Latarjet procedure. To perform subscapularis split along the muscle safe zone, two thirds' proportions throughout all the split must be maintained. CONCLUSIONS Subscapularis muscle has a triple innervation and was not altered after Latarjet procedure. Therefore, Latarjet technique seems to respect subscapularis muscle innervation if its split is placed through the subscapularis muscle safe zone.
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Affiliation(s)
- I Coifman
- Unidad de Cirugía Reconstructiva de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, España.
| | - M Valencia
- Unidad de Cirugía Reconstructiva de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, España
| | - A Ariza
- Unidad de Cirugía Reconstructiva de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, España
| | - F Clascá
- Departamento de Anatomía, Histología y Neurociencia, Facultad de Medicina, Universidad Autónoma, Madrid, España
| | - E Calvo
- Unidad de Cirugía Reconstructiva de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, España
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Reddy RP, Como M, Charles S, Herman ZJ, Nazzal EM, Como CJ, Singh-Varma A, Fails A, Popchak A, Lin A. Criteria-based return to sport testing after open Latarjet reveals residual deficits and can be utilized for sports clearance with excellent outcomes at mean 3.6 year follow-up: A small case series of competitive athletes. Phys Ther Sport 2024; 65:23-29. [PMID: 37995416 DOI: 10.1016/j.ptsp.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the use of a criteria-based return to sport (CBRTS) test to evaluate readiness for return to play (RTP) in competitive athletes that underwent open Latarjet. DESIGN Retrospective case series. METHODS Ten competitive athletes (mean age 19.9 years) treated with open Latarjet for recurrent glenohumeral instability underwent CBRTS testing at a mean of 5.3 months postoperatively. Testing consisted of four components: 1. isometric strength, 2. isokinetic strength, 3. endurance, and 4. function. Patients failing 0 or 1 component of the test were cleared to RTP. Patients failing multiple components underwent additional deficit-based rehabilitation. RESULTS Of the 10 patients that tested, 4 passed their overall CBRTS test and were cleared to RTP. The remaining 6 patients failed the overall CBRTS test. Seven patients (70%) failed at least one section of the strength testing, two patients (20%) failed endurance testing, and two patients (20%) failed functional testing. At final follow-up (mean 3.6 years), 1 patient had recurrent instability (10%) and 9 patients returned to play (90%). CONCLUSIONS CBRTS testing may be clinically useful for return to play clearance decisions after open Latarjet procedure, as it can reveal deficits that may not be identified with time-based clearance alone.
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Affiliation(s)
- Rajiv P Reddy
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Matthew Como
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Shaquille Charles
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Ehab M Nazzal
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Christopher J Como
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Anya Singh-Varma
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Alex Fails
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Adam Popchak
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA.
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Khan AZ, Fares MY, Abboud JA. Distal Radius Allograft for Glenohumeral Instability: A Novel Osteochondral Allograft Reconstruction Option in the Setting of Glenoid Bone Loss. Am J Sports Med 2024; 52:201-206. [PMID: 38164671 DOI: 10.1177/03635465231210938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Distal tibial allograft (DTA) reconstruction for glenoid bone loss is nonanatomic, as it does not match the glenoid radius of curvature (ROC) in the anterior-posterior (AP) plane. The dorsal articular portion of the distal radius has not been previously described as an allograft reconstruction option for glenoid bone loss. PURPOSE To evaluate distal radius fresh-frozen allograft (DRA) as a potential match for glenoid reconstruction. STUDY DESIGN Controlled laboratory study. METHODS Eighteen fresh-frozen human cadaveric specimens-including 6 shoulder, 6 wrist, and 6 tibia specimens-were used. The ROC and the graft length were measured in the superior-inferior (SI) plane. A 30% defect was created in all glenoid specimens, and both DTAs and DRAs were harvested to assess graft fit after fixation. Computed tomography analysis was used to assess bony ROC and bone mineral density (BMD). RESULTS The cadaveric specimens had a mean age of 77 years. The mean SI glenoid length was 39.7 mm compared with 36.8 mm for the DRA and 30 mm for the DTA. The ROC in the SI plane was 29 ± 5.3 mm for the glenoid, 37.8 ± 4.9 mm for the DRA, and 24 ± 3.7 mm for the DTA. In the AP plane, the ROC was 39.6 ± 6.6 mm for the glenoid, 30.4 ± 18.6 mm for the DRA, and 126.3 ± 9.5 mm for the DTA. On computed tomography analysis, the ROC in the SI plane was 30.4 ± 1.5 mm for the glenoid, 30.3 ± 5.6 mm for the DRA, and 24.5 ± 9.4 mm for the DTA. In the AP plane, the ROC was 30.8 ± 2 mm for the glenoid, 19.1 ± 2.3 mm for the DRA, and 46.7 ± 21.7 mm for the DTA. The BMD was 226.3 ± 79 Hounsfield units (HU) for the glenoid, 228.5 ± 94.7 HU for the DRA, 235 ± 96.2 HU for the coracoid process, and 235.1 ± 84.6 HU for the DTA. CONCLUSION Compared with the DTA, the DRA had a greater mean graft length in the SI plane, providing utilization in cases of larger bony defects; the DRA has a more acute ROC in the AP plane (closer to that of the glenoid), providing a greater potential buttress to anterior humeral translation. Compared with currently utilized grafts, the DRA BMD was not significantly diminished. This study presents the DRA as a novel allograft reconstruction option in the setting of anterior glenoid bone loss; further biomechanical and clinical investigation is indicated.
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Affiliation(s)
- Adam Z Khan
- Southern California Permanente Medical Group, Panorama City, California, USA
| | - Mohamad Y Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Joseph A Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
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Thamrongskulsiri N, Limskul D, Tanpowpong T, Kuptniratsaikul S, Itthipanichpong T. Clinical Outcomes, Union Rates, and Complications of Screw Versus Button Fixation in the Bristow- Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review and Meta-Analysis. Clin Orthop Surg 2023; 15:1000-1012. [PMID: 38045573 PMCID: PMC10689233 DOI: 10.4055/cios23154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/24/2023] [Accepted: 07/14/2023] [Indexed: 12/05/2023] Open
Abstract
Background The Latarjet procedure is a common procedure for treating critical glenoid bone loss in anterior shoulder instability. Implants such as the screw and cortical button are widely used. The aim of this study was to compare studies on screw versus button fixation techniques in the Bristow-Latarjet procedure for anterior shoulder instability in terms of clinical outcomes, union rates, and complications. Methods The PubMed, Scopus, and Embase databases were searched to find comparative studies that reported outcomes of using screw versus button fixation in the Bristow-Latarjet procedure following the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies that directly compared the screw and button fixation techniques and provided postoperative patient-reported outcomes, union rates, or complications were included. The Methodology Index for Non-Randomized Research (MINORS) criteria were used to assess the quality of the included studies. Odds ratios (ORs) were calculated for dichotomous outcomes whereas mean differences were calculated for continuous outcomes. Results Five articles included a total of 877 shoulders. All five studies had level 3 evidence. There was no statistically significant difference between the two techniques using the Walch-Duplay score, visual analog scale for pain, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, range of motion, and graft union rates. However, the button fixation technique had statistically significantly higher recurrence rates than the screw fixation technique (OR, 0.24; 95% confidence interval, 0.10-0.58; p = 0.001). Conclusions The screw fixation technique had statistically significantly lower recurrence rates than the button fixation technique. However, there was no significant difference between screw and button fixation techniques regarding postoperative patient-reported outcomes, range of motion, graft union rates, nerve injury rates, infection rates, and reoperation rates.
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Affiliation(s)
- Napatpong Thamrongskulsiri
- Department of Anatomy, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Danaithep Limskul
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanathep Tanpowpong
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somsak Kuptniratsaikul
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thun Itthipanichpong
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Karavan MP, Hurley ET, Mills FB, Pasqualini I, Rossi L, Dickens JF, Anakwenze O, Mullett H, Millett PJ, Klifto CS. Primary Latarjet procedure versus Latarjet in the setting of previously failed Bankart repair: a systematic review. J ISAKOS 2023; 8:490-496. [PMID: 37666300 DOI: 10.1016/j.jisako.2023.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES The purpose of this study is to systematically review the comparative studies in the literature to compare the outcomes of the Latarjet procedure in the setting of a previously failed Bankart repair versus those undergoing the Latarjet procedure as a primary surgery for anterior shoulder instability. METHODS A systematic search in Pubmed, EMBASE, and The Cochrane Library databases was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Cohort studies comparing outcomes in the Latarjet procedure as a primary surgery versus the Latarjet procedure in the setting of a previously failed Bankart repair were included. RESULTS Ten studies with 1913 patients were included. There was a significantly lower rate of recurrent instability in those with a Latarjet procedure as a primary surgery (4.8% vs 12.1%, p = 0.007). There was also a significantly lower rate of complications with the Latarjet procedure as a primary surgery (6.2% vs 10.2%, p = 0.03). Furthermore, there was a significant difference in the rate of revision surgery in favour of the Latarjet procedure as a primary surgery (4.8% vs 10.9%, p = 0.02). However, there were similar rates of redislocations (2.8% vs 3.4%, p = 0.82) and return to play (67.7% vs 78.5%, p = 0.30) between the two cohorts. CONCLUSION This study found that the Latarjet procedure as a revision procedure for a previously failed Bankart repair resulted in higher rates of complications, recurrent instability, and revisions than the Latarjet procedure performed as a primary procedure. LEVEL OF EVIDENCE Level III, Systematic Review & Meta-Analysis of Level III studies.
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Affiliation(s)
- Mark P Karavan
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA.
| | - F Baker Mills
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA
| | - Ignacio Pasqualini
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA
| | - Luciano Rossi
- Italian Hospital Buenos Aires, Buenos Aires, Argentina
| | - Jonathan F Dickens
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA
| | - Oke Anakwenze
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA
| | | | | | - Christopher S Klifto
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA
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25
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Davey MS, Hurley ET, Liu K, White-Gibson A, Molony DC, Moran CJ, Delaney RA, Mullett H. The clinical utility of immediate post-operative PACU plain film radiographs following uncomplicated open Latarjet procedure - An institutional series of consecutive patients. J Orthop 2023; 46:178-181. [PMID: 38037554 PMCID: PMC10685133 DOI: 10.1016/j.jor.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
Background Immediate post-operative plain film radiograph x-rays in PACU following open Latarjet procedure are often ordered as routine. However, such radiographs utilize institutional cost and time, whilst potentially exposing patients to often-unnecessary additional radiation. This study sought to evaluate whether routine immediate post-operative radiographs following uncomplicated open Latarjet procedures impacted clinical decision-making in our institution. Methods From 2017 to 2020, patients who underwent open Latarjet procedure by one of four fellowship-trained upper limb surgeons at a single institution were included in this study. Post-operative radiographs taken immediately in PACU were reviewed to determine if any reported radiographic findings impacted on clinical decision-making in the immediate post-operative setting. SPSS was used for descriptive statistics. Results A total of 337 patients underwent an X-ray in PACU immediate after uncomplicated open Latarjet procedure. Overall, 98.5% were male (n = 332), the mean patient age of included patients was 22.9 ± 4.2 years. No patient had an abnormal finding on their post-operative x-ray. Two patients returned to the operating room in the immediate post-operative period, both requiring washout and debridement due to haemtoma or superficial wound infection. Conclusion The findings of this study suggest that the use of post-operative plain films in PACU following open Latarjet procedure remains a costly use of resources, with little ultimate impact on clinical decision making in the short-term post-operatively. Level of Evidence IV - Institutional Case Series of Consecutive Patients.
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Affiliation(s)
| | | | - Kathy Liu
- Sports Surgery Clinic, Dublin, Ireland
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Jegatheesan V, Patel D, Lu V, Domos P. Outcomes of primary Latarjet vs. revision Latarjet after prior surgery for anterior shoulder instability: a systematic review and meta-analysis. J Shoulder Elbow Surg 2023; 32:2599-2612. [PMID: 37541335 DOI: 10.1016/j.jse.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Latarjet has become an increasingly popular treatment option for recurrent anterior shoulder instability. With the reported complication rates for primary Latarjet surgery, there are concerns about the complications of Latarjet as a revision surgery. It remains unclear if poor results after previous surgical management can be improved with revision Latarjet as well as with primary Latarjet. The aim of this systematic review and meta-analysis is to compare the outcomes of primary Latarjet and revision Latarjet for the treatment of anterior shoulder instability. METHODS A systematic search was performed on 3 databases for studies that compared primary Latarjet with revision Latarjet used after failed arthroscopic stabilization or failed free bone block procedures. From the included studies, demographic data, clinical outcome scores, range of motion measurements, and postoperative complications were obtained. RESULTS A total of 11 studies were included for data analysis. Compared with the primary Latarjet cohort, revision Latarjet cohorts had a higher infection rate (1.2% vs. 2.6%; RR 0.46, P = .039). The primary Latarjet group showed a greater rate of return to sport (89.7% vs. 80.5%; RR 1.12, P = .41) and less subjective feeling of instability (12.6% vs. 20.9%; RR 0.60, P = .085) compared with the revision Latarjet group; however, this was not statistically significant. There were no significant differences in complication rates, reoperation, recurrence, and range of motion between primary Latarjet and revision Latarjet groups. Clinical outcome scores such as visual analog scale and Rowe scores were not significantly different between the cohorts. CONCLUSION Based on the current evidence, primary Latarjet presents reduced infection rates but similar clinical outcome measures, overall complication, and range of motion measurements than revision Latarjet performed after failed prior operative treatment.
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Affiliation(s)
| | - Dhruv Patel
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Peter Domos
- Department of Trauma and Orthopaedics, Barnet and Chase Farm Hospitals, Royal Free London NHS Foundation Trust, London, United Kingdom
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Dey R, Glenday J, du Plessis JP, Kauta N, Sivarasu S, Roche S. Moment arms of the coracobrachialis and short head of biceps following a Latarjet procedure: a modeling study. J Shoulder Elbow Surg 2023:S1058-2746(23)00827-3. [PMID: 38008373 DOI: 10.1016/j.jse.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/26/2023] [Accepted: 10/18/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND The Latarjet procedure transfers the coracoid process to the anterior glenoid. This prevents recurrent anterior humeral dislocation but alters the origins of the coracobrachialis (CBR) and short head of the biceps (SHB). The impact of this alteration on the moment arms of these muscles has not been examined. METHODS The Newcastle Shoulder Model was updated with 15 healthy cadaveric bone models to create customized shoulder models. The CBR and SHB muscles were attached to the anterior glenoid via an elliptical wrapping object. Muscle moment arms were calculated for abduction, forward flexion, scapular plane elevation, and internal rotation with 20° and 90° of abduction. Statistical comparison of moment arms between native and Latarjet shoulders was performed using spm1D. RESULTS By transferring the origins of the CBR and SHB to the anterior glenoid, both muscles had extension moment arms during glenohumeral elevation in the coronal, sagittal, and scapular planes. Their average moment arms during abduction (-30.4 ± 3.2 mm for CBR and -29.8 ± 3.0 mm for SHB) and forward flexion (-26.0 ± 3.1 mm for CBR and -26.2 ± 3.2 mm for SHB) suggested that their role after the Latarjet procedure changed compared with their role in the native shoulder (P < .001). At higher abduction levels, both the muscles had higher internal rotation moment arms compared with the native shoulder. CONCLUSION The Latarjet procedure affected the moment arms of the CBR and SHB. Both muscles had increased extension and internal rotation moment arms at higher degrees of elevation compared with the native shoulders. This finding suggests that these muscles act as dynamic stabilizers after the Latarjet procedure.
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Affiliation(s)
- Roopam Dey
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Orthopaedic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa; Health Through Physical Activity, Lifestyle and Sport, University of Cape Town, Cape Town, South Africa.
| | - Jonathan Glenday
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Jean Pierre du Plessis
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ntambue Kauta
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sudesh Sivarasu
- Division of Biomedical Engineering, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Biomedical Engineering Research Centre, University of Cape Town, Cape Town, South Africa
| | - Stephen Roche
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Masud S, Momtaz D, Betsch M, Migliorini F, Ghali A, Popa A, Gouveia K, Leroux T, Degen R, Khan M. A comprehensive comparison and evaluation of surgical techniques for anterior shoulder instability: a Bayesian network meta-analysis. J Shoulder Elbow Surg 2023; 32:e531-e547. [PMID: 37541334 DOI: 10.1016/j.jse.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Anterior shoulder instability is a common clinical problem; however, conflicting evidence exists regarding optimal treatment algorithms. We perform a comparative analysis of stabilization techniques used for recurrent anterior shoulder instability to identify the one associated with the lowest rate of recurrent instability. We additionally explore how glenoid bone loss and osseus lesions affect recurrence rates. METHODS PubMed, MEDLINE, Embase, and Cochrane databases were searched for clinical studies comparing surgical techniques for anterior shoulder instability. Two team members independently assessed all potential studies for eligibility and extracted data. Each included study underwent a risk of bias assessment using the Cochrane risk of bias summary tool. The primary outcome of interest was the rate of recurrent instability, which underwent a Bayesian network meta-analysis. Additional analyses were performed relating to the degree of glenoid bone loss and the presence of osseous lesions. RESULTS Of 2699 studies screened, 52 studies with 4209 patients were included. Patients who underwent open Latarjet demonstrated the overall lowest rate of recurrent instability [log odds ratio (LOR) 1.93], whereas patients who underwent arthroscopic Bankart repair demonstrated the highest (LOR 2.87). When glenoid bone loss was 10% to 20%, open Latarjet had significantly lower recurrent instability (P = .0016) compared to arthroscopic Bankart repair. When glenoid bone loss increased from 0%-10% to 10%-20%, arthroscopic Bankart repair had a significantly increased rate of recurrence (P = .021). In the presence of an engaging Hill-Sachs lesion, both open Latarjet (P = .01) and arthroscopic Bankart with remplissage (P = .029) had significantly reduced recurrence rates compared to arthroscopic Bankart repair. Finally, regardless of procedure, the presence of a Hill-Sachs or bony Bankart lesion was associated with an increased risk of recurrent instability (r = 0.44, P = .0003, and r = 0.40, P = .006, respectively). CONCLUSION The open Latarjet has the overall lowest recurrent instability and significantly lower compared to arthroscopic Bankart repair in the setting of increasing glenoid bone loss. Bone loss between 0% and 10% results in similar outcomes across all procedures.
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Affiliation(s)
- Saad Masud
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Hospital Mannheim, Medical Faculty of the University Heidelberg, Mannheim, BW, Germany
| | - Filippo Migliorini
- Department of Orthopaedics and Trauma Surgery, University Hospital RWTH Aachen, Aachen, NW, Germany
| | - Abdullah Ghali
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, USA
| | | | - Kyle Gouveia
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Ryan Degen
- Division of Orthopaedic Surgery, University of Western Ontario, London, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada.
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Knapik DM, Kuhn AW, Ganapathy A, Gibian JT, Yaeger LH, Matava MJ, Smith MV, Brophy RH. Global variations in treatment and outcomes reported for anterior shoulder instability: a systematic review of the literature. JSES Rev Rep Tech 2023; 3:469-476. [PMID: 37928980 PMCID: PMC10625007 DOI: 10.1016/j.xrrt.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Anterior shoulder instability is a common problem around the world, with a high risk for recurrence following the index dislocation. Surgical stabilization is commonly indicated for persistent instability, particularly in patients at high risk for recurrence, to minimize the risk of further labral injury and glenoid bone loss. However, there is little known about global geographic differences in the surgical management of anterior shoulder instability. As such, the purpose of this study was to evaluate and systematically review regional differences in the surgical treatment of anterior shoulder instability, particularly the indications for and outcomes from bony stabilization procedures compared to soft tissue procedures. Methods A systematic review, in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was performed. Inclusion criteria consisted of level I and II evidence studies evaluating indications, techniques, and outcomes following operative management of anterior shoulder instability published from January 2000 to September 2021. Studies meeting inclusion criteria were grouped into four global regions (Asia, Europe, North America, South America) based on primary study location. Patient demographics, procedural details, patient reported outcomes, and complications (recurrence and reoperation rates) were compared between regions. Results Sixty (n = 60) studies (5480 patients) were identified. Eighty-six percent of all patients were male, with a mean age of 26.7 years. There was no difference in mean patient age, though patients undergoing bony stabilization procedures were older than those undergoing soft-tissue stabilization procedures (P = .0002) in all regions. The proportion of bony versus soft-tissue procedure groups did not differ significantly among regions. The indications for bony stabilization procedures varied significantly. Mean final follow-up was 3.5 years. Recurrent instability was 5.0% and did not vary across regions. However, recurrent instability occurred more frequently following soft-tissue compared to bony stabilization procedures (P = .017). South American studies utilized fewer anchors during soft tissue stabilization (P < .0001) and reported a higher reoperation rate compared to other regions (P = .009). Conclusion There is global variation in the reporting of outcomes following surgery for anterior shoulder instability. The proportion of bony and soft-tissue procedures is similar, irrespective of geographic region. Recurrent instability does not vary by region but occurs more frequently following soft-tissue compared to bony stabilization procedures. There are a number of potential medical and nonmedical factors that may affect global variation in the surgical treatment of anterior shoulder instability.
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Affiliation(s)
- Derrick M. Knapik
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew W. Kuhn
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Joseph T. Gibian
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren H. Yaeger
- Becker Medical Library, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew J. Matava
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew V. Smith
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert H. Brophy
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Posey SL, Jolissaint JE, Boylan M, Hurwit D, Sonnenfeld J, Yu Z, Odum SM, Schiffern S, Hamid N, Riboh J. Size and morphology of the coracoid and glenoid in pediatric and adolescent patients: implications for Latarjet procedure. JSES Int 2023; 7:2289-2295. [PMID: 37969517 PMCID: PMC10638555 DOI: 10.1016/j.jseint.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Background Glenohumeral instability is a challenging problem in children and adolescents. For patients with anterior glenoid bone loss, the Latarjet procedure is an effective treatment option. However, concerns about coracoid size and morphology may limit its utilization within this patient population. The purpose of this study was to establish normative data on coracoid and glenoid size and morphology among a large cohort of adolescent patients and describe the anatomic relationships with demographic factors. Methods This is a retrospective cross-sectional study of a consecutive series of 584 patients aged 12-21 years after a chest computed tomography scan for non-shoulder related trauma at a single level I trauma center. Demographic characteristics were collected from the electronic medical record, and the following coracoid anatomic measurements were obtained from computed tomography scans: coracoid length, coracoid thickness, coracoid width, glenoid height, and glenoid width. The ratio of coracoid thickness to glenoid width was calculated to estimate the percent bone loss that could be addressed with a traditional Latarjet coracoid transfer. To ensure reliability among 3 reviewers, all measured the same 25 scans and inter-rater reliability was excellent with all Kappa coefficients >0.81. The remaining scans were divided equally and assessed separately by these reviewers. Correlation coefficients were used to quantify the relationships between all anatomic measures and the age, weight, and height of individuals. Growth curves for each measurement were modeled using quantile regression with height and height∗height as predictors. Additionally, we stratified the growth curves by sex, when significant. Of the 584 subjects, 55% were male, and average age was 19 years (range 12, 21). Results All growth curves illustrated increase anatomic size across the height range of 145-190 cm. The growth curve including all patients (Fig. 1) illustrated that the 50% percentile of median coracoid length increased from approximately 28 to 32 mm. In addition to height, sex was a significant predictor for coracoid width and glenoid width. The median coracoid width increased from approximately 9.5 to 10.2 mm for females compared to an increased width from approximately 10 to 11 mm for males. The median glenoid width for females increased from approximately 21 to 25 mm and for males the median glenoid width increased from just under 22 to 25.5 mm. Conclusions Among children and adolescents, coracoid and glenoid size are correlated with patient height. These data can help guide patient selection for the Latarjet procedure.
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Affiliation(s)
- Samuel L. Posey
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Josef E. Jolissaint
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Matthew Boylan
- OrthoCarolina Sports Medicine Center, Charlotte, NC, USA
| | - Daniel Hurwit
- OrthoCarolina Sports Medicine Center, Charlotte, NC, USA
| | | | - Ziqing Yu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Susan M. Odum
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | | | - Nady Hamid
- OrthoCarolina Sports Medicine Center, Charlotte, NC, USA
| | - Jonathan Riboh
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
- OrthoCarolina Sports Medicine Center, Charlotte, NC, USA
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31
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Schrouff CL, Verlaan L. Bankart repair with remplissage vs. Latarjet procedure on recurrence, postoperative pain scores, external rotation, and Rowe score in patients with a Hill-Sachs lesion. A systematic review. JSES Rev Rep Tech 2023; 3:461-468. [PMID: 37928988 PMCID: PMC10625001 DOI: 10.1016/j.xrrt.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Currently, recurrent anterior shoulder instability in patients with a Hill-Sachs lesion managed using the Bankart repair showed higher recurrent instability compared with the Latarjet technique. Addition of posterior capsulodesis with infraspinatus remplissage to the Bankart repair, known as Bankart with remplissage (BR), increases shoulder stability in patients with a Hill-Sachs lesion. BR can potentially match the low recurrence rates of the Latarjet procedure while being less invasive. This systematic review compares the Bankart repair with remplissage and Latarjet procedure on postoperative pain, external rotation range of motion, and recurrent instability in anterior shoulder instability patients with a Hill-Sachs lesion. Methods A systematic search of the PubMed, Web of Science, and Cochrane Library databases was performed. Studies comparing BR and Latarjet on recurrent instability and/or visual analogue scale (VAS) pain score in anterior shoulder instability patients with a Hill-Sachs lesion were included. Expert opinion, conference presentations, editorials, abstracts, case reports, and nonclinical studies were excluded. Records were initially screened by title and abstract, during the second screening full text was consulted. Study quality was examined using the Methodological Index for Nonrandomized Studies criteria. Risk ratios were calculated for recurrent instability, and standardized mean difference (Cohen's d) were calculated for VAS pain, external rotation, and Rowe score. Results Eight of the 146 studies were included in the analysis. The study population consisted of a total of 845 patients, of whom 450 patients underwent the Latarjet procedure and 395 patients underwent BR. Three studies included revision surgery patients; more revision surgery patients were allocated to the Latarjet group. Risk ratios for recurrent instability varied from 0.45 to 2.41. Effect size varied for VAS pain from -2.28 to 0.04, for external rotation from -1.44 to 1.12, and for Rowe score from -0.67 to 1.37. Limitations of the included studies were differences in baseline demographics and functional outcomes. Conclusion Recurrent instability seems equal between BR and Latarjet in patients with a Hill-Sachs lesion depth <10 mm. Latarjet showed superior external rotation than BR. Future research should examine patient demographics optimal for minimizing recurrent instability using BR.
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Affiliation(s)
- Casper L.J.H. Schrouff
- Department of Orthopaedic Surgery, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, Netherlands
| | - Loek Verlaan
- Department of Orthopaedic Surgery, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, Netherlands
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Kim YT, Lee KJ, Jang YH, Yang S, Lee TQ, McGarry M, Kim SH. Cadaveric Biomechanical Study of Partial Glenoid Arthroplasty Versus the Latarjet Procedure for Anterior Glenoid Bone Loss. Am J Sports Med 2023; 51:3217-3225. [PMID: 37715516 DOI: 10.1177/03635465231192086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
BACKGROUND For severe anterior glenoid bone loss due to recurrent shoulder instability, the Latarjet procedure offers a dynamic sling effect in addition to bone augmentation. Yet, it heavily alters the surrounding anatomy, while fixation and graft union issues are also common. PURPOSE/HYPOTHESIS The purpose of this study was to compare a novel printed 3-dimensional (3D) partial glenoid arthroplasty (PGA) implant with the classic Latarjet procedure. It was hypothesized that by replicating the original glenoid geometry and preserving soft tissue anatomy, PGA may better reproduce normal joint kinematics. In addition, the locking screw construct may offer stronger fixation. STUDY DESIGN Controlled laboratory study. METHODS A total of 14 matched cadaveric shoulders were tested. The PGA implant was 3D printed in titanium based on preoperative computed tomography. The intact, 25% anterior glenoid bone loss, and postoperative states were tested in the scapular and coronal planes. The following parameters were measured: articular surface area and stepoff, rotational range of motion and the humeral head apex position during rotation, and load and linear stiffness at 25% anterior translation and at 2-mm construct displacement. RESULTS The baseline dimensions of the glenoid articular surface were comparable between the groups. The articular surface area after PGA was significantly larger (P = .006) with less articular stepoff (P = .030). PGA better approximated the intact state's external (P = .006) and total (P = .019) rotational range of motion in the scapular plane. The course of the humeral head apex after PGA better followed that of the intact state (P < .001). Resistance against anterior translation after PGA was not significantly different compared with after the Latarjet procedure. Greater linear stiffness (P = .031) and loading (P = .002) at 2-mm construct displacement were demonstrated in the PGA group. CONCLUSION In addressing anterior glenoid bone loss, PGA better approximated intact glenohumeral joint kinematics compared with the Latarjet procedure with less articular stepoff in a cadaveric model. PGA was comparable in resisting anterior translation while being significantly stronger against loading at 2-mm construct displacement. Further clinical studies are warranted to validate this novel procedure. CLINICAL RELEVANCE A 3D-printed PGA implant may offer an alternative treatment option for severe glenoid bone loss due to shoulder instability, overcoming the previous drawbacks of the Latarjet procedure, including altered kinematics, fixation failure, and hardware issues.
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Affiliation(s)
- Yong Tae Kim
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Kyung Jae Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Young Hoon Jang
- Department of Orthopedic Surgery, CM Hospital, Seoul, Republic of Korea
| | - Sook Yang
- Research Center, Cusmedi, Suwon, Republic of Korea
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Michelle McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Davis WH, DiPasquale JA, Patel RK, Sandler AB, Scanaliato JP, Dunn JC, Parnes N. Arthroscopic Remplissage Combined With Bankart Repair Results in a Higher Rate of Return to Sport in Athletes Compared With Bankart Repair Alone or the Latarjet Procedure: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3304-3312. [PMID: 36622005 DOI: 10.1177/03635465221138559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Traumatic anterior shoulder instability affects athletes at a higher rate compared with the general population. In recent years, indications for arthroscopic remplissage, an adjunct procedure classically used to reduce the recurrence of anterior shoulder instability in patients with off-track Hill-Sachs lesions, have expanded. PURPOSE To investigate return-to-sport (RTS) rates, functional outcomes, and adverse events in athletes who underwent arthroscopic Bankart repair with remplissage compared with surgical alternatives such as Bankart repair alone or the Latarjet procedure. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A literature review of the Embase, PubMed (MEDLINE), and Web of Science databases was conducted for articles published before May 22, 2022. For the systematic review, 16 of 457 studies that reported RTS rates at any time point after remplissage were deemed eligible for inclusion in quantitative analysis and 17 of 457 studies in qualitative analysis. For the meta-analysis, 8 of 457 studies reported RTS rates after remplissage compared with surgical alternatives including Bankart repair alone or the Latarjet procedure and were deemed eligible for inclusion. RESULTS In total, 538 athletes underwent remplissage and were included in the study. RTS at any level was achieved by 86% (395/457) of patients, and the odds of RTS at any level were significantly higher after remplissage compared with surgical alternatives (odds ratio [OR], 2.71 [95% CI, 1.14-6.43]; P = .02). The odds of RTS at a previous or higher level were also significantly higher after remplissage compared with surgical alternatives (OR, 2.07 [95% CI, 1.29-3.31]; P = .002). The mean Rowe score increased significantly from 43.9 ± 7.77 preoperatively (n = 173) to 92.2 ± 4.02 after remplissage (n = 397) (P < .001), but there was no significant difference in Rowe scores between remplissage and surgical alternatives (P = .54). After remplissage, the recurrence rate was 5.0% for athletes (n = 220) and 7.3% for all patients (n = 634), with a mean time to recurrence of 24.0 ± 12.5 months. Reoperations occurred in 3.6% of athletes (n = 110) and 4.1% of all patients (n = 445). Recurrence and reoperations were significantly less likely after remplissage compared with surgical alternatives (OR, 0.18 [95% CI, 0.08-0.39]; P < .001 and OR, 0.17 [95% CI, 0.06-0.50]; P = .001, respectively). CONCLUSION Arthroscopic Bankart repair with remplissage augmentation significantly improved RTS rates among athletes, both at any level and at previous levels of play. Additionally, remplissage appeared to significantly decrease recurrence and reoperation rates compared with surgical alternatives such as Bankart repair alone or the Latarjet procedure.
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Affiliation(s)
- William H Davis
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Jake A DiPasquale
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Reema K Patel
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alexis B Sandler
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - John P Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - John C Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nata Parnes
- Department of Orthopedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Department of Orthopedic Surgery, Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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van Iersel TP, Tutuhatunewa ED, Kaman I, Twigt BA, Vorrink SNW, van den Bekerom MPJ, van Deurzen DFP. Patient perceptions after the operative and nonoperative treatment of shoulder instability: A qualitative focus group study. Shoulder Elbow 2023; 15:497-504. [PMID: 37811392 PMCID: PMC10557926 DOI: 10.1177/17585732221122363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 10/10/2023]
Abstract
Background Little evidence is available regarding patient perceptions of the treatment of shoulder instability. The aim of this study is to investigate patient perceptions regarding the operative and nonoperative treatment of anterior shoulder instability. Methods Patients who presented to the emergency department or outpatient clinic between 2016 and 2020 were retrospectively selected using diagnosis and procedure codes. Online focus groups and semistructured interviews were conducted, systematically recorded and subsequently transcribed to MaxQDA 2007 for qualitative analysis. Coded transcripts of all focus groups were subjected to a grounded theory-based analysis. Results Six focus groups and two semistructured interviews were hosted with 35 included patients. The mean age of included patients was 34.1 years (±11.5). Eight patients were female (23%), and 27 patients were male (77%). Fear of (recurrent) dislocation, preoperative counseling, communication between surgeon and physiotherapists and need for a consistent postoperative rehab protocol turned out to be important patient perceptions. The most crucial factor for discontent was a lack of communication from the surgeon. Discussion This patient-centered focus group study revealed that fear of (recurrent) dislocation, preoperative counseling, communication between surgeons and physiotherapists and the need for a consistent postoperative rehabilitation protocol was the most frequently discussed themes.
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Affiliation(s)
- Theodore P van Iersel
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Eric D Tutuhatunewa
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Ithri Kaman
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Bas A Twigt
- Trauma Unit, Department of Surgery, OLVG, Amsterdam, The Netherlands
| | - Sigrid NW Vorrink
- Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Michel PJ van den Bekerom
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Derek FP van Deurzen
- Trauma Unit & Shoulder and Elbow Unit, Department of orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
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Bockmann B, Nebelung W, Gröger F, Leuzinger J, Agneskirchner J, Brunner U, Seybold D, Streich J, Bartsch S, Schicktanz K, Maier D, Königshausen M, Patzer T, Venjakob AJ. The arthroscopic treatment of anterior shoulder instability with glenoid bone loss shows similar clinical results after Latarjet procedure and iliac crest autograft transfer. Knee Surg Sports Traumatol Arthrosc 2023; 31:4566-4574. [PMID: 37386197 DOI: 10.1007/s00167-023-07480-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/02/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Recurrent anterior shoulder instability caused by critical bone loss of the glenoid is a challenging condition for shoulder surgeons. The purpose of this prospective multicenter trial was to compare the arthroscopic transfer of the coracoid process (Latarjet procedure) with the arthroscopic reconstruction of the glenoid using iliac crest autografts. METHODS A prospective multi-center trial was performed in nine orthopaedic centres in Austria, Germany and Switzerland between July 2015 and August 2021. Patients were prospectively enrolled and received either an arthroscopic Latarjet procedure or an arthroscopic iliac crest graft transfer. Standardized follow-up after 6 months and mimimum 24 months included range of motion, Western Ontario stability index (WOSI), Rowe score and subjective shoulder value (SSV). All complications were recorded. RESULTS 177 patients (group Latarjet procedure: n = 110, group iliac crest graft: n = 67) were included in the study. WOSI (n.s.), SSV (n.s.) and Rowe score (n.s.) showed no difference at final follow-up. 10 complications were seen in group Latarjet procedure and 5 in group iliac crest graft; the frequency of complications did not differ between the two groups (n.s.). CONCLUSION The arthrosopic Latarjet procedure and arthroscopic iliac crest graft transfer lead to comparable results regarding clinical scores, frequency of recurrent dislocations and complication rates. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Benjamin Bockmann
- Department of Orthopaedics and Trauma Surgery, St. Josef Hospital, Ruhr University, Gudrunstraße 56, 44791, Bochum, Germany.
- Department of Shoulder and Elbow Surgery, St. Josef Krankenhaus Essen-Kupferdreh, Essen, Germany.
| | | | - Falk Gröger
- Shouldercare, Engeriedspital, Bern, Switzerland
| | - Jan Leuzinger
- Center for Minimally Invasive Surgery, Etzelclinic, Pfäffikon, Switzerland
| | | | - Ulrich Brunner
- Trauma and Orthopaedic Surgery, Krankenhaus Agatharied, Hausham, Germany
| | | | - Jörg Streich
- Department of Shoulder and Elbow Surgery, St. Josef Krankenhaus Essen-Kupferdreh, Essen, Germany
| | - Stefan Bartsch
- Schaumburg Centre of Joint Surgery, Praxis am Wall Rinteln, Rinteln, Germany
| | | | - Dirk Maier
- Department of Orthopaedics and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Matthias Königshausen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Thilo Patzer
- Centre for Shoulder, Elbow, Knee and Sports Orthopedics, Schön-Klinik, Düsseldorf, Germany
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Song Q, Zhang S, Bai J, Cheng X, Luo H, Shao Z, Cui G. Previously failed Bankart repair and the duration from first dislocation to surgery were the risk factors associated with the level of return to sports after coracoid transfer. Knee Surg Sports Traumatol Arthrosc 2023; 31:4052-4059. [PMID: 37212830 DOI: 10.1007/s00167-023-07453-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE This study aims to determine the rate of different levels of return to sports (RTS) in athletes undergoing the modified arthroscopic Bristow procedure and the factors associated with the level of RTS. METHODS The study was performed retrospectively on patients with traumatic anterior shoulder instability who underwent the modified arthroscopic Bristow procedure with a minimum follow-up of 2 years. The RTS rate, the level of return and the timing of return were assessed. Additionally, factors such as preoperative basic information, clinical outcomes, graft position, graft healing and graft absorption were analysed to investigate their correlation with the level of RTS. Multivariate regression models were used to evaluate the factors affecting the level of RTS. RESULTS In total, this study included 182 shoulders of 177 athletes undergoing the modified arthroscopic Bristow procedure. Of these patients, 142 (78.0%) shoulders of 137 athletes were enrolled, with a mean of 3.3-year follow-up. At the final follow-up, 134 (94.4%) shoulders were able to RTS, 123 (86.6%) shoulders were able to RTS to the pre-injury level, 52 (36.6%) shoulders could be completely "forgotten" without any psychological barrier during exercise. The multivariate logistic regression analysis identified the variable associated with RTS at the pre-injury level as previously failed arthroscopic Bankart repair (p < 0.001). As for the "forgetting" operated shoulder, the duration from first dislocation to surgery was a significant independent predictor (p = 0.034). CONCLUSION Although a large majority of athletes were able to RTS at the pre-injury level after the modified arthroscopic Bristow procedure, about two-thirds of the athletes felt difference in shoulders on both sides and could not completely "forget" the operated shoulder during exercise. Previously failed Bankart repair and the duration from first dislocation to surgery were the risk factors associated with the level of RTS after the modified arthroscopic Bristow procedure. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Qingfa Song
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Shuhan Zhang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jucheng Bai
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Xu Cheng
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Hao Luo
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Zhenxing Shao
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Guoqing Cui
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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Nair AV, Mohan PK, Jangale A, Krishna P, Goud N. Arthroscopic Salvage Procedure for Iatrogenic Conjoint Tendon Avulsion Fracture Following Arthroscopic Latarjet Procedure Using Double Sling Fixation Technique - A Case Report. J Orthop Case Rep 2023; 13:77-82. [PMID: 37753126 PMCID: PMC10519315 DOI: 10.13107/jocr.2023.v13.i09.3884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/10/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction We present a case report of an iatrogenic conjoint tendon avulsion fracture following arthroscopic Latarjet and salvage technique to address the complication with a novel double sling technique. Case Report A 16-year-old male patient who presented with recurrent instability of the right shoulder was counseled for an arthroscopic Latarjet procedure, taking account of critical glenoid bone loss and his contact sporting activities. An intraoperative coracoid tip fracture occurred, which was managed with the double sling technique. At 1-year follow-up, the patient has made a good recovery with a full range of movements and a stable shoulder; the CT scans showed a well-approximated coracoid tip fragment. Conclusion Iatrogenic intraoperative coracoid graft fractures during arthroscopic Latarjet can be managed depending on the site of the fracture and quality of the bone. The double sling fixation technique helps in maintaining the sling action of the conjoint tendon in patients with recurrent instability.
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Affiliation(s)
- Ayyappan V Nair
- Department of Shoulder and Sports Injury, Bangalore Shoulder Institute, Bengaluru, Karnataka, India
| | - Pramod Kumar Mohan
- Department of Shoulder and Sports Injury, Bangalore Shoulder Institute, Bengaluru, Karnataka, India
| | - Ajit Jangale
- Department of Shoulder and Sports Injury, Bangalore Shoulder Institute, Bengaluru, Karnataka, India
| | - Pavan Krishna
- Department of Shoulder and Sports Injury, Bangalore Shoulder Institute, Bengaluru, Karnataka, India
| | - Naresh Goud
- Department of Shoulder and Sports Injury, Bangalore Shoulder Institute, Bengaluru, Karnataka, India
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Best MJ, Wang KY, Nayar SK, Agarwal AR, Kreulen RT, Sharma S, McFarland EG, Srikumaran U. Epidemiology of shoulder instability procedures: A comprehensive analysis of complications and costs. Shoulder Elbow 2023; 15:398-404. [PMID: 37538528 PMCID: PMC10395401 DOI: 10.1177/17585732221116814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 08/05/2023]
Abstract
Background Recurrent shoulder instability is a debilitating condition that can lead to chronic pain, decreased function, and inability to return to activities or sport. This retrospective epidemiology study was performed to report 90-day postoperative complications and costs of Latarjet, anterior bone block reconstruction, arthroscopic, and open Bankart repair for shoulder instability. Methods Patients 18 years and older who underwent four primary shoulder surgeries from 2010 to 2019 were identified using national claims data. Patient demographics, comorbidities, and 90-day postoperative complications were analyzed using univariate analysis and multivariable logistic regression. Total and itemized 90-day reimbursements were determined for each procedure. Results The 90-day medical and surgery-specific complication rates were highest for anterior bone block reconstruction, followed by Latarjet. Arthroscopic Bankart repair had the highest 90-day costs and primary procedure costs compared to other procedures. Conclusion Anterior bone block reconstruction and Latarjet procedures were associated with the highest rates of 90-day medical and surgery-specific complications, while arthroscopic Bankart repair was associated with the highest costs.
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Affiliation(s)
- Matthew J Best
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Suresh K Nayar
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Amil R Agarwal
- George Washington University School of Medicine, Washington DC, USA
| | - R Timothy Kreulen
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sribava Sharma
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward G McFarland
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bonnevialle N, Mattési L, Martinel V, Letartre R, Barret H, Mansat P. Outcomes at Long-term Follow-up After Open Latarjet Versus Open Bankart Repair in Rugby Players. Orthop J Sports Med 2023; 11:23259671231184394. [PMID: 37564951 PMCID: PMC10411275 DOI: 10.1177/23259671231184394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/13/2023] [Indexed: 08/12/2023] Open
Abstract
Background Because rugby is a collision sport, it exposes players to a high risk of recurrence after anterior shoulder stabilization. Therefore, the choice of surgical procedure warrants close attention in order to optimize the time to return to sport and the stability of the shoulder throughout the player's career. Hypothesis The open Latarjet procedure would allow for a faster return to play and provide a lower rate of recurrence than the open Bankart repair at long-term follow-up. Study Design Cohort study; Level of evidence, 3. Methods The study retrospectively enrolled 62 competitive rugby players who had undergone an anterior shoulder instability procedure and had at least 5 years of follow-up data. A total of 32 players treated with an open Bankart repair (BK group) were compared with 30 players (31 shoulders) treated with an open Latarjet procedure (LT group). Outcomes between groups were compared with the Rowe score, Walch-Duplay score, recurrence rate, and osteoarthritis evaluation on plain radiograph (Samilson classification). Results The recurrence rate was significantly higher at 18.8% for the BK group (mean follow-up, 6.9 ± 1.7 years) compared with 3.3% for the LT group (mean follow-up, 6.2 ± 1.4 years) (P = .04). No postoperative complications occurred in the BK group, whereas 1 infection and 1 hematoma required a second surgery in the LT group (P = .14). In the BK and LT groups, 97% and 90% of players, respectively, were able to return to rugby at the same level or higher (P = .27), at a mean time of 8 and 6.3 months, respectively (P = .03). The mean Rowe and Walch-Duplay scores were not significantly different between the groups; however, the osteoarthritis rate was significantly higher in the BK versus the LT group (68% vs 38%, respectively; P = .03); 23% of patients, all in the BK group, had Samilson grade 2 osteoarthritis. Conclusion The open Latarjet procedure outperformed the open Bankart procedure in terms of stability, time to return to play, and radiological outcomes at long-term follow-up in competitive rugby players.
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Affiliation(s)
| | - Lucas Mattési
- Clinique Universitaire du Sport, CHU de Toulouse, Toulouse, France
| | | | | | - Hugo Barret
- Clinique Universitaire du Sport, CHU de Toulouse, Toulouse, France
| | - Pierre Mansat
- Clinique Universitaire du Sport, CHU de Toulouse, Toulouse, France
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Fares MY, Boufadel P, Daher M, Koa J, Khanna A, Abboud JA. Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes. Clin Orthop Surg 2023; 15:521-533. [PMID: 37529197 PMCID: PMC10375816 DOI: 10.4055/cios23018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/15/2023] [Accepted: 04/16/2023] [Indexed: 08/03/2023] Open
Abstract
The shoulder, being the most mobile joint in the human body, is often susceptible to dislocations and subluxations more so than other joints. As such, shoulder instability constitutes a common complaint among patients worldwide, especially those who are young, participate in contact sports, and have increased innate flexibility in their joints. Management options in the setting of instability vary between conservative and surgical options that aim to mitigate symptoms and allow return of function. Surgical options can be arthroscopic and open, with a general shift among surgeons towards utilizing arthroscopic surgery in the past several decades. Nevertheless, open procedures still play a role in managing shoulder instability patients, especially those with significant bone loss, recurrent instability, coexisting shoulder pathologies, and high risk of failure with arthroscopic surgery. In these clinical settings, open procedures, like the Latarjet procedure, open Bankart repair, glenoid bone augmentation using iliac crest autograft or distal tibial allograft, and salvage options like glenohumeral arthrodesis and arthroplasty may show good clinical outcomes and low recurrence rates. Each of these open procedures possesses its own set of advantages and disadvantages and entails a specific set of indications based on published literature. It is important to cater treatment options to the individual patient in order to optimize outcomes and reduce the risk of complications. Future research on open shoulder stabilization procedures should focus on the long-term outcomes of recently utilized procedures, investigate different graft options for procedures involving bone augmentation, and conduct additional comparative analyses in order to establish concrete surgical management guidelines.
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Affiliation(s)
- Mohamad Y. Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Peter Boufadel
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Mohammad Daher
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Jonathan Koa
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Akshay Khanna
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A. Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Bauer S, Collin P, Zumstein MA, Neyton L, Blakeney WG. Current concepts in chronic traumatic anterior shoulder instability. EFORT Open Rev 2023; 8:468-481. [PMID: 37289134 DOI: 10.1530/eor-22-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Chronic traumatic anterior shoulder instability can be defined as recurrent trauma-associated shoulder instability requiring the assessment of three anatomic lesions: a capsuloligamentous and/or labral lesion; anterior glenoid bone loss and a Hill-Sachs lesion. Surgical treatment is generally indicated. It remains controversial how risk factors should be evaluated to decide between a soft-tissue, free bone-block or Latarjet-type procedure. Patient risk factors for recurrence are age; hyperlaxity; competitive, contact and overhead sports. Trauma-related factors are soft tissue lesions and most importantly bone loss with implications for treatment. Different treatment options are discussed and compared for complications, return to sports parameters, short- and long-term outcomes and osteoarthritis. Arthroscopic Bankart and open Latarjet procedures have a serious learning curve. Osteoarthritis is associated with the number of previous dislocations as well as surgical techniques. Latarjet-type procedures have the lowest rate of dislocation recurrence and if performed correctly, do not seem to increase the risk of osteoarthritis.
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Affiliation(s)
- Stefan Bauer
- Ensemble hospitalier de la Côte, Chirurgie de l'épaule, Chemin du Crêt 2, Morges, Vaud, Switzerland
- The University of Western Australia, Perth, Australia
| | - Phillipe Collin
- CHP Saint-Gregoire, 6 Boulevard de la Boutière 35760 Saint-Grégoire, France
- Clinique Victor Hugo, 5 Bis rue du Dôme 75016 Paris, France
- American Hospital of Paris, 55 Boulevard du Château, 92200 Neuilly-sur-Seine, France
| | - Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland
- Shoulder, Elbow Unit, Sportsclinicnumber1, Papiermuehlestrasse 73, 3014 Bern, Switzerland
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Lionel Neyton
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - William G Blakeney
- The University of Western Australia, Perth, Australia
- Royal Perth Hospital, Perth, Australia
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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: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Lavaill M, Martelli S, Cutbush K, Gupta A, Kerr GK, Pivonka P. Latarjet's muscular alterations increase glenohumeral joint stability: A theoretical study. J Biomech 2023; 155:111639. [PMID: 37245383 DOI: 10.1016/j.jbiomech.2023.111639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/20/2023] [Accepted: 05/10/2023] [Indexed: 05/30/2023]
Abstract
The surgical Latarjet procedure aims to stabilise the glenohumeral joint following anterior dislocations. Despite restoring joint stability, the procedure introduces alterations of muscle paths which likely modify the shoulder dynamics. Currently, these altered muscular functions and their implications are unclear. Hence, this work aims to predict changes in muscle lever arms, muscle and joint forces following a Latarjet procedure by using a computational approach. Planar shoulder movements of ten participants were experimentally assessed. A validated upper-limb musculoskeletal model was utilised in two configurations, i.e., a baseline model, simulating normal joint, and a Latarjet model simulating its related muscular alterations. Muscle lever arms and differences in muscle and joint forces between models were derived from the experimental marker data and static optimisation technique. Lever arms of most altered muscles, hence their role, were substantially changed after Latarjet. Altered muscle forces varied by up to 15% of the body weight. Total glenohumeral joint force increased by up to 14% of the body weight after Latarjet, mostly due to increase in compression force. Our simulation indicated that the Latarjet muscular alterations lead to changes in the muscular recruitment and contribute to the stability of the glenohumeral joint by increasing compression force during planar motions.
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Affiliation(s)
- Maxence Lavaill
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia.
| | - Saulo Martelli
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, Australia
| | - Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; St Andrew's War Memorial Hospital, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Ashish Gupta
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, Australia
| | - Graham K Kerr
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; Movement Neuroscience Group, School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia
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Hirose T, Tanaka M, Nakai H, Hanai H, Kotani Y, Kuratani K, Hayashida K. Association Between Preoperative Glenoid Bone Loss and Postoperative Outcomes After Coracoid Transfer Combined With Open Bankart Repair: Comparison of the Bristow and Latarjet Techniques. Orthop J Sports Med 2023; 11:23259671231172219. [PMID: 37260581 PMCID: PMC10227879 DOI: 10.1177/23259671231172219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/26/2023] [Indexed: 06/02/2023] Open
Abstract
Background Whether the extent of glenoid bone loss (GBL) affects clinical outcome after coracoid process transfer (CPT) is still unclear. Purpose To evaluate postoperative outcomes after CPT combined with open Bankart repair in young rugby players in terms of the extent of GBL and between the Bristow and Latarjet techniques. Study Design Cohort study; Level of evidence, 3. Methods The authors investigated 101 shoulders in 91 competitive rugby players who underwent CPT combined with open Bankart repair by the Bristow (group B; 66 shoulders) or Latarjet (group L; 35 shoulders) procedure between 2007 and 2017. The extent of GBL was calculated from the en face view of the glenoid on preoperative 3-dimensional computed tomography scans and was used to categorize shoulders into 4 grades (grade 0, 0%; grade 1, >0% and ≤10%; grade 2, >10% and ≤20%; grade 3, >20%). At the minimum 2-year follow-up, the authors analyzed the relationship between GBL or GBL grade and postoperative outcome scores (American Shoulder and Elbow Surgeons score, Rowe score, Western Ontario Shoulder Instability Index, and patient satisfaction), return-to-play (RTP) times, graft failure (insufficient union or translocation), and recurrence. Results The mean GBL in all shoulders was 10.9% ± 9.2% and was not significantly different between the 2 groups. There were no significant correlations between GBL and any outcome measure in either group. The mean RTP time was significantly shorter in group L versus group B (4.8 ± 1.1 vs 5.8 ± 1.8 months, respectively; P = .002), but it was not associated with GBL. In group B, the rate of graft failure was not significantly higher in shoulders with grade 0 or 1 GBL versus grade 2 or 3 GBL (8 [25.0%] vs 4 [11.8%], respectively; P = .21). In group B, graft failure was confirmed in 12 shoulders (18.2%), compared with 1 shoulder (2.9%) in group L. Postoperative recurrence occurred in significantly fewer shoulders in group B than in group L (2 [3.0%] vs 5 [14.3%], respectively; P = .047). Conclusion The extent of GBL did not affect outcome scores after CPT, regardless of operative procedure.
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Affiliation(s)
- Takehito Hirose
- Department of Orthopaedic Surgery,
Daini Osaka Police Hospital, Osaka, Japan
| | - Makoto Tanaka
- Department of Orthopaedic Surgery,
Daini Osaka Police Hospital, Osaka, Japan
- Center for Sports Medicine, Daini Osaka
Police Hospital, Osaka, Japan
| | - Hidekazu Nakai
- Department of Orthopaedic Surgery,
Daini Osaka Police Hospital, Osaka, Japan
| | - Hiroto Hanai
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuki Kotani
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kosuke Kuratani
- Department of Orthopaedic Surgery, JCHO
Osaka Hospital, Osaka, Japan
| | - Kenji Hayashida
- Department of Orthopaedic Surgery,
Osaka Central Hospital, Osaka, Japan
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Ren Z, Huang X, Peng H, Ma J, Zhang Y, Yu T. 3D MRI PD-SPACE-COR Predicting Safety Margin for Coracoid Transfer. Orthop Surg 2023. [PMID: 37092459 DOI: 10.1111/os.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVE The maximum bone length available for coracoid process transfer varies among individuals, while no preoperative guideline has been developed for predicting the safety margin (SM) in Latarjet shoulder reconstruction. The aim of the study was to evaluate the 3D MRI proton density (PD)-weighted sampling perfection with application-optimized contrasts using different flip-angle evolution (SPACE) sequence in preoperatively predicting SM for coracoid transfer. METHODS The post-multiplanar reconstructed images were obtained from 24 volunteers (17 males, seven females) to determine the clarity and sensitivity of the PD-SPACE-COR and PD-SPACE-FS-COR protocols. Furthermore, the distance from the coracoid tip to the lateral edge of the attachment of trapezoid ligament (TL) was measured. To evaluate the accuracy of 3D MRI prediction, a cadaveric cohort has been launched in 32 shoulders (nine males, seven females). The distance between the tip of coracoid process and the outmost edge of TL footprint, namely, the SM, was measured. RESULTS A better sensitivity was found in PD-SPACE-COR in detecting coracoclavicular ligaments (CCLs), including TL and conoid ligament (CL), compared to PD-SPACE-FS-COR by ranking, McNemar test (P = 0.001), and kappa coefficients (κ = 0.51, P = 0.43). The SM determined by the PD-SPACE-COR protocol was 24.28 ± 2.17 mm while that by cadaveric morphometry was 25.53 ± 2.84 mm. No difference was found between measurements (P = 0.78). CONCLUSION This research provides new insights for preoperatively geometrical planning coracoid transfer by 3D MRI PD-SPACE-COR, which motivates personalized medicine in orthopedics.
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Affiliation(s)
- Zhongkai Ren
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaohong Huang
- Shandong Institute of Traumatic Orthopedics, Medical Research Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haining Peng
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jinlong Ma
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yingze Zhang
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tengbo Yu
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Orthopedic Surgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
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Ahmed AS, Gabig AM, Dawes A, Gottschalk MB, Lamplot JD, Wagner E. Trends and Projections in Surgical Stabilization of Glenohumeral Instability in the United States from 2009 to 2030: Rise of the Latarjet and Fall of the Open Bankart. J Shoulder Elbow Surg 2023:S1058-2746(23)00313-0. [PMID: 37044304 DOI: 10.1016/j.jse.2023.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/11/2023] [Accepted: 03/11/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Advances in surgical techniques have improved the ability to address recurrent glenohumeral instability via arthroscopic capsulolabral repair and bone restoring procedures such as Latarjet. Given the paucity of studies analyzing temporal trends in surgical management of glenohumeral instability, the purpose of this study was to assess trends in treatment of anterior, posterior, and multidirectional instability over a 10-year period and model projections to 2030. METHODS Using IBM Watson Marketscan national database, all patients that underwent glenohumeral instability procedures from 2009 to 2018 were identified. Procedures were identified using common procedural terminology (CPT) codes for open Bankart Repair, Latarjet, anterior bone block, posterior bone block, multidirectional capsular shift, and arthroscopic Bankart procedures. Sample weights provided by the database were utilized to calculate national estimates. The United States (U.S.) Census Bureau annual population data were utilized for calculating incidence. Future projections to 2030 were modeled using Poisson and linear regression. RESULTS There were an estimated 446,072 glenohumeral instability cases from 2009-2018. Per capita (per 100,000) incidence remained constant, from 14.8 in 2009 to 14.5 in 2018. Arthroscopic Bankart comprised the highest number of procedures throughout the study period, accounting for 89% of all procedures in 2009 and 93% in 2018. Open Bankart procedures decreased by 65% from 2009 to 2018, while there was a 250% increase in Latarjet procedures over the same period. Patient demographics did not change over the study period, and males aged 18-25 comprised the largest demographic group undergoing anterior instability procedures. Multidirectional instability procedures exhibited the least pronounced gender differences. Future modeling from 2018-2030 projected continued steady rise in arthroscopic Bankart (40,000-49,000 case/yr), rapid growth in Latarjet (1370-4300 cases/yr), and continued decline in open Bankart (1000-250 cases/yr) procedures. CONCLUSIONS Arthroscopic Bankart continues to be the most common glenohumeral instability procedure in the U.S. From 2009 to 2018, incidence of open Bankart procedures declined while Latarjet procedures markedly increased. Future projections to 2030 mirrored these findings. These data may provide an enhanced understanding of the evolution of surgical treatment of glenohumeral instability within the U.S. laying the foundation for continued prospective studies into the appropriate indications and advancements in surgical techniques.
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Affiliation(s)
| | - Andrew M Gabig
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Alex Dawes
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | | | - Joseph D Lamplot
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Eric Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA.
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Min KS, Wake J, Cruz C, Miles R, Chan S, Shaha J, Bottoni C. Surgical treatment of shoulder instability in active-duty service members with subcritical glenoid bone loss: Bankart vs. Latarjet. J Shoulder Elbow Surg 2023; 32:771-775. [PMID: 36375750 DOI: 10.1016/j.jse.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/02/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Subcritical bone loss has been identified as a risk factor for potentially inferior outcomes following typical arthroscopic soft tissue repair. One alternative that has been presented as an option for patients with bone loss is the Latarjet, an ipsilateral coracoid transfer to the anteroinferior glenoid. The purpose of this study is to compare the outcomes between the arthroscopic Bankart repair and the open Latarjet for the treatment of anterior shoulder instability in patients with subcritical bone loss. We hypothesize that the open Latarjet will provide higher patient-reported outcome measure scores and lower rates of dislocation. METHODS A retrospective cohort comparison of patients with anterior glenohumeral instability procedures was performed. Inclusion criteria included symptomatic anterior shoulder instability, subcritical glenoid bone loss (13.5%-24%), surgical treatment with arthroscopic Bankart repair or open Latarjet, and minimum follow-up of 2 years. Outcomes included recurrent instability (defined as postoperative dislocation or subjective subluxation), permanent physical restrictions, Western Ontario Shoulder Index (WOSI), and Single Assessment Numeric Evaluation (SANE) scores. RESULTS Forty-seven patients were included, 25 of whom underwent an arthroscopic Bankart repair and 23 patients an open Latarjet. The average bone loss was 17.8% and 19.3%, respectively. Overall, 8 patients experienced recurrent instability, 6 in the arthroscopic Bankart group and 2 in the open Latarjet group (P = .162). The average postoperative SANE score for arthroscopic Bankart group was 48% and for the open Latarjet group, 84% (P < .001). The average postoperative WOSI score for the arthroscopic Bankart group was 53.6% and for the open Latarjet group, 67.9% (P = .069). There were significantly more patients placed on permanent physical restrictions in the arthroscopic Bankart repair group (16) compared with open Latarjet (3) (P < .001). CONCLUSION In patients with subcritical glenoid bone loss (defined as 13.5%-24%), patients treated with an open Latarjet have insignificantly higher SANE and WOSI scores and lower permanent physical restrictions than patients treated with an arthroscopic Bankart repair. We found no statistically significant difference in recurrent instability rates between the open Latarjet and arthroscopic Bankart repair (P = .162).
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Affiliation(s)
- Kyong S Min
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA; Uniformed Services University, Bethesda, MD, USA; John A Burns School of Medicine, Honolulu, HI, USA.
| | - Jeff Wake
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Christian Cruz
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | | | - Sean Chan
- John A Burns School of Medicine, Honolulu, HI, USA
| | - Jimmy Shaha
- Department of Orthopaedic Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Craig Bottoni
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
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Pugliese M, Loppini M, Vanni E, Longo GU, Castagna A. Cost-effectiveness analysis of arthroscopic Bankart repair versus open Latarjet reconstruction in anterior shoulder instability. Int Orthop 2023:10.1007/s00264-023-05736-7. [PMID: 36973428 DOI: 10.1007/s00264-023-05736-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/13/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE The ideal surgical treatment for anterior shoulder instability is still under debate. In the healthcare setting, both clinical and economic factors must be considered for optimal resource allocation. From the clinical perspective, the Instability Severity Index Score (ISIS) is a helpful and validated tool for surgeons, although a gray area between 4 and 6 exists. In fact, patients with an ISIS < 4 and > 6 can be treated effectively with arthroscopic Bankart repair and open Latarjet, respectively. The purpose of this study was to conduct a cost-effectiveness analysis of arthroscopic Bankart repair versus open Latarjet in patients with an ISIS between 4 and 6. METHODS A decision-tree model was constructed to simulate the clinical scenario of an anterior shoulder dislocation patient with an ISIS between 4 and 6. Based on previously published literature, outcome probabilities and utility values in the form of Western Ontario Instability Score (WOSI) were assigned to each branch of the tree, alongside institutional cost. The primary outcome assessed was an Incremental cost-effectiveness ratio (ICER) of the two procedures. Eden-Hybbinette was also considered in the model as a salvage procedure for failed Latarjet. A two-way sensitivity analysis was performed to identify the most impactful parameters on the ICER upon their variation within a pre-determined interval. RESULTS Base case cost was 1245.57 € (1220.48-1270.65 €) for arthroscopic Bankart repair, 1623.10 € (1580.82-1665.39 €) for open Latarjet and 2.373.95 € (1940.81-2807.10 €) for Eden-Hybbinette. Base-case ICER was 9570.23 €/WOSI. Sensitivity analysis showed that the most impactful parameters were the utility of arthroscopic Bankart repair, the probability of success of open Latarjet, the probability of undergoing surgery after post-operative recurrence of instability and the utility of Latarjet. Of these, utility of arthroscopic Bankart repair and Latarjet had the most significant impact on the ICER. CONCLUSION From a hospital perspective, open Latarjet was more cost-effective than arthroscopic Bankart repair in preventing further shoulder instability in patients with an ISIS between 4 and 6. Despite its several limitations, this is the first study to analyze this subgroup of patients from a European hospital setting from both an economic and clinical perspective. This study can help surgeons and administrations in the decision-making process. Further clinical studies are needed to prospectively analyze both aspects to further delineate the best strategy.
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Affiliation(s)
- Mattia Pugliese
- Trauma & Orthopaedics Department, Ospedale Maggiore C.A. Pizzardi, Bologna, Italy.
| | - Mattia Loppini
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Elena Vanni
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Giuseppe Umile Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Alessandro Castagna
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Clinical and Research Center, Humanitas University, IRCCS, HumanitasRozzano, Milan, Italy
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Kim D, Lee DW, Lee J, Jang Y. Latarjet procedure without capsular repair produces favorable clinical results and avoids limitation in external rotation. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07393-0. [PMID: 36951982 DOI: 10.1007/s00167-023-07393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE This study aimed at analyzing the range of motion (ROM) and other clinical outcomes in patients with > 20% glenoid bone loss who underwent the Latarjet procedure with or without anterior capsule repair. METHODS This retrospective study included 47 patients with > 20% glenoid bone loss who underwent the classic Latarjet procedure from 2016 to 2021. Of these, 25 did not undergo capsular repair (no-capsular-repair group; group I) whereas 22 patients did (capsular-repair group; group II). The Rowe score, American Shoulder and Elbow Surgeons score, Visual Analogue Scale, ROM, recurrence, and complications were evaluated before and 3, 6, and 12 months after the surgery. A goniometer was used to measure the forward flexion and external rotation (arm adducted, 90° abducted) of both shoulders. The ROM deficit was measured as the difference from the contralateral healthy shoulder. RESULTS The external rotation in arm adduction at 3 and 6 months after surgery showed significantly better results in group I than group II(p = 0.002 at 3 months; p = 0.005 at 6 months). The deficit in external rotation with arm adduction was also significantly lower in group I at 3 months (p = 0.001) and 6 months (p = 0.001) after surgery. However, external rotation with arm adduction at 12 months after surgery did not significantly differ between the groups. Moreover, the ROM in external rotation with 90° arm abduction was significantly better in group I than that in group II at 3, 6, and 12 months postoperatively (p = 0.002, p = 0.001, and p = 0.005, respectively). The deficit in external rotation with 90° arm abduction gradually decreased with time after surgery and differed significantly between the groups. However, the difference in deficit between the two groups at 12 months after surgery did not exceed the measurement error. All clinical scores significantly improved after surgery compared to before surgery; however, the improvement did not significantly differ between the two groups. CONCLUSION The Latarjet procedure without capsular repair showed good laxity restoration and clinical results with less early postoperative external rotation limitation than that achieved by the same procedure with capsular repair. However, external rotation deficit at 1 year after surgery did not show a clinically relevant difference difference between the two groups. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- DooSup Kim
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, 20 Ilsan-Ro, Wonju, 26426, Republic of Korea
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Korea
| | - Dong-Woo Lee
- Department of and Orthopedics, Hanil General Hospital, Seoul, Republic of Korea
| | - JaeMin Lee
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, 20 Ilsan-Ro, Wonju, 26426, Republic of Korea
| | - YoungHwan Jang
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, 20 Ilsan-Ro, Wonju, 26426, Republic of Korea.
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Korea.
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Abstract
Bone loss has been identified as a risk factor for recurrent shoulder dislocations or failure after soft tissue repair. Although the range for "critical" bone loss is yet to be determined, glenoid and humeral bone defects should not be regarded as independent problems, but the interaction between them during shoulder motion should be evaluated as suggested by the glenoid track concept. The glenoid track concept is now widely accepted and considered essential for making decisions about surgery. Soft-tissue procedures usually work well in patients with on-track Hill-Sachs lesions but in off-track lesions do not. In this situation additional procedures should be performed.Different surgical options have been described to address off-track Hill-Sachs lesions, most commonly remplissage, Latarjet or free bone block procedures. Coracoid graft and free bone grafts convert the off-track Hill-Sachs lesion into on-track by lengthening the glenoid-track, whereas remplissage fill-in the humeral lesion so that it does not engage. In the setting of a Hill-Sachs lesion with little or no glenoid bone loss, remplissage has demonstrated satisfactory outcomes with a low complications and recurrence rate. Favorable results have been reported with glenoid bone grafting when managing isolated Hill-Sachs or bipolar lesions. Studies analyzing Latarjet and Eden-Hybinette procedures show that both procedures are safe and effective in the management of anterior glenohumeral instability. Attention should be paid to those patients with large bone defects not amenable to be restored with an isolated Latarjet that may be better addressed with an Eden-Hybinnete or adding a remplissage to the Latarjet procedure.
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Affiliation(s)
- Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Hospital Universitario Fundacion Jimenez Diaz, Universidad Autonoma, Avda Reyes Católicos, 2, Madrid, 28040, Spain.
| | - Cristina Delgado
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Hospital Universitario Fundacion Jimenez Diaz, Universidad Autonoma, Avda Reyes Católicos, 2, Madrid, 28040, Spain
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