|
1
|
Massin V, Dawes AM, Cooke HL, Wagner ER, Werthel JD. Geographic Variability in the Management of Anterior Glenohumeral Instability: A Binational Analysis. Orthop J Sports Med 2025; 13:23259671251324515. [PMID: 40353250 PMCID: PMC12065994 DOI: 10.1177/23259671251324515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Accepted: 10/15/2024] [Indexed: 05/14/2025] Open
Abstract
Background The Bankart and Latarjet procedures are the 2 most commonly performed procedures for stabilization of anterior glenohumeral instability around the world. The aim of this study was to describe actual trends in surgery for anterior instability in the United States and in France. Hypothesis Glenohumeral stabilization surgery overall is becoming more frequent in France and in the United States, with an increasing number of Latarjet procedures having been performed in each country in recent years. Study Design Cross-sectional study; Level of evidence, 3. Methods A retrospective review was performed using French and American databases from 2009 to 2018. Procedure codes MEMA005 and MEMC004 were pulled from the French National Health Insurance System and Current Procedural Terminology codes 23455, 29806, and 23462 were pulled from IBM MarketScan. During this period, 73,914 patients underwent anterior shoulder stabilization surgery in France and 391,521 in the United States. For each year and the global period, the estimated number of Bankart procedures in the United States was compared with the number of French procedures. The same comparison was done for Latarjet procedures. The sex ratio was compared using chi-square testing. The mean age was compared using a Student t test. Results The Bankart procedure represents 98% of the shoulder stabilization procedures in the United States, but the Latarjet procedure is becoming more common in the United States, having increased by 154% during the 10-year study period. In France, the Latarjet procedure represents 75% of the surgeries, having increased by 40% during the 10-year study period. However, use of the Bankart procedure in France increased from 11.2/100,000 in 2009 to 13.4/100,000 in 2018. Conclusion This study demonstrated that, overall, use of the Latarjet procedure has been increasing over the last decade in both the United States and France. However, there remains a divergence in the treatment of anterior shoulder instability between the 2 countries. The Latarjet procedure remains the preferred treatment option in France for anterior shoulder instability (75% Latarjet vs 25% Bankart), whereas the Bankart procedure is dominant within the United States (98% Bankart vs 2% Latarjet). When breaking data down by age groups, more Bankart procedures are being performed on younger patients, and in both countries the incidences of women requiring these surgeries are increasing. The authors hope this study will serve as a foundation for future prospective studies establishing evidence-based algorithms to guide the treatment of anterior instability and provide a root cause analysis on why different surgeons choose a specific procedure to treat this problem.
Collapse
Affiliation(s)
- Valentin Massin
- Department of Orthopaedic Surgery, Aix Marseille Université, Marseille, France
| | | | - Hayden L. Cooke
- Department of Orthopaedic Surgery, Division of Upper Extremity, Emory University, Atlanta, Georgia, USA
| | - Eric R. Wagner
- Department of Orthopaedic Surgery, Division of Upper Extremity, Emory University, Atlanta, Georgia, USA
| | - Jean-David Werthel
- Department of Orthopaedic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| |
Collapse
|
|
2
|
Oenning S, Wermers J, Köhler A, Sußiek J, Wiethölter M, Raschke MJ, Katthagen JC. The Biomechanical Importance of Bone Block Positioning in Glenoid Augmentation: Every Millimeter Matters. Am J Sports Med 2025; 53:1164-1170. [PMID: 40025625 PMCID: PMC11951349 DOI: 10.1177/03635465251322796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 12/20/2024] [Indexed: 03/04/2025]
Abstract
BACKGROUND In the presence of anterior glenoid bone loss (aGBL), options for bony glenoid augmentation include Latarjet procedures and free bone block transfers. Bone graft placement is challenging, and malposition causes complications, such as recurrent instability or osteoarthritis. HYPOTHESIS With minimal changes in bone block positioning, osteochondral shoulder stability cannot be restored sufficiently. STUDY DESIGN Controlled laboratory study. METHODS In a robotic test setup, 14 human cadaveric scapulae were included. Soft tissue was resected, and matching artificial humeri were selected for each specimen. Testing was performed in 60° of glenohumeral abduction with 50 N of glenohumeral compression and anterior-directed translational force to the humerus. Application of 20% aGBL and screw fixation of artificial bone blocks (artBBs) with different buildup shells allowed the following testing stages: (1) intact, (2) 20% aGBL, (3) flush artBB, (4) 1-mm medialized artBB, and (5) 1-mm lateralized artBB. The stability ratio (SR) and medial-lateral humeral head starting position were assessed. RESULTS Specimens with 20% aGBL provided lower mean SRs than native joints (20.6% [SD, 4.7%] vs 27.8% [SD, 6.7%]; P < .0001). Flush artBB placement (mean, 35.4%; SD, 7.7%) led to an increased SR compared with both native joints (P = .002) and 20% aGBL (P < .0001). The mean SR in 1-mm medialized artBBs (21.5%; SD, 5.7%) did not differ compared with that for 20% aGBL (P = .908). One-millimeter lateralized artBBs (mean, 40.8%; SD, 5%) provided higher SR and more lateral humeral head starting positions compared with flush artBB (P = .003 and P = .003, respectively). CONCLUSION In the presence of aGBL, flush bone block placement restores osteochondral glenohumeral stability, while a 1-mm medialized bone block fails to increase stability. Bone block lateralization of 1 mm provides higher stability but is associated with humeral head lateralization. CLINICAL RELEVANCE Glenoid bone block augmentations are established in patients with glenohumeral instability and aGBL. In the case of bone block malposition, complications like recurrent instability or the development of osteoarthritis can occur. This study underlines the importance of accurate bone block placement since only minimum bone block malposition relevantly affects osteochondral shoulder biomechanics.
Collapse
Affiliation(s)
- Sebastian Oenning
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Jens Wermers
- Faculty of Engineering Physics, FH Muenster, Muenster, Germany
| | - Alina Köhler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Julia Sußiek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Mats Wiethölter
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Michael J. Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - J. Christoph Katthagen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
|
3
|
Schulz E, Diepold J, Siegert P, Wierer G, Matis N, Hoffelner T, Auffarth A, Resch H, Habermeyer P, Tauber M, Moroder P. Hawkins Award 2024: free bone graft transfer vs. Latarjet procedure for treatment of anterior shoulder instability with glenoid bone loss: Five-year follow-up of a prospective randomized trial. J Shoulder Elbow Surg 2025:S1058-2746(25)00146-6. [PMID: 39971093 DOI: 10.1016/j.jse.2025.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 01/01/2025] [Accepted: 01/04/2025] [Indexed: 02/21/2025]
Abstract
BACKGROUND Free bone graft transfer (FBGT) and the Latarjet procedure are 2 competing techniques for the treatment of anterior shoulder instability with glenoid bone loss. In the current literature, there are no mid- to long-term prospective randomized comparative studies comparing both surgical methods. METHODS This prospective, twin-center, randomized study enrolled 60 patients with anterior shoulder instability and more than 15% glenoid bone loss. The study cohort was randomly assigned in a 1:1 ratio to either an open FBGT surgery (J-bone graft technique) or an open Latarjet procedure. Clinical data, including Western Ontario Shoulder Index (WOSI), Rowe Score, Subjective Shoulder Value, visual analog scale, satisfaction with the operation, sports and work limitations, range of motion and strength, as well as the extent of instability arthropathy were collected preoperatively and at 6, 12, 24, and 60 months postoperatively. The 5-year follow-up rate was 63.3% for the FBGT group and 66.6% for the Latarjet group. RESULTS The primary outcome parameter (ie, WOSI) showed no significant differences at the 5-year follow-up (J-Span 221 ± 186, Latarjet 201 ± 239; P = .529) and other time points. The secondary clinical scores also showed no significant differences between the 2 groups (Rowe Score, P = .596; Subjective Shoulder Value, P = .368; visual analog scale, P = .238; and Athletic Shoulder Outcome Scoring System, P = .594). Comparable results were observed regarding strength and motion, except for significantly better internal rotation in the FBGT group at all time points, including the 5-year follow-up (P = .004). A single recurrence of instability was observed in 3 patients of the FBGT group and 1 patient of the Latarjet group (P = .342). Postoperative hypesthesia at the iliac crest was reported in 3.3% of the FBGT patients. The degree of instability arthropathy showed a comparable increase in both cohorts (P = .154). CONCLUSION Neither of the 2 surgical methods showed clinical superiority at the 5-year follow-up, except for statistically better internal rotation in the FBGT group. Both cohorts showed comparable success in joint stabilization, but neither could prevent the progression of instability arthropathy.
Collapse
Affiliation(s)
- Eva Schulz
- Kardinal Schwarzenberg Clinic, Schwarzach im Pongau, Austria.
| | - Julian Diepold
- Department of Orthopedics and Traumatology, Kepler University Clinic, Linz, Austria
| | - Paul Siegert
- 1st Orthopaedic Department, Orthopaedic Hospital Speising, Vienna, Austria
| | | | - Nicholas Matis
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Hoffelner
- 2nd Orthopaedic Department, Herz-Jesu Hospital Vienna, Vienna, Austria
| | - Alexander Auffarth
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Herbert Resch
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Peter Habermeyer
- 2nd Orthopaedic Department, Herz-Jesu Hospital Vienna, Vienna, Austria
| | - Mark Tauber
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria; Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
| | - Philipp Moroder
- Department of Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| |
Collapse
|
|
4
|
Kizilkurt T, Darilmaz MF, Okatar F, Ersen A. Does Scapular and Thoracic Morphology Affect Latarjet Alpha Angle? J Clin Med 2025; 14:274. [PMID: 39797355 PMCID: PMC11721271 DOI: 10.3390/jcm14010274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 12/24/2024] [Accepted: 01/04/2025] [Indexed: 01/13/2025] Open
Abstract
Purpose: This study aimed to determine the relationship between alpha angle (the angle between the screws and the glenoid) and thoracic diameters in patients undergoing the Latarjet procedure. Defining the relationship between thoracic morphology and alpha angle is aimed at filling the gap in the literature and improving surgical outcomes. Methods: This retrospective study analyzed 74 patients who underwent the Latarjet procedure for recurrent anterior shoulder instability between 2022 and 2024. All procedures were performed by the same surgeon using a standardized protocol to ensure consistency of surgical technique across cases. In postoperative chest CT scans, alpha angle, anteroposterior diameter of the thorax, transverse diameter of hemithorax, scapular inclination, and glenoid version were evaluated. Results: The study included predominantly male patients (90%) with a mean age of 26.4 ± 6.4 years who underwent Latarjet procedures predominantly on the right side (60%). Significant associations were observed between thoracic morphology and alpha angle on postoperative CT scans. There was a significant positive correlation between anterior-posterior/transverse diameter ratio (AP/T) and alpha angle (r = 0.407, p < 0.001), as well as correlations between scapular inclination, glenoid version, thoracoscapular angle, and alpha angle (r = 0.275, p = 0.018; r = 0.241, p = 0.039; r = -0.288, p = 0.013, respectively). Patients were divided based on an alpha angle threshold of 15 degrees, with results indicating worse outcomes for angles above this threshold. Additionally, the AP/T ratio demonstrated predictive value for poor outcomes (AUC = 0.660, p = 0.018) with a threshold of 1.2545. Conclusions: This study highlights the direct impact of thoracic morphology on the alpha angle observed on post-Latarjet chest CT scans. Specifically, patients with a higher ratio of anterior-posterior to transverse thoracic diameter (AP/T) show a proportional increase in alpha angle. When the AP/T ratio exceeds 1.25, surgeons may face challenges in achieving the target alpha angle.
Collapse
Affiliation(s)
| | - Muhammed Furkan Darilmaz
- Department of Orthopedics and Traumatology, Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey; (T.K.); (F.O.); (A.E.)
| | | | | |
Collapse
|
|
5
|
Castillo de la Peña J, Chalmers PN, Ma J, Wong I. Subscapularis Muscle Radiographic Integrity and Patient-Reported Outcomes Following Arthroscopic Anatomic Glenoid Reconstruction With Distal Tibial Allograft. Am J Sports Med 2024; 52:3480-3487. [PMID: 39543912 DOI: 10.1177/03635465241291843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2024]
Abstract
BACKGROUND Shoulder stabilization surgery has evolved over time, and bony augmentation procedures on the glenoid side are being performed more often. The Latarjet procedure modifies subscapularis anatomy because the conjoined tendon divides the subscapularis muscle fibers through a split/takedown, which has structural and functional implications. Arthroscopic anatomic glenoid reconstruction (AAGR) re-creates anatomy. This technique uses the Halifax portal to deploy and fix a distal tibial allograft (DTA) through the rotator interval, thus preserving the subscapularis anatomy. PURPOSE/HYPOTHESIS The purpose was to analyze the radiographic properties of the subscapularis muscle after AAGR. It was hypothesized that the subscapularis muscle structure remains preserved postoperatively. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective review was performed comprising a consecutive series of patients treated with AAGR with DTA between November 2012 and April 2021 for traumatic anterior shoulder instability with glenoid bone loss. Patients were excluded if they had posterior instability, glenoid fracture, missing pre- or postoperative computed tomography (CT) scans, or only CT arthrogram available. Radiographic variables measured on CT scans included estimates of subscapularis muscle volume, subscapularis/infraspinatus muscle ratio, and fatty infiltration according to the Goutallier classification. Pre- and postoperative Western Ontario Shoulder Instability index scores were collected as a secondary outcome of this study. RESULTS Ninety-three patients were included in the study with a clinical follow-up of 2.3 ± 1.5 years (mean ± SD). The subscapularis volume increased from 185.91 ± 45.85 mL preoperatively to 194.1 ± 49.0 mL postoperatively (P = .006). The subscapularis to infraspinatus muscle ratio showed a significant increase from 0.96 ± 0.27 to 1.05 ± 0.30 after surgery (P = .002). All patients had a Goutallier stage of 0 before and after surgery. The Western Ontario Shoulder Instability scores showed a significant improvement from 64.8 ± 15.5 preoperatively to 28.2 ± 24.0 postoperatively (P < .001). CONCLUSION Patients who undergo AAGR with DTA for traumatic shoulder instability with glenoid bone loss have a preserved subscapularis muscle volume with no fatty infiltration, while showing a significant improvement in clinical outcomes.
Collapse
Affiliation(s)
| | - Peter N Chalmers
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jie Ma
- Department of Orthopaedic Surgery, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Ivan Wong
- Department of Orthopaedic Surgery, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
|
6
|
Portes A, Santana F, Torrens C. Does plate fixation improve the Latarjet procedure for anterior glenohumeral instability? Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00190-5. [PMID: 39536814 DOI: 10.1016/j.recot.2024.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 10/29/2024] [Accepted: 11/06/2024] [Indexed: 11/16/2024] Open
Abstract
The Latarjet technique is a procedure used to treat anterior glenohumeral instability with glenoid bone loss. Various fixation systems for the coracoid have been described in the literature. This study aims to compare the results in quality of life and complications between patients treated with plate and screws (GP) and those with screws only (GSP) for coracoid fixation. MATERIAL AND METHODS A retrospective study including patients with anterior glenohumeral instability and glenoid bone loss treated with Latarjet at the same center between October 2009 and February 2021. A total of 85 shoulders were analyzed, of which 64 completed at least one year of follow-up. Patients with previous surgical history in the same shoulder, bone loss <10%, ligamentous hyperlaxity (Beighton score >6), and previous infections were excluded. Complications were recorded, and the WOSI and Rowe tests were used to assess quality of life and return to sports activity. RESULTS Of the 64 patients, 35 were treated with a plate (GP) and 29 with screws (GSP). The mean age was 30±8.78years. Both groups were statistically comparable. No significant differences were found in the WOSI test (P=.140), the Rowe test (P=.380) or in complications (P=.692). A higher percentage of the GP group returned to sports activity (77.1% GP vs. 51.7% GSP, P=.039). CONCLUSIONS No statistically differences were observed in quality of life, complications, or re-dislocations. However, the use of a plate showed a greater predisposition to return to sports activity (P=.039) in patients with anterior glenohumeral instability.
Collapse
Affiliation(s)
- A Portes
- Departamento de Cirugía Ortopédica y Traumatología, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
| | - F Santana
- Departamento de Cirugía Ortopédica y Traumatología, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | - C Torrens
- Departamento de Cirugía Ortopédica y Traumatología, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| |
Collapse
|
|
7
|
Briggs DV, Hurley ET, Warren E, Amanah AY, Levin JM, Lau BC, Dickens JF, Klifto CS, Anakwenze O. Bone block options for treating glenoid bone loss and glenohumeral instability: A systematic review. Shoulder Elbow 2024:17585732241293763. [PMID: 39545005 PMCID: PMC11559950 DOI: 10.1177/17585732241293763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 09/30/2024] [Accepted: 10/02/2024] [Indexed: 11/17/2024]
Abstract
Background To systematically review the literature assessing glenoid bone loss restoration by different bone block options and compare their dimensions. Methods Systematic examination of articles in PubMed and EMBASE databases was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to find studies of bone grafts for treating anterior glenohumeral instability. Statistical analyses were conducted via Review Manager, and a p-value of <0.05 was statistically significant. Results Our review included 25 studies evaluating 870 shoulders. Traditional arc Latarjet (TL) had more depth than congruent arc Latarjet (CAL; p = 0.003). The coronal radii of curvature of TL, CAL, distal tibia, and iliac crest bone blocks were similar to native glenoid (p = 0.400, 0.817, 0.467, 0.216, respectively). CAL coracoid bone blocks restored significantly more glenoid surface area (30.3%) than TL bone blocks (p = 0.012). The glenoid width and surface area restoration by distal clavicle bone blocks were equivalent to TL (p = 0.058 and p = 0.103, respectively). Discussion The CAL technique restored higher percentages of glenoid surface area than TL but has less depth, which may increase fracture risk during screw insertion. The distal clavicle bone block is a suitable substitute to TL as it was equivalent regarding glenoid width and surface area restoration.
Collapse
Affiliation(s)
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Eric Warren
- Duke University School of Medicine, Durham, NC, USA
| | | | - Jay M Levin
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA
| | | | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA
| |
Collapse
|
|
8
|
Gillinov SM, Islam W, Modrak M, Mahatme RJ, Wilhelm CV, McLaughlin WM, Surucu S, Moran J, Lee MS, Grauer JN, Jimenez AE. Female Patients Undergoing Latarjet Surgery Show Similar 2-Year Secondary Surgery Rates but Greater Risk of Emergency Department Visits Compared With a Matched Cohort of Male Patients. Arthroscopy 2024; 40:2645-2651.e1. [PMID: 38513877 DOI: 10.1016/j.arthro.2024.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/24/2024] [Accepted: 02/25/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To evaluate sex-based differences in 30-day postoperative emergency department (ED) visits, 90-day complication rates, and 2-year secondary surgery rates after the Latarjet procedure for the treatment of recurrent shoulder instability. METHODS A national administrative claims database was used to identify patients with International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes for shoulder subluxation or dislocation on the day of first-time stabilization with the Latarjet technique between 2015 and 2021. Male patients were matched 4:1 to female patients based on age, Elixhauser Comorbidity Index (ECI) score, and body mass index class. Rates of 30-day ED visits and 90-day complications were compared between cohorts, and risk factors for ED visits were identified by multivariate regression. The incidence of secondary surgery within 2 years was compared by Kaplan-Meier analysis. RESULTS Prior to matching, 1,059 male and 360 female patients met the inclusion and exclusion criteria. Subsequent 4:1 (male-to-female) matching controlling for age, ECI score, and body mass index yielded 694 male and 185 female patients who underwent the Latarjet procedure. The overall incidence of 30-day ED visits was 9.3%, with an incidence of 8.2% for male patients and 13.5% for female patients. On the basis of multivariate logistic regression, these 30-day ED visits were associated with female sex (odds ratio, 1.79; P = .029) and incrementally higher ECI scores; relative to an ECI score of 0, ECI scores of 1 to 2, 3 to 4, and 5 or greater were associated with odds ratios of 5.31 (P = .006), 8.12 (P < .001), and 12.84 (P < .001), respectively. Ninety-day complications occurred in 1.5% of the total cohort, and the incidence was not statistically different between sexes. Overall, 2-year secondary surgery rates were similar between male and female patients (5.1% and 6.7%, respectively; P = .4). CONCLUSIONS Female patients undergoing the Latarjet procedure for recurrent shoulder instability showed similar 90-day complication and 2-year secondary surgery rates to a matched cohort of male patients. Female sex, along with ECI score, however, was associated with a greater rate of 30-day ED visits. LEVEL OF EVIDENCE Level III, retrospective comparative case series.
Collapse
Affiliation(s)
- Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A..
| | - Wasif Islam
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Maxwell Modrak
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | - Christopher V Wilhelm
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - William M McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Serkan Surucu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Michael S Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| |
Collapse
|
|
9
|
Zhang C, Yang S, Pang L, Li T, Li Y, Wang H, Huang Y, Tang X. Salvage Latarjet may provide worse outcomes in terms of recurrent instability and returning to sports compared to primary Latarjet: a systematic review of comparative studies. BMC Musculoskelet Disord 2024; 25:500. [PMID: 38937741 PMCID: PMC11212418 DOI: 10.1186/s12891-024-07593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The Latarjet procedure (LP) is performed as a primary stabilization procedure (primary LP) and a salvage procedure when an earlier shoulder stabilization procedure has failed (salvage LP). However, whether primary LP or salvage LP provides better outcomes for anterior shoulder instability remains unknown. METHODS Two independent reviewers performed the literature search based on the PRISMA guidelines. A comprehensive search of PubMed, Embase, web of science and Cochrane Library was performed from their inception date to December 4, 2023. Inclusion criteria mainly included the comparison of postoperative outcomes between primary and salvage LP, English language, and full text availability. Two reviewers independently examined the literature, collected data, and evaluated the methodological robustness of the included studies. The Methodological Index for Nonrandomized Studies was used to evaluate the quality of nonrandomized studies. Recurrent instability, complications, reoperations, return to sports, patient-reported outcomes, and range of motion were assessed. Statistical evaluations were conducted using Manager V.5.4.1 (The Cochrane Collaboration, Software Update, Oxford, UK). RESULTS Twelve studies were included in the systematic review, with 940 shoulders undergoing primary LP and 631 shoulders undergoing salvage LP. Statistically significant differences in favor of primary LP were found in 2 of the 11 and 2 of 4 included studies in terms of recurrent instability and returning to the same sports (RTS) at preinjury level, respectively. In terms of the visual analog scale, subjective shoulder value and the Western Ontario Shoulder Instability Index, 2 of the 4, 1 of the 3 and 1 of the 3 included studies reported statistically significant differences in favor of primary LP. Differences were not noticed regarding complications, reoperations, the time to RTS, the Rowe score, the Athletic Shoulder Outcome Scoring System, and forward flexion. CONCLUSION Current evidence suggests that compared with primary LP, salvage LP may provide inferior postoperative outcomes in terms of recurrent instability and the rate of RTS at preinjury level. Primary and salvage LP may yield comparable efficacy in terms of complications, reoperations, the rate of RTS, the time to RTS, pain, shoulder function, and range of motion. PROSPERO ID CRD42023492027.
Collapse
Affiliation(s)
- Chunsen Zhang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Songyun Yang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Santai County People's Hospital, Mianyang, 621199, China
| | - Long Pang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Tao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yinghao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Haoyuan Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yizhou Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
|
10
|
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 2024; 33:1387-1396. [PMID: 38008373 DOI: 10.1016/j.jse.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 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.
Collapse
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
| |
Collapse
|
|
11
|
Vuletić F, Bøe B. Current Trends and Outcomes for Open vs. Arthroscopic Latarjet. Curr Rev Musculoskelet Med 2024; 17:136-143. [PMID: 38467987 PMCID: PMC11068718 DOI: 10.1007/s12178-024-09889-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE OF REVIEW This paper aims to analyze and compare the existing research on open and arthroscopic Latarjet procedures for treating anterior shoulder instability. The review will assess different factors such as graft positioning, functional outcomes, complications, and return-to-play rates for both approaches. The study's primary goal is to establish which technique yields superior outcomes. RECENT FINDINGS Recent studies have suggested that arthroscopic Latarjet surgery can produce outcomes similar to open surgery regarding functional scores and patient satisfaction. Some research indicates that arthroscopy may even provide slightly better results. Both techniques have similar complication rates, but arthroscopy requires a longer learning curve and operating time. It is crucial to ensure the proper placement of the graft, and some studies suggest that arthroscopy may be better at achieving accurate positioning. Both open and arthroscopic Latarjet procedures are equally effective in treating shoulder instability. While arthroscopy offers a faster recovery time and causes less soft tissue damage, it requires surgeons to undergo a steeper learning curve. The optimal graft position for both techniques is still debated. More long-term data is needed to establish superiority. Future research should compare approaches in larger cohorts and identify outcome-affecting factors to improve the treatment of shoulder instability. Both techniques are promising, but arthroscopy may be a better option as the procedure evolves into a less invasive reconstruction.
Collapse
Affiliation(s)
- Filip Vuletić
- Department for Orthopaedic and Trauma Surgery, University Hospital "Sveti Duh", Sveti Duh 64, 10000, Zagreb, Croatia
- Faculty of Kinesiology, University of Zagreb, Horvaćanski zavoj 15, 10000, Zagreb, Croatia
| | - Berte Bøe
- Division of Orthopaedic Surgery, Oslo University Hospital, Trondheimsveien 235, 0586, Aker, Oslo, Norway.
| |
Collapse
|
|
12
|
DeClercq MG, Martin MD, Whalen RJ, Cote MP, Midtgaard KS, Peebles LA, Di Giacomo G, Provencher MT. Postoperative Radiographic Outcomes Following Primary Open Coracoid Transfer (Bristow-Latarjet) Vary in Definition, Classification, and Imaging Modality: A Systematic Review. Arthroscopy 2024; 40:1311-1324.e1. [PMID: 37827435 DOI: 10.1016/j.arthro.2023.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/10/2023] [Accepted: 09/17/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE To analyze radiographic outcomes by conventional radiography, computed tomography (CT), or both and complication rates of open coracoid transfer at a minimum of 12-months follow-up. METHODS A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Medline (Ovid), and EMBASE library databases. Inclusion criteria were clinical studies reporting on open Latarjet as the primary surgical procedure(revision coracoid transfer after failed prior stabilization excluded) with postoperative radiographic outcomes at a minimum mean 1-year follow-up. Patient demographics, type of postoperative imaging modality, and radiographic outcomes and complications including graft union, osteoarthritis, and osteolysis were systematically reviewed. Data were summarized as ranges of reported values for each outcome metric. Each radiographic outcome was graphically represented in a Forest plot with point estimates of the incidence of radiographic outcomes with corresponding 95% confidence intervals and I2. RESULTS Thirty-three studies met inclusion criteria, with a total of 1,456 shoulders. The most common postoperative imaging modality was plain radiography only (n = 848 [58.2%]), both CT and radiography (n = 287 [19.7%]), and CT only (n = 321 [22.1%]). Overall, the reported graft union rate ranged from 75% to 100%, of which 79.8% (n = 395) were detected on plain radiography. The most common reported postoperative radiographic complications after the open coracoid transfer were osteoarthritis (range, 0%-100%, pooled mean 28%), graft osteolysis (range, 0%-100%, pooled mean 30%), nonunion (range, 0%-32%, pooled mean 5.1%), malpositioned graft (range, 0%-75%, pooled mean 14.75%), hardware issues (range, 0%-9.1%, pooled mean 5%), and bone block fracture (range, 0%-8%, pooled mean 2.1%). Graft healing was achieved in a majority of cases (range, 75%-100%). CONCLUSION Postoperative radiographic outcomes after open coracoid transfer vary greatly in definition, classification, and imaging modality of choice. Greater consistency in postoperative radiographic outcomes is essential to evaluate graft healing, osteolysis, and nonunion. LEVEL OF EVIDENCE Level IV, systematic review of Level III-IV studies.
Collapse
Affiliation(s)
| | | | - Ryan J Whalen
- Steadman Philippon Research Institute, Vail, Colorado
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Kaare S Midtgaard
- Steadman Philippon Research Institute, Vail, Colorado; Steadman Clinic, Vail, Colorado; Norwegian Armed Forces Joint Medical Services, Oslo, Norway; Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | | | | | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado; Steadman Clinic, Vail, Colorado.
| |
Collapse
|
|
13
|
Şahin K, Sarıkaş M, Çeşme DH, Topal M, Kapıcıoğlu M, Bilsel K. Does previous arthroscopic Bankart repair influence coracoid graft osteolysis in Latarjet procedure? A case-control study with computed tomography scan data. J Shoulder Elbow Surg 2024; 33:e223-e230. [PMID: 37757904 DOI: 10.1016/j.jse.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/14/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The Latarjet procedure is commonly performed in the treatment of recurrent shoulder instability and is also indicated as a salvage procedure for recurrence after failed arthroscopic Bankart repair. Although this procedure has shown success, there has been an increased awareness of complications in recent studies, especially graft osteolysis. Most relevant research has focused on the pathophysiology, incidence, or location of graft osteolysis or the risk factors for graft osteolysis; however, the data are limited to primary Latarjet procedures. This study aimed to investigate the effect of previous arthroscopic Bankart repair surgery on coracoid bone graft osteolysis in the Latarjet procedure. METHODS This retrospective case-control study analyzed data from patients who underwent primary Latarjet procedures or revision Latarjet procedures following failed arthroscopic Bankart repair. Clinical outcome measures included range of motion, the Subjective Shoulder Value, and the Rowe score. Volumetric analysis of each transferred coracoid graft was performed using early postoperative and late postoperative computed tomography scan data, and the amount of graft osteolysis was then calculated as the percentage of volume reduction of each graft. RESULTS A total of 32 patients who met the inclusion criteria were included in this study, with 24 patients in the primary Latarjet group (group I) and 8 patients in the revision Latarjet group (group II). The mean age of the patients was 32.5 ± 7.7 years, and the mean follow-up duration was 52.1 ± 8.9 months. Both study groups showed significant improvement in the Subjective Shoulder Value compared with baseline (P < .05). Comparison of postoperative clinical outcome measures showed no significant difference in any outcome parameter between the 2 study groups (P > .05). No recurrence was observed during the follow-up period. A positive apprehension sign was present in 6 patients (25%) in group I and 4 patients (50%) in group II (P > .05). Analysis of radiologic data revealed that all patients underwent some degree of graft osteolysis, with varying osteolysis ratios between 12% and 98%. The mean osteolysis ratio of the coracoid graft was 67.3% ± 22.6% in group I and 69.4% ± 25.6% in group II, with no significant difference between the 2 groups (P > .05). CONCLUSION The findings of this study suggest that a considerable amount of coracoid graft osteolysis is observed after both primary Latarjet procedures and revision Latarjet procedures following failed arthroscopic Bankart repair. Previous arthroscopic Bankart repair did not seem to have a significant influence on the amount of graft osteolysis, and both primary and revision Latarjet procedures showed satisfactory clinical outcomes.
Collapse
Affiliation(s)
- Koray Şahin
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Murat Sarıkaş
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Murat Topal
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kastamonu University, Kastamonu, Turkey
| | - Mehmet Kapıcıoğlu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey.
| |
Collapse
|
|
14
|
Calvo E, Dzidzishvili L, Valencia M, Calvo C. Outcomes of Arthroscopic Latarjet as a Revision Surgery After Failed Arthroscopic Bankart Repair. Am J Sports Med 2024; 52:190-200. [PMID: 38164667 DOI: 10.1177/03635465231209986] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND The role of arthroscopic Latarjet as a revision surgery after failed arthroscopic Bankart repair has yet to be established. PURPOSE To compare clinical outcomes, recurrences, and complication rates of arthroscopic Latarjet as a revision procedure after failed arthroscopic Bankart repair versus arthroscopic Latarjet as a primary procedure. DESIGN Cohort study; Level of evidence, 3. METHODS This is a retrospective study of prospectively collected data of patients who were diagnosed with anterior shoulder instability and underwent arthroscopic Latarjet stabilization between 2009 and 2018. Patients were separated into 2 groups depending on whether Latarjet was performed after a previous instability surgery (revision) or as a primary surgery (primary). Rowe score, Western Ontario Shoulder Instability Index (WOSI), Constant-Murley Shoulder Outcome (CMSO) score, and Single Assessment Numeric Evaluation (SANE) were assessed pre- and postoperatively with a minimum 24 months of follow-up. In addition, pre- and postoperative levels of sports activity, dislocations, subluxations, and complications were assessed. RESULTS A total of 97 patients (n = 62 revision; n = 35 primary), with a mean age of 31.0 ± 8.8 and 29.4 ± 7.6 years old in the revision and primary Latajet group, respectively, met the inclusion criteria. The mean follow-up in the revision group was 32 months (24-53) and 35.5 months (27.7-42.2) in the primary Latarjet group. No significant differences between groups were observed in Rowe score (revision = 91.4, primary = 94.1; P = .223), CMSO score (revision = 90.7, primary = 94; P = .105), and SANE (revision = 85.8, primary = 87.3; P = .683) postoperatively. However, the postoperative difference in the WOSI score between the revision and primary Latarjet groups was nearly significant (510 ± 334 vs 403 ± 343, respectively; P = .05). Four (6.4%) postoperative dislocations were reported in the revision and 1 (2.8%) in the primary Latarjet group (P = .14). Patients in the revision group had a lower return to the previous level of sports participation (P = .008) and decreased external rotation with the arm by the side compared with the primary Latarjet group (P = .000). CONCLUSION Arthroscopic Latarjet as a revision surgery is a reasonable surgical option in failed Bankart repair cases. The decision to perform arthroscopic Latarjet stabilization as a revision surgery should not be influenced by the potential risk of future complications as it provides comparable clinical outcomes to the primary Latarjet procedure with a low postoperative recurrence rate. However, a decreased level of postoperative sports participation and external rotation with the arm by the side can be expected.
Collapse
Affiliation(s)
- Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lika Dzidzishvili
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Claudio Calvo
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
|
15
|
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] [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.
Collapse
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
| |
Collapse
|
|
16
|
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 REVIEWS, REPORTS, AND TECHNIQUES 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] [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.
Collapse
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
| |
Collapse
|
|
17
|
Ritter D, Hachem AI, Scheibel M, Raiss P, Denard PJ, Campagnoli A, Wijdicks CA, Bachmaier S. Primary Stability and Bone Contact Loading Evaluation of Suture and Screw based Coracoid Graft Fixation for Anterior Glenoid Bone Loss. Am J Sports Med 2023; 51:2858-2868. [PMID: 37656204 DOI: 10.1177/03635465231188976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Reconstruction techniques for anterior glenoid bone loss have seen a trend from screws to suture-based fixations. However, comparative biomechanical data, including primary fixation and glenoid-graft contact pressure mapping, are limited. HYPOTHESIS Suture-based bone block cerclage (BBC) and suspensory suture button (SB) techniques provide similar primary fixation and cyclic stability to double-screw fixation but with higher contact loading at the bony interface. STUDY DESIGN Controlled laboratory study. METHODS In total, 60 cadaveric scapulae were prepared to simulate anterior glenoid bone loss with coracoid autograft reconstruction. Graft fixation was performed with 3 different techniques: (1) an interconnected all-suture BBC, (2) 2 SB suspensions, and (3) 2 screws. Initial compression was analyzed during primary fixation. Cyclic peak loading with 50 N and 100 N over 250 cycles at 1 Hz was performed with a constant valley load of 25 N. Optical recording and pressure foils allowed for spatial bone block tracking and contact pressure mapping at the glenoid-graft interface. Load-to-failure testing was performed at a rate of 1.5 mm/s with ultimate load and stiffness measured. RESULTS Initial graft compression was higher with screw fixation (141 ± 5 N) compared with suture-based fixations (P < .001), with BBC fixation providing significantly higher compression than SB fixation (116 ± 7 N vs. 91 ± 5 N; P < .001). Spatial bone block migration and ultimate failure load were similar between the BBC and screw groups. The SB group showed significantly increased bone block translation (3.1 ± 1.0 mm; P≤ .014) and rotation (2.5°± 1.4°; P≤ .025) and significantly lower ultimate failure load (180 ± 53 N) compared with the BBC (P = .046) and screw (P = .002) groups. Both suture-based fixations provided significantly increased graft-glenoid contact loading with higher pressure amplitudes (P≤ .032) and contact pressure after cyclic loading (+13%; SB: P = .007; BBC: P = .004) compared with screw fixation. CONCLUSION Both SB and interconnected cerclage fixation improved dynamic contact loading compared with screw fixation in a biomechanical glenoid bone loss model. Cerclage fixation was biomechanically comparable with screw fixation but with a greater variability. SB fixation showed significantly lower primary fixation strength and greater bone block rotation and migration. CLINICAL RELEVANCE Suture-based bone block fixations improved graft-glenoid contact loading, but the overall clinical consequence on healing remains unclear.
Collapse
Affiliation(s)
- Daniel Ritter
- Arthrex Department of Orthopedic Research, Munich, Germany
| | - Abdul-Ilah Hachem
- Department of Orthopedic and Traumatology Surgery, Hospital Universitari Bellvitge & Centro Médico Teknon, University of Barcelona, Barcelona, Spain
| | - Markus Scheibel
- Schulthess Clinic, Zurich, Switzerland
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | |
Collapse
|
|
18
|
Lho T, Lee J, Oh KS, Chung SW. Latarjet procedure for failed Bankart repair provides better stability and return to sports, but worse postoperative pain and external rotation limitations with more complications, compared to revision Bankart repair: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07410-2. [PMID: 37038019 DOI: 10.1007/s00167-023-07410-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE This study aimed to compare the clinical results of revision Bankart repair versus the Latarjet procedure for failed Bankart repair. METHODS A literature search was performed in databases, such as Pubmed, Embase, and Scopus Library. The studies were appraised using the Methodological Index for Non-randomized Studies tool. Studies for failed Bankart repair with revision Bankart repair or Latarjet procedure were included. The pain VAS, ROWE score, rate of return to sports and preinjury level of sports, recurrent instability, range of motion, and complications were compared. Additionally, the pain VAS, ROWE score, forward flexion, and external rotation at side were subjected to a meta-analysis. RESULTS Twenty-four articles were included in the systematic review. The functional outcomes in terms of the ROWE score, recurrent instability, return to sports, and the preinjury level of sports was better in the Latarjet procedure group than those in the revision Bankart repair group (ROWE score, 91 vs. 86.7; recurrent instability rate, 3.5% vs. 14.4%; return to sports rate, 100% vs. 87.9%; return to preinjury level of sports rate, 89.9% vs. 74.9%; all P < 0.001). However, the results of postoperative pain and the postoperative limitation of external rotation at side were worse in the Latarjet procedure group than those in the revision Bankart repair group (pain VAS, 1.4 vs. 0.8; postoperative external rotation at side, 38° vs. 60°; all P < 0.001). In addition, the majority of the complications occurred in the Latarjet procedure group. In the meta-analysis, the postoperative ROWE score was significantly higher in the Latarjet procedure group than that in the revision Bankart group (revision Bankart repair: 95% CI 88.9-80.9, I2 = 65.70; Latarjet procedure: 95% CI 95.8-88.1, I2 = 93.37; P = 0.014). However, the pain VAS, forward flexion, and external rotation at side did not reach the significant level in the meta-analysis. CONCLUSION Compared with revision Bankart repair, the Latarjet procedure for failed Bankart repair showed better ROWE scores, stability, and return to sports or preinjury level of sports; however, the postoperative pain and the limitation of external rotation at side were worse with more complications. IRB NO KUMC 2022-01-024. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Taewoo Lho
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - JiHwan Lee
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea.
| |
Collapse
|
|
19
|
Kim BI, Hudson CP, Taylor DC, Anakwenze OA, Dickens JF, Lau BC. Distal Clavicle Autograft Versus Traditional and Congruent Arc Latarjet Procedures: A Comparison of Surface Area and Glenoid Apposition With 3-Dimensional Computed Tomography and 3-Dimensional Magnetic Resonance Imaging. Am J Sports Med 2023; 51:1295-1302. [PMID: 36927084 DOI: 10.1177/03635465231157430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Limited studies have compared graft-glenoid apposition and glenoid augmentation area between the Latarjet procedure and distal clavicle graft in glenohumeral stabilization. Additionally, preoperative planning is typically performed using computed tomography (CT), and few studies have used 3-dimensional (3D) magnetic resonance imaging (MRI) reformations to assess graft dimensions. PURPOSE The purpose of this study was 2-fold: (1) to compare bony apposition, glenoid augmentation, and graft width among coracoid and distal clavicle bony augmentation techniques and (2) to determine the viability of 3D MRI to assess bone graft dimensions. STUDY DESIGN Controlled laboratory study. METHODS A total of 24 patients with recurrent glenohumeral instability and bone loss were included in this study. 3D CT and 3D MRI reformations were utilized to measure pertinent dimensions for 5 orientations of coracoid and distal clavicle autografts: (1) standard Latarjet procedure (SLJ), (2) congruent arc Latarjet procedure (CLJ), (3) distal clavicle attached by its posterior surface (DCP), (4) distal clavicle attached by its inferior surface (DCI), and (5) distal clavicle attached by its resected end (DCR). Glenoid augmentation was defined as the graft surface area contributing to the glenoid. Bone-on-bone apposition was defined as the graft-glenoid contact area for bone healing potential, and graft width was pertinent for fixation technique. Glenoid bone loss ranged from 0% to 34%. Paired t tests were used to compare graft sizes between patients and compare 3D CT versus 3D MRI measurements. RESULTS The CLJ had the largest graft surface area (mean, 318.41 ± 74.44 mm2), while the SLJ displayed the most bone-on-bone apposition (mean, 318.41 ± 74.44 mm2). The DCI had the largest graft width (mean, 20.62 ± 3.93 mm). Paired t tests revealed no significant differences between the Latarjet techniques, whereas distal clavicle grafts varied significantly with orientation. All 3D CT and 3D MRI measurements were within 1 mm of each other, and only 2 demonstrated a statistically significant difference (coracoid width: 13.03 vs 13.98 mm, respectively [P = .010]; distal clavicle thickness: 9.69 vs 10.77 mm, respectively [P = .002]). 3D CT and 3D MRI measurements demonstrated a strong positive correlation (r > 0.6 and P < .001 for all dimensions). CONCLUSION Glenoid augmentation, bony apposition, and graft width varied with coracoid or distal clavicle graft type and orientation. Differences between 3D CT and 3D MRI were small and likely not clinically significant. CLINICAL RELEVANCE 3D MRI is a viable method for preoperative planning and graft selection in glenoid bone loss.
Collapse
Affiliation(s)
- Billy I Kim
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Caroline P Hudson
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Dean C Taylor
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| |
Collapse
|
|
20
|
Makaram NS, Nicholson JA, Yapp LZ, Gillespie M, Shah CP, Robinson CM. Factors affecting a patient's experience following the open Latarjet procedure to treat recurrent anterior shoulder instability. Bone Joint J 2023; 105-B:389-399. [PMID: 36924182 DOI: 10.1302/0301-620x.105b4.bjj-2022-1049.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
The open Latarjet procedure is a widely used treatment for recurrent anterior instability of the shoulder. Although satisfactory outcomes are reported, factors which influence a patient's experience are poorly quantified. The aim of this study was to evaluate the effect of a range of demographic factors and measures of the severity of instability on patient-reported outcome measures in patients who underwent an open Latarjet procedure at a minimum follow-up of two years. A total of 350 patients with anterior instability of the shoulder who underwent an open Latarjet procedure between 2005 and 2018 were reviewed prospectively, with the collection of demographic and psychosocial data, preoperative CT, and complications during follow-up of two years. The primary outcome measure was the Western Ontario Shoulder Instability Index (WOSI), assessed preoperatively, at two years postoperatively, and at mid-term follow-up at a mean of 50.6 months (SD 24.8) postoperatively. The secondary outcome measure was the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. The influence of the demographic details of the patients, measurements of the severity of instability, and the complications of surgery were assessed in a multivariate analysis. The mean age of the patients was 25.5 years (22 to 32) and 27 (7.7%) were female. The median time to surgery after injury was 19 months (interquartile range (IQR) 13 to 39). Seven patients developed clinically significant complications requiring further intervention within two years of surgery. The median percentage WOSI deficiency was 8.0% (IQR 4 to 20) and median QuickDASH was 3.0 (IQR 0 to 9) at mid-term assessment. A minority of patients reported a poorer experience, and 22 (6.3%) had a > 50% deficiency in WOSI score. Multivariate analysis revealed that consumption of ≥ 20 units of alcohol/week, a pre-existing affective disorder or epilepsy, medicolegal litigation, increasing time to surgery, and residing in a more socioeconomically deprived area were independently predictive of a poorer WOSI score. Although most patients treated by an open Latarjet procedure have excellent outcomes at mid-term follow-up, a minority have poorer outcomes, which are mainly predictable from pre-existing demographic factors, rather than measures of the severity of instability.
Collapse
Affiliation(s)
- Navnit S Makaram
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | - Jamie A Nicholson
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | - Liam Z Yapp
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matthew Gillespie
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - C M Robinson
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
|
21
|
Nicholson AD, Carey EG, Mathew JI, Pinnamaneni S, Jahandar A, Kontaxis A, Dines DM, Dines JS, Blaine TA, Fu MC, Rodeo SA, Warren RF, Gulotta LV, Taylor SA. Biomechanical analysis of anterior stability after 15% glenoid bone loss: comparison of Bankart repair, dynamic anterior stabilization, dynamic anterior stabilization with Bankart repair, and Latarjet. J Shoulder Elbow Surg 2022; 31:2358-2365. [PMID: 35597534 DOI: 10.1016/j.jse.2022.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Dynamic anterior shoulder stabilization (DAS) with Bankart repair is a recently described stabilization technique thought to be more robust than an isolated Bankart repair while avoiding many coracoid transfer-related complications and technical demands. DAS involves transfer of the long head biceps through a subscapularis split to the anterior glenoid to create a sling effect. We hypothesize that DAS with Bankart repair will restore anterior stability in a human-cadaveric model with subcritical (15%) glenoid bone loss. METHODS Eight cadaveric shoulders were tested using an established shoulder simulator to record glenohumeral translations with an accuracy of ±0.2 mm. Shoulders were tested in 5 states-intact soft tissues, Bankart defect with 15% bone loss, isolated Bankart repair, DAS with Bankart repair, isolated DAS, and Latarjet. A 45 N anterior force was applied through the pectoralis major tendon, and translation of the humeral head was recorded and compared with repeated measures analysis of variance. RESULTS The anterior translation in the intact (native) glenoid was 4.7 mm at neutral position and 4.6 mm at 45° external rotation. Anterior translation significantly increased after introducing a Bankart defect with 15% glenoid bone loss to 9.1 mm (neutral, P = .002) and 9.5 mm (45° external rotation, P < .001). All repair conditions showed a significant decrease in anterior translation relative to Bankart defect. DAS with Bankart repair decreased anterior translation compared with the Bankart defect: 2.7 mm (neutral, P < .001) and 2.1 mm (45° external rotation, P < .001). DAS with Bankart repair significantly decreased anterior translation compared with the isolated Bankart repair (2.7 mm vs. 4.7 mm, P = .023) and the isolated DAS (2.7 mm vs. 4.3 mm, P = .041) in neutral position. The Latarjet procedure resulted in the greatest reduction in anterior translation compared with the Bankart defect: 1.2 mm (neutral, P < .001) and 1.9 mm (45° external rotation, P < .001). CONCLUSIONS DAS with Bankart repair is a viable alternative to restore anterior glenohumeral stability with a 15% glenoid defect at a greater degree than either DAS or Bankart repair alone. The Latarjet procedure was the most effective in reducing anterior translation but restrained the anterior translation significantly more than the native glenoid.
Collapse
Affiliation(s)
- Allen D Nicholson
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA.
| | - Edward G Carey
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joshua I Mathew
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Sridhar Pinnamaneni
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Amirhossein Jahandar
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Andreas Kontaxis
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - David M Dines
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joshua S Dines
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Theodore A Blaine
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Michael C Fu
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Scott A Rodeo
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Russell F Warren
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Lawrence V Gulotta
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Samuel A Taylor
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
|
22
|
Falbo R, Moore A, Singleton A, Steffenson A, Levine J, Miller R. Glenoid bone augmentation: a contemporary and comprehensive systematic review of open procedures. Orthop Rev (Pavia) 2022; 14:37834. [PMID: 36045697 DOI: 10.52965/001c.37834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction There is a trend towards arthroscopically treating shoulder instability with glenoid deficiency. Despite this, there remains the option for treatment through an open technique. Multiple bone augmentation options are available for recurrent anterior shoulder instability. Objective To provide a systematic review of recent studies for recurrent anterior shoulder instability necessitating glenoid bone augmentation specifically through open procedures using coracoid bone or free bone blocks [iliac crest bone autograft/allograft or distal tibia allograft (DTA)]. Methods PubMed, Cochrane, EMBASE, and Google Scholar were searched for studies reporting open glenoid bone augmentation procedures with iliac crest, tibia, or coracoid bones within 10 years. Extracted data included study/patient characteristics, techniques, prior surgeries, prior dislocations, radiographic findings, range of motion (ROM), recurrent instability, patient-reported outcomes, and complications. Results 92 met inclusion criteria (5693 total patients). Six were studies of iliac crest bone, four of DTA, and 84 using the coracoid bone. 29 studies measured postoperative arthritis showing no development or mild arthritis. 26 studies reported postoperative graft position. 62 studies reported ROM noting decline in internal/external rotation. 87 studies measured postoperative instability with low rates. Rowe Scores with noted improvement across 31/59 (52.5%) studies were seen. Common post operative complications included infection, hematoma, graft fracture, nerve injury, pain, and screw-related irritation. Conclusion Despite a trend towards arthroscopic management of recurrent anterior shoulder instability with glenoid deficiency, open procedures continue to provide satisfactory outcomes. Additionally, studies have demonstrated safe and efficacious use of free bone block graft options in the primary and revision setting.
Collapse
Affiliation(s)
- Ryan Falbo
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | - Austin Moore
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | - Amy Singleton
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | | | - Jason Levine
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | - Richard Miller
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| |
Collapse
|
|
23
|
Hsu KL, Yeh ML, Kuan FC, Hong CK, Chuang HC, Wang WM, Su WR. Biomechanical comparison between various screw fixation angles for Latarjet procedure: a cadaveric biomechanical study. J Shoulder Elbow Surg 2022; 31:1947-1956. [PMID: 35398164 DOI: 10.1016/j.jse.2022.02.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Latarjet procedure is a reliable treatment for the management of anterior glenohumeral instability with glenoid bone loss. However, the biomechanical properties of different fixation angles between screw and glenoid surface (α angle) have rarely been studied. The aim of the study was to investigate and compare the fixation stability, failure load, and failure mechanism between different α angles for Latarjet procedures, which were performed on cadaver specimens. METHODS Twenty-four shoulder specimens (8 in each of 3 groups) were dissected free of all soft tissue, and a 25% glenoid defect was created. The coracoid process was osteomized and fixed with 2 screws at 3 different α angles: 0° (group A), 15° (group B), and 30° (group C). Specimens were mounted to a testing apparatus, and cyclic loading (100 cycles at 1 Hz) was applied with a staircase protocol (50, 100, 150, and 200 N). Gross graft displacement and interface displacement were measured. The ultimate failure loads and failure mechanisms were recorded. RESULTS There was no significant difference in gross displacement under any cyclic load between 3 groups. However, a significant larger interface displacement was noted in group C than in group A in 150-N cyclic loading (P = .017). Under failure strength testing, all 24 specimens failed because of screw cutout from the glenoid, and the ultimate failure load was similar among the three groups. CONCLUSION Compared with the 0° α angle, the displacement after cyclic loading did not significantly increase when the α angle was increased to 15° but significantly increased at 30° for Latarjet procedures, which were performed on cadaver specimens. The results suggest that surgeons should apply the screws as parallel as possible to the glenoid surface when performing the Latarjet procedure. Although mild deviation may not reduce fixation stability, α angles greater than 30° should be avoided.
Collapse
Affiliation(s)
- Kai-Lan Hsu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, National Cheng Kung University, Yunlin, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ming Wang
- Department of Statistics and Institute of Data Science, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
|
24
|
Bodine M, Bishai SK, Ball GR, King CN, Wait L, Brannan GD. Arthroscopic Latarjet Procedure Does Not Lead to Loss of Clinically Significant External Rotation at 0° and 90° of Shoulder Abduction. JSES Int 2022; 6:1023-1028. [PMID: 36353414 PMCID: PMC9637787 DOI: 10.1016/j.jseint.2022.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Several reports have shown that shoulder stabilizing procedures lead to postoperative external rotation (ER) deficits. However, no study on arthroscopic Latarjet procedures has investigated the effect on ER when the arm is abducted at 0° (ER0) and 90° (ER90). This study examined the relationship between the arthroscopic Latarjet procedure and the subsequent effect on ER0 and ER90. Methods Patients who underwent an arthroscopic Latarjet procedure from December 2015 to April 2021 were retrospectively evaluated. Preoperative ER0 and ER90 values were obtained from the contralateral shoulder. ER0 and ER90 values from the operative side were collected at both 3 and 6 months postoperatively. A repeated measures ANOVA was performed to assess the mean preoperative and postoperative values. Results Forty-six patients met the inclusion criteria. Mean ER0 for the 3- and 6-month time frames measured 44.2° and 54.6°, respectively. Mean ER90 for the 3- and 6-month time frames measured 78.4° and 90.4°, respectively. Comparison to the contralateral arm at the 3-month follow-up period showed a deficit of 14.9° (P = .0001) and 17.2° (P = .0001) for ER0 and ER90, respectively. At the 6-month follow-up period, patients demonstrated an average decline in ER0 and ER90 of 4.57° (P = .063) and 5.11° (P = .008), respectively. Conclusion A nominal deficit in ER occurred for both ER0 and ER90 status post arthroscopic Latarjet procedure. Despite loss of ER90 at 6 months achieving statistical significance, the clinical impact is arguably inconsequential. Such limited loss of ER provides more information regarding bony procedures being a more definitive treatment for glenohumeral instability and the ability to restore native motion.
Collapse
Affiliation(s)
| | - Shariff K. Bishai
- Corresponding author: Shariff K. Bishai, DO, 24715 Little Mack Avenue Suite 100, Saint Clair Shores, MI 48080, USA.
| | | | | | | | | |
Collapse
|
|
25
|
Boileau P, Gendre P, Saliken DJ, Thélu CÉ, Trojani C. Tensioning device increases coracoid bone block healing rates in arthroscopic Latarjet procedure with suture-button fixation. J Shoulder Elbow Surg 2022; 31:1451-1462. [PMID: 35172210 DOI: 10.1016/j.jse.2022.01.126] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is growing interest in using suture buttons for coracoid fixation to avoid the complications associated with screws during the Latarjet procedure. However, achieving bone block healing is critical for successful shoulder stabilization and return to sport. The purpose of this study was to assess and compare the healing rates and positioning of the coracoid bone block fixed with cortical suture buttons that were either manually tensioned (using a knot pusher) or mechanically tensioned (using a tensioning device) during arthroscopic Latarjet procedures. METHODS This prospective, nonrandomized, comparative study enrolled 69 consecutive patients (mean age, 27 years) who underwent an arthroscopic guided Latarjet procedure with suture-button fixation. Hand tensioning was performed in the first 34 shoulders, whereas the next 35 shoulders underwent mechanical tensioning. Twelve patients (17%) had a history of failed Bankart stabilization. The characteristics of the patients in each group in terms of age, sex, type of sport, bone loss, number of previous failed surgical procedures, smoking, and length of follow-up were comparable. Intraoperatively, the tensioning device was set at 100 N successively 3 times until complete immobilization of the bone block was confirmed, as assessed with a probe. The primary outcome measure was coracoid bone block union and position on computed tomography scan images at 6 months' follow-up. Secondary outcome measures included functional outcome scores, shoulder stability, return to sports, and complications at last follow-up. RESULTS Overall, the rate of bone block healing was 74% (25 of 34 patients) in the hand-tensioning group and 94% (33 of 35 patients) in the mechanical tensioning group (P = .043). Smoking was an independent risk factor associated with nonunion (P < .001) in each group. Patient age, size of the preoperative glenoid bone defect (<20% or >20%), and a history of surgery were not found to have any influence. The tensioning modality did not affect the bone block position, which was subequatorial in 92% of the cases and flush with the glenoid rim in 92%. At a mean of 34 months of follow-up (range, 24-62 months), 96% of the patients (65 of 69) had a stable shoulder and 87% returned to sports. At final follow-up, no significant difference in clinical scores was noted between the groups; no neurologic or hardware complications were observed. CONCLUSION Mechanical tensioning achieves significantly higher healing rates than hand tensioning during the arthroscopic Latarjet procedure with suture-button fixation. The use of a suture-tensioning device is a key step to the suture-button fixation technique during arthroscopic Latarjet procedures. By making the suture-button construct rigid, the tensioning device transforms the initially flexible suture into a "rigid fixation", similar to a bolt (or a rivet).
Collapse
Affiliation(s)
- Pascal Boileau
- Institut de Chirurgie Réparatrice (ICR)-Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France.
| | | | | | | | - Christophe Trojani
- Institut de Chirurgie Réparatrice (ICR)-Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| |
Collapse
|
|
26
|
Waltenspül M, Ernstbrunner L, Ackermann J, Thiel K, Galvin JW, Wieser K. Long-Term Results and Failure Analysis of the Open Latarjet Procedure and Arthroscopic Bankart Repair in Adolescents. J Bone Joint Surg Am 2022; 104:1046-1054. [PMID: 36149240 PMCID: PMC10017301 DOI: 10.2106/jbjs.21.01050] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to analyze the long-term results of arthroscopic Bankart repair compared with an open Latarjet procedure in adolescents who are at high risk for recurrent anterior shoulder instability. We hypothesized that the long-term stability rate of an open Latarjet procedure would be superior to that of arthroscopic Bankart repair. METHODS Forty eligible patients (41 shoulders) with a mean age of 16.4 years (range, 13 to 18 years) underwent arthroscopic Bankart repair, and 37 patients (40 shoulders) with a mean age of 16.7 years (range, 14 to 18 years) underwent an open Latarjet procedure. Of these, 34 patients (35 shoulders) in the Bankart group and 30 patients (31 shoulders) in the Latarjet group with long-term follow-up were compared; the overall follow-up rate was 82%. Clinical and radiographic results were obtained after a mean follow-up of 12.2 years (range, 8 to 18 years). RESULTS Treatment failure occurred in 20 shoulders (57%) in the Bankart repair group and in 2 shoulders (6%) in the open Latarjet procedure group (p < 0.001), representing a significantly higher revision rate for instability in the Bankart group (13) compared with the Latarjet group (1) (p < 0.001). In patients without recurrent shoulder instability (15 in the Bankart group and 29 in the Latarjet group), there was a significant improvement in the Constant score (p = 0.006 in the Bankart group and p < 0.001 in the Latarjet group) and Subjective Shoulder Value (p = 0.009 in the Bankart group and p < 0.001 in the Latarjet group), without any significant difference between the 2 groups. Younger age was the only variable significantly correlated with failure following a Bankart repair (p = 0.01). CONCLUSIONS Adolescents are at a high risk for treatment failure after Bankart repair, and, therefore, the Latarjet procedure should be strongly considered as a primary procedure for recurrent anterior shoulder instability in this population. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Manuel Waltenspül
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jakob Ackermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Katja Thiel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Joseph W. Galvin
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
|
27
|
Deng Z, Long Z, Lu W. LUtarjet-limit unique coracoid osteotomy Latarjet (With video). BURNS & TRAUMA 2022; 10:tkac021. [PMID: 35664892 PMCID: PMC9155144 DOI: 10.1093/burnst/tkac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/10/2022] [Indexed: 12/05/2022]
Abstract
Background The Latarjet procedure is an effective technique for the treatment of recurrent anterior shoulder dislocation with glenoid bone loss. However, the inevitable destruction of the coracoacromial arch may result in humeral head translation. The aim of the study is to introduce a modified Latarjet technique with coracoacromial arch preservation as well as its short term clinical outcomes. Methods We propose a novel individualized flexible arthroscopic suture button fixation Latarjet technique called `LUtarjet' with video. Precise measurements of the coracoid process, glenoid deficiency and osteotomy plane were made preoperatively. Only three arthroscopic portals were needed and limit unique coracoid osteotomy was performed with coracoacromial arch preservation. The mini window splitting of the subscapularis was performed from the posterior to the anterior direction and the split window was as small as 8–10 mm in length. Results A total of 27 patients (25.6 ± 5.4 years) were included in the study. The average surgical duration was 55.6 ± 6.3 min and the mean follow-up time was 8.1 ± 1.5 months. The functional score was significantly improved at the last follow-up. Radiologic evidence showed that the bone graft healing was placed in the desired position. No complications were found. Conclusions We present a fast, easy, accurate, safe arthroscopic ‘LUtarjet’ technique called FEAST that can simplify the arthroscopic Latarjet process and achieve a satisfactory bone graft position and satisfactory short-term clinical outcomes. Level of evidence IV, case series.
Collapse
Affiliation(s)
- Zhenhan Deng
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, 518035, China
| | - Zeling Long
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, 518035, China
| | - Wei Lu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, 518035, China
| |
Collapse
|
|
28
|
Arthroscopic Trillat technique for chronic post-traumatic anterior shoulder instability: outcomes at 2 years of follow-up. J Shoulder Elbow Surg 2022; 31:e270-e278. [PMID: 35017078 DOI: 10.1016/j.jse.2021.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to assess the outcomes of a new arthroscopic Trillat technique at a 2-year follow-up. Our current hypothesis was that this technique could be used for the effective treatment of chronic post-traumatic unidirectional anterior shoulder instability, and that the recurrence and complication rates, external rotation, and functional outcomes would be as good as those of the reference technique. METHODS Between April 2012 and August 2016, all patients older than 16 years who underwent the arthroscopic Trillat technique for unidirectional chronic post-traumatic anterior shoulder instability at the Dijon University Hospital (France), after the failure of well-conducted medical and rehabilitation treatment with at least 24 months of follow-up, were included. Criteria for noninclusion were association with posterior and/or inferior instabilities, voluntary instabilities, and glenoid bone loss greater than 20%. Patients attended follow-up with their surgeon before the intervention, in the immediate postoperative period, at 6 weeks, 3 and 6 months, and then by an independent observer for the last evaluation. Patients were then examined clinically with scores such as Constant, Rowe and Walch-Duplay scores, and subjective shoulder value, for shoulder range of motion, and radiographically (anteroposterior and Lamy's lateral x-rays of the operated shoulder). RESULTS Forty-nine patients and 52 shoulders were included, with a mean follow-up of 40 months (range, 24-71 months). The recurrence rate of instability was 3.8% (2 of 52). No conversion to arthrotomy was necessary. No intraoperative complications, postoperative neurological lesions, or sepsis were observed. The mean Constant score was 92.1 (77.5-100) points, Walch-Duplay 82.9 (40-100), Rowe 81.73 (5-100), and subjective shoulder value 86.1 (50-100) at the last follow-up. The arm at side external rotation limitation averaged 8.4° (-25° to 40°) and the external rotation with 90° arm abduction limitation 0.34° (-5° to 15°). Forty-one patients (79%) resumed their sports activity at the same level. Fifty patients (96%) were satisfied to very satisfied. One patient developed nonunion of the coracoid process and subsequently underwent a Latarjet procedure with a good outcome. CONCLUSIONS The arthroscopic Trillat procedure offers good outcomes as a first-line treatment for chronic anterior post-traumatic glenohumeral instability. It should be excluded in cases of glenoid loss greater than 20%.
Collapse
|
|
29
|
Rodriguez S, Mancini MR, Kakazu R, LeVasseur MR, Trudeau MT, Cote MP, Arciero RA, Denard PJ, Mazzocca AD. Comparison of the Coracoid, Distal Clavicle, and Scapular Spine for Autograft Augmentation of Glenoid Bone Loss: A Radiologic and Cadaveric Assessment. Am J Sports Med 2022; 50:717-724. [PMID: 35048738 DOI: 10.1177/03635465211065446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Glenohumeral instability caused by bone loss requires adequate bony restoration for successful surgical stabilization. Coracoid transfer has been the gold standard bone graft; however, it has high complication rates. Alternative autologous free bone grafts, which include the distal clavicle and scapular spine, have been suggested. STUDY DESIGN Controlled laboratory study. PURPOSE The purpose of this study was to determine the percentage of glenoid bone loss (GBL) restored via coracoid, distal clavicle, and scapular spine bone grafts using a patient cohort and a cadaveric evaluation. METHODS Autologous bone graft dimensions from a traditional Latarjet, congruent arc Latarjet, distal clavicle, and scapular spine were measured in a 2-part study using 52 computed tomography (CT) scans and 10 unmatched cadaveric specimens. The amount of GBL restored using each graft was calculated by comparing the graft thickness with the glenoid diameter. RESULTS Using CT measurements, we found the mean percentage of glenoid restoration for each graft was 49.5% ± 6.7% (traditional Latarjet), 45.1% ± 4.9% (congruent arc Latarjet), 42.2% ± 7.7% (distal clavicle), and 26.2% ± 8.1% (scapular spine). Using cadaveric measurements, we found the mean percentage of glenoid restoration for each graft was 40.2% ± 5.0% (traditional Latarjet), 53.4% ± 4.7% (congruent arc Latarjet), 45.6% ± 8.4% (distal clavicle), and 28.2% ± 7.7% (scapular spine). With 10% GBL, 100% of the coracoid and distal clavicle grafts, as well as 88% of scapular spine grafts, could restore the defect (P < .001). With 20% GBL, 100% of the coracoid and distal clavicle grafts but only 66% of scapular spine grafts could restore the defect (P < .001). With 30% GBL, 100% of coracoid grafts, 98% of distal clavicle grafts, and 28% of scapular spine grafts could restore the defect (P < .001). With 40% GBL, a significant difference was identified (P = .001), as most coracoid grafts still provided adequate restoration (congruent arc Latarjet, 82.7%; traditional Latarjet, 76.9%), but distal clavicle grafts were markedly reduced, with only 51.9% of grafts maintaining sufficient dimensions. CONCLUSIONS The coracoid and distal clavicle grafts reliably restored up to 30% GBL in nearly all patients. The coracoid was the only graft that could reliably restore up to 40% GBL. CLINICAL RELEVANCE With "subcritical" GBL (>13.5%), all autologous bone grafts can be used to adequately restore the bony defect. However, with "critical" GBL (≥20%), only the coracoid and distal clavicle can reliably restore the bony defect.
Collapse
Affiliation(s)
- Santiago Rodriguez
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Rafael Kakazu
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Maxwell T Trudeau
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| |
Collapse
|
|
30
|
Clowez G, Gendre P, Boileau P. The Bristow-Latarjet procedure for revision of failed arthroscopic Bankart: a retrospective case series of 59 consecutive patients. J Shoulder Elbow Surg 2021; 30:e724-e731. [PMID: 34087273 DOI: 10.1016/j.jse.2021.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recurrence of anterior instability after arthroscopic Bankart prevents return to sports and remains a surgical challenge. We aim to assess clinical and radiologic outcomes after coracoid bone-block performed either open or under arthroscopy, for the management of failed arthroscopic Bankart PATIENTS AND METHODS: Fifty-nine consecutive patients with anterior instability recurrence after arthroscopic Bankart were revised with a Bristow or Latarjet procedure performed either open (25 cases) or under arthroscopy (34 cases). Patients were reviewed for clinical and radiologic examination at a minimum 2-year follow-up. Glenohumeral bony lesions were evaluated preoperatively with computed tomographic scans. Postoperative bone-block position, union, and postinstability arthritis were also evaluated. RESULTS The mean follow-up was 89 months (24-193). The epidemiologic analysis showed that patients with failed arthroscopic Bankart were young (age <23 years), 58 (98%) were practicing sports, with contact/forced overhead sports (53%), often in competition (53%), had hyperlaxity (71%), and for the most part of them glenohumeral bone loss (88%). Their mean preoperative Instability Severity Index Score was 5.4 ± 2.2 points. After revision with Bristow-Latarjet procedure, 53 patients (91%) returned to sports, 37 (70%) to their previous sports activity, and 17 (46%) to their previous level. No patient suffered recurrent dislocation. Four patients (7%) had recurrent subluxations, all after open procedure; 8 patients (14.5%) had persistent anterior apprehension. A large and deep Hill-Sachs lesion was a risk factor for persistent anterior apprehension (P = .002) and lower level when returned to sports (P = .04). Ninety-two percent of bone-blocks were positioned flush with the glenoid anterior rim, with 84% of bone union. At last follow-up, 5% of patients had severe postinstability osteoarthritis (Samilson 4). CONCLUSION The Bristow-Latarjet, performed either open or under arthroscopy, is an efficient procedure to restore shoulder stability and allow returning to sports in patients with failed arthroscopic Bankart and glenoid bone loss. Patients with a large and deep Hill-Sachs lesion had more persistent anterior apprehension and a lower sports level.
Collapse
Affiliation(s)
- Gilles Clowez
- University Institute for Locomotion & Sports (iULS), Côte d'Azur University, Nice, France
| | | | - Pascal Boileau
- ICR-Institut de Chirurgie Réparatrice, Locomoteur & Sports, Nice, France.
| |
Collapse
|
|
31
|
Biceps Brachii Alterations Following the Latarjet Procedure: A Prospective Multicenter Study. J Clin Med 2021; 10:jcm10235487. [PMID: 34884188 PMCID: PMC8658084 DOI: 10.3390/jcm10235487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/08/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: To prospectively investigate the postoperative forearm supination and elbow flexion strength of both upper extremities and popeye deformity in patients who underwent a mini-open Latarjet procedure for anterior shoulder instability. Methods: Patients who underwent a mini-open Latarjet procedure at two specialized shoulder centers were prospectively evaluated preoperatively (T0) and at least 6 months (T1) after surgery. Subjects were tested for elbow flexion and forearm supination strength of both upper extremities using an isometric dynamometer and customized torque dynamometer. Clinical outcome was assessed by the Constant Score (CS), American Shoulder and Elbow Score (ASES) and Simple Shoulder test (SST). Popeye deformity was defined as a distalization of the greatest circumference of the biceps muscle belly towards the lateral epicondyle of the elbow. Results: A total of 20 patients with a mean age of 27 ± 6 years were included in the study. At a mean follow-up of 10 ± 3 months, the elbow flexion strength was restored to the preoperative state (p = 0.240). Forearm supination strength significantly decreased at final follow-up, to 88 % in the surgical arm (p = 0.015) vs. 90 % in the non-surgical arm (p = 0.023). There was no statistical difference when comparing both arms concerning elbow flexion strength (p = 0.510) and forearm supination strength (p = 0.495). No significant popeye deformity was observed in both arms (p = 0.111 vs. p = 0.508). Clinical outcome scores improved significantly from 73 ± 18 to 82 ± 13 (p = 0.014) for CS and 76 ± 22 to 89 ± 12 (p = 0.008) for ASES score preoperatively to final follow-up. No difference in the SST was documented (p = 0.10). Conclusion: The Latarjet procedure showed to preserve elbow flexion strength and provided comparable forearm supination strength compared to the uninjured arm with reliable clinical outcome in this study population. However, a decrease of forearm supination strength in both arms was persistent at a mean of 10 months postoperatively. No popeye deformity was noted in the postoperative examinations. Level of evidence: Case series, Level III.
Collapse
|
|
32
|
De Carli A, Vadalà AP, Fedeli G, Scrivano M, Gaj E, Ferretti A. Anterior Capsulolabral Reconstruction with Semitendinosus Autograft after Latarjet Failure: A Case Report. J Orthop Case Rep 2021; 11:1-5. [PMID: 34790592 PMCID: PMC8576779 DOI: 10.13107/jocr.2021.v11.i07.2290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/02/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: The treatment of chronic shoulder instability, associated with poor tissue quality, remains challenging in the setting of anterior capsular deficiency. There are a few viable alternatives in the end-stage shoulder instability when multiple surgical attempts to correct the pathology have failed. The purpose of the present paper is to demonstrate the efficacy of anterior capsular reconstruction with semitendinosus autograft for the management of capsulolabral deficiency without associated bone loss. Case Report: A 39-year-old female admitted in our institution with a history of recurrent atraumatic anterior dislocation of the left shoulder after three unsuccessful surgical attempts: Arthroscopic and open capsulorrhaphy and a Latarjet coracoid transfer. CT scan images showed adequate placement (flush) of the coracoid transfer without any sign of reabsorption. Reconstruction of anterior capsulolabral structure was performed using a Semitendinosus autograft. The middle and inferior glenohumeral ligaments, the more crucial ligaments for anterior-inferior shoulder stability, were effectively recreated. The patient did not suffer any recurrent dislocation or subjective symptoms of instability at the time of the final follow-up, 2 years after surgery, and the ASES score increased from 36 preoperatively to 86. Conclusion: This technique, described for the first time as a salvage procedure after Latarjet failure, could represent a safe and viable treatment option in the context of multiple ineffective surgeries.
Collapse
Affiliation(s)
- Angelo De Carli
- Department of Orthopaedic and Traumatology, Sant'Andrea Hospital, University of Rome "Sapienza," Rome, Italy
| | - Antonio P Vadalà
- Department of Orthopaedic and Traumatology, Sant'Andrea Hospital, University of Rome "Sapienza," Rome, Italy
| | - Gianluca Fedeli
- Department of Orthopaedic and Traumatology, Sant'Andrea Hospital, University of Rome "Sapienza," Rome, Italy
| | - Marco Scrivano
- Department of Orthopaedic and Traumatology, Sant'Andrea Hospital, University of Rome "Sapienza," Rome, Italy
| | - Edoardo Gaj
- Department of Orthopaedic and Traumatology, Sant'Andrea Hospital, University of Rome "Sapienza," Rome, Italy
| | - Andrea Ferretti
- Department of Orthopaedic and Traumatology, Sant'Andrea Hospital, University of Rome "Sapienza," Rome, Italy
| |
Collapse
|
|
33
|
Gowd AK, Liu JN, Polce EM, Agarwalla A, Garcia GH, Nicholson GP, Cole BJ, Romeo AA, Verma NN. Return to sport following Latarjet glenoid reconstruction for anterior shoulder instability. J Shoulder Elbow Surg 2021; 30:2549-2559. [PMID: 33930559 DOI: 10.1016/j.jse.2021.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Latarjet coracoid transfer reconstruction is the gold standard for the treatment of recurrent shoulder instability with anterior-inferior glenoid bone loss, and return to sport is often a primary outcome of interest in this patient population. The purpose of this study was to determine the rate of return to sport in patients undergoing the Latarjet procedure and variables that are associated with a higher likelihood of a successful return to sport. METHODS A prospectively maintained institutional registry was retrospectively queried between August 2012 and August 2016 for all patients who underwent the Latarjet procedure. Patients were contacted electronically and via telephone to administer a previously validated and standardized return-to-sport survey. Patients self-reported return to sport, varying sports participation, recurrence of instability, and time to return to sport. Multivariate analysis was performed to determine variables associated with each outcome. RESULTS Of 83 patients, 66 (75.3%) were available for final follow-up, of whom 60 participated in sports prior to surgery and were eligible for inclusion. The average follow-up period was 53.8 ± 11.8 months. The average age at surgery was 26.7 ± 11.3 years, and the average body mass index was 26.2 ± 4.0 kg/m2. There were 54 patients (90%) who were able to return to sport at an average of 8.6 ± 4.1 months following surgery. In total, 36 patients (60%) were able to return to sport at the same level or a better level of intensity, 19 of 28 patients (67.9%) were able to return to throwing sports without difficulty, and 31 of 60 patients (51.7%) reported that their shoulder was a hindrance to some activity. An increased likelihood of returning to sport was associated with increased body mass index (P = .016), male sex (P = .028), and decreased humeral bone loss volume (P = .034). An increased likelihood of returning to sport at the same level or a better level of intensity was associated with reduced humeral bone loss volume (P = .026). Recurrent instability was associated with humeral bone loss (P = .038). CONCLUSION Although a large majority of patients were able to return to sport following the Latarjet procedure, some patients experienced limitation with throwing and return to sport at the preinjury level. Greater humeral bone loss was associated with inferior outcomes. These findings should be discussed with patients in the preoperative setting to manage expectations appropriately.
Collapse
Affiliation(s)
- Anirudh K Gowd
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Evan M Polce
- Rush University Medical Center, Chicago, IL, USA
| | | | | | | | - Brian J Cole
- Rush University Medical Center, Chicago, IL, USA
| | | | | |
Collapse
|
|
34
|
Nourissat G, Kamel A, Martinel V, Housset V. The Open Capsular Shift-Latarjet Procedure for Recurrent Anterior Shoulder Instability. VIDEO JOURNAL OF SPORTS MEDICINE 2021; 1:26350254211044510. [PMID: 40309272 PMCID: PMC11894028 DOI: 10.1177/26350254211044510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/12/2021] [Indexed: 05/02/2025]
Abstract
Background Capsular management is having an increasingly important place during the open Latarjet procedure especially in preventing postoperative glenohumeral arthritis. The open capsular shift-Latarjet procedure consists of the classic Latarjet procedure associated with a glenoid T-based capsular shift to treat patients with high risk of recurrent anterior shoulder instability. Indications Patients presenting with humeral and/or glenoid bone loss, patients practicing professional activities or sports at risk of recurrence and without any previous capsular surgery, or major capsular deficiency. Technique Description After a classic deltopectoral approach and the osteotomy of the coracoid process, a horizontal split of the subscapularis is performed. Then a glenoid T-based capsulotomy is performed, and 2 passing wire suture threads are passed through the inferior flap of the capsule to prepare the capsular shift. A first, soft, all-sutured anchor is inserted at the inferior part of the glenoid medially to the articular surface. The coracoid graft is then positioned with a first inferior cancellous screw to be flush with the articular surface and fixed using a second cancellous screw. A second anchor is placed laterally and superiorly to the coracoid at the anterior scapular neck. The capsular shift is performed using a passing wire technique to suture the capsular flap to both anchors and to ensure the extraarticular positioning of the coracoid. Results Bouju et al found a low rate of recurrence with no revision surgeries and a significative lower incidence of osteoarthritis (8.6%) at 10-year follow-up compared with the current literature when suturing the capsule to the coracoid process. Itoigawa et al concluded that suturing the capsule on the coracoid may increase the risk of osteoarthritis due to a direct contact between the humeral head and the transferred coracoid, thus we suggest attaching the capsule over the glenoid. Discussion/Conclusion With appropriate patient selection, this technique is safe and reliable to treat patients with anterior instability without any specific risk related to the surgery. The association of the capsular repair is an appropriate solution to better restore the anatomy and to prevent the long-term risk of glenohumeral arthritis.
Collapse
Affiliation(s)
| | - Anthony Kamel
- Clinique Maussins-Nollet, Sorbonne Université, Paris, France
| | | | - Victor Housset
- Clinique Maussins-Nollet, Sorbonne Université, Paris, France
| |
Collapse
|
|
35
|
Rodkey DL, Colantonio DF, LeClere LE, Kilcoyne KG, Dickens JF. Latarjet After Failed Arthroscopic Bankart Repair Results in Twice the Rate of Recurrent Instability Compared With Primary Latarjet. Arthroscopy 2021; 37:3248-3252. [PMID: 33964387 DOI: 10.1016/j.arthro.2021.04.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/21/2021] [Accepted: 04/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess recurrent instability of the shoulder following open Latarjet performed as the primary stabilization procedure or as a salvage procedure. METHODS A retrospective, comparative cohort study was performed for a consecutive series of patients in the Military Health System who underwent open Latarjet from January 1, 2010, to December 31, 2018. All patients were diagnosed with recurrent anterior shoulder instability and had a minimum of 2 years of postoperative follow-up. Patients were categorized as either having a primary Latarjet (PL; no prior shoulder stabilization procedure) or salvage Latarjet (SL; ≥1 previous arthroscopic surgical stabilization procedures). RESULTS A total of 234 Latarjet procedures were performed in 234 patients. The overall recurrent instability rate was 15.8% (37/234), the overall reoperation rate was 16.7% (36/234), and the overall complication rate was 14.2% (33/234) over a mean 5.0 years of follow-up. There were 99 PL procedures and 135 SL procedures. The SL group had significantly more recurrent instability than the PL group (SL 28/135, 20.7%; PL 9/99, 9.1%; P = .0158). There was no difference in overall reoperation rates (SL 26/135, 19.3%; PL 13/99, 13.1%; P = .2140) or complication rates (SL 20/135, 14.8%; PL 13/99, 13.3%; P = .9101). CONCLUSION The rate of recurrent instability following the Latarjet procedure in an active, high-risk population is 15.8%. Primary Latarjet was found to have lower rates of recurrence compared with salvage Latarjet procedures (9.1% versus 20.7%). LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Daniel L Rodkey
- Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.
| | | | - Lance E LeClere
- Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Kelly G Kilcoyne
- Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | | |
Collapse
|
|
36
|
Zeng Z, Liu C, Liu Y, Huang Y. Early outcomes of the arthroscopic Latarjet procedure in a series of 37 patients with shoulder instability. BMC Musculoskelet Disord 2021; 22:845. [PMID: 34600519 PMCID: PMC8487569 DOI: 10.1186/s12891-021-04726-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Anterior shoulder dislocation remains a clinical challenge. This study aimed to assess the graft position and clinical outcomes of the arthroscopic Latarjet procedure and capsular repair for the treatment of recurrent anterior shoulder dislocation with significant glenoid bone loss in 37 patients. Methods Between 2017 and 2017, 37 patients underwent arthroscopic Latarjet plus capsular repair procedure for recurrent anterior shoulder dislocation combined with significant glenoid bone loss. In follow-up examinations, Walch-Duplay scores, subjective shoulder value (SSV) scores, Rowe scores, and active range of motion (AROM) were assessed. Three-dimensional computed tomography (CT) was used to evaluate coracoid graft position and bone resorption. A new method of evaluating the position of the coracoid bone block after Latarjet (H-Z method) was developed. Results Thirty-seven patients were included in this study. Follow-up ranged from 6 to 36 months postoperatively (with an average of 13 months). No recurrent dislocation occurred at the final follow-up, and there was no significant effect on the AROM (all p > 0.05). Rowe (from 42.2 ± 5.6 to 91.1 ± 3.3), Walch-Duplay (from 31.5 ± 8.0 to 92.6 ± 3.7), and SSV (from 63.9 ± 6.1 to 79.3% ± 5.0%) scores were improved significantly after surgery (all p < 0.001). CT showed that the 29 patients had varying degrees of bone resorption, and 23 recovered to the preinjury level of motional function within 6–12 months after surgery. Conclusions In active patients with recurrent anterior shoulder dislocations and significant glenoid bone loss, the arthroscopic Latarjet procedure plus capsular repair could restore shoulder stability satisfactory.
Collapse
Affiliation(s)
- Zheng Zeng
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Chuan Liu
- Department of Orthopaedic Sports Medicine, the 7th center of PLAGH, Beijing, 100700, China
| | - Yang Liu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
| | - Yan Huang
- Department of Orthopaedic Sports Medicine, the 7th center of PLAGH, Beijing, 100700, China.
| |
Collapse
|
|
37
|
Intra-articular biomechanical environment following modified Bristow and Latarjet procedures in shoulders with large glenoid defects: relationship with postoperative complications. J Shoulder Elbow Surg 2021; 30:2260-2269. [PMID: 33711500 DOI: 10.1016/j.jse.2021.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although coracoid transfers including the modified Bristow and Latarjet procedures are widely used to treat anterior shoulder instability, the influence of the choice of procedure on the biomechanical outcomes is not well characterized. We aimed to clarify the intra-articular stress distribution following these 2 procedures using 3-dimensional finite-element analysis and to investigate the role of stress distribution in the pathophysiology of postoperative complications. METHODS Overall, 6 male patients aged 17-47 years with unilateral anterior shoulder instability were recruited. Computed tomographic digital imaging and communications in medicine (CT-DICOM) data of the contralateral (healthy) shoulder of each patient was obtained and used for developing the 3-dimensional normal glenohumeral joint model. A 25% bony defect was created in the anterior glenoid rim where the coracoid process was transferred in the standing and lying-down positions to create the Bristow and Latarjet models, respectively. The arm position was set as 0° or 90° abduction. The Young moduli of the humerus and scapula were calculated using CT data, and set as 35.0 MPa and 113.8 GPa for the articular cartilage and inserted screw, respectively. A compressive load (50 N) was applied to the greater tuberosity toward the center of the glenoid, and a tensile load (20 N) was applied to the tip of the coracoid in the direction of conjoint tendon. Elastic analysis was used to determine the equivalent stress distribution. RESULTS A significant reduction in mean equivalent stress was observed within the glenoid cartilage for both models (P = .031); however, a new stress concentration appeared within the grafted coracoid-facing region of the humeral-head cartilage in both models. The proximal half of the coracoid graft exhibited lower equivalent stress than the distal half in 5 of the 6 Latarjet models, whereas the proximal half showed higher equivalent stress than the distal half in all 6 Bristow models. High stress concentration was identified at the midpoint of the inserted screw in Bristow models. DISCUSSION AND CONCLUSIONS Intra-articular stress distribution may explain the different rates of postoperative complications associated with the modified Bristow and Latarjet procedures. New stress concentration within the humeral-head cartilage might contribute to the development of glenohumeral osteoarthritis following both procedures. Stress shielding in the proximal part of the coracoid graft might contribute to osteolysis following the Latarjet procedure. Surgeons should be aware of the risk of breakage of the inserted screw following the modified Bristow procedure.
Collapse
|
|
38
|
Ali ZS, Hurley ET, Jamal MS, Horan MP, Montgomery C, Pauzenberger L, Millett PJ, Mullett H. Low rate of recurrent instability following the open Latarjet procedure as a revision procedure for failed prior stabilization surgery. Knee Surg Sports Traumatol Arthrosc 2021; 29:2110-2117. [PMID: 32710144 DOI: 10.1007/s00167-020-06155-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/14/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study is to systematically review the literature to ascertain functional outcomes, recurrence rates and subsequent revision rates following the open Latarjet procedure when performed as a revision procedure. METHODS Two independent reviewers performed the literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Studies where the Latarjet procedure was performed as a revision procedure were included. Clinical outcomes analyzed were: (1) functional outcomes, (2) recurrent instability, (3) revisions, and (4) complications. RESULTS The review found 16 studies with 713 shoulders that met the inclusion criteria. 605 of the patients were male (84.9%), with an average age of 28.2 years (15-62) and follow-up of 47.7 months. The most commonly reported functional outcome measure was the Rowe score, with a weighted mean of 92.7. 86/95 patients had good-excellent outcomes (90.4%). 136/143 patients reported return to play (95.1%). 141/161 patients returned to the same level of competition (87.6%). 50 patients experienced recurrence (8.4%). Five patients experienced redislocation (0.9%) and 37 patients experienced subluxation (6.7%). There were 29 revisions (5.1%), with 12 revisions due to recurrence (2.1%). There were 68 total complications, not including recurrence (11%). The most common complications were 13 cases of nerve damage and infection respectively (2.1%). There was 17 cases of new instability arthropathy (6.5%), and 31 cases of residual pain (6.7%). CONCLUSION This review shows that the revision Latarjet provides excellent functional outcomes, low rates of recurrence and complications, and a high rate of return to sport among athletes. This results from study can be used to explain the expected outcomes associated with the Latarjet procedure performed as a revision. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Zakariya S Ali
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T Hurley
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland. .,Royal College of Surgeons in Ireland, Dublin, Ireland. .,National University of Ireland Galway, Galway, Ireland.
| | - M Shazil Jamal
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Connor Montgomery
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland
| | - Leo Pauzenberger
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland
| | | | - Hannan Mullett
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
|
39
|
Calvo E, Luengo G, Morcillo D, Foruria AM, Valencia M. Revision Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Failed Primary Arthroscopic Stabilization With Subcritical Bone Loss. Orthop J Sports Med 2021; 9:23259671211001809. [PMID: 34017877 PMCID: PMC8114265 DOI: 10.1177/23259671211001809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/12/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Limited evidence is available regarding the recommended technique of revision surgery for recurrent shoulder instability. Only 1 previous study has compared the results of soft tissue repair and the Latarjet technique in patients with persistent shoulder instability after primary surgical stabilization. Purpose/Hypothesis: To evaluate the results of revision surgery in patients with previous surgical stabilization failure and subcritical glenoid bone defects, comparing repeated Bankart repair versus arthroscopic Latarjet technique. The hypothesis was that Latarjet would be superior to soft tissue procedures in terms of objective and subjective functional scores, recurrence rates, and range of movement. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 45 patients (mean age, 29.1 ± 8.9 years) with subcritical bone loss (<15% of articular surface) who had undergone revision anterior shoulder instability repair after failed Bankart repair. Of these, 17 patients had arthroscopic Bankart repair and 28 had arthroscopic Latarjet surgery. Patients were evaluated at a minimum of 2 years postoperatively with the Rowe score, Western Ontario Shoulder Instability Index, and Subjective Shoulder Value. Subluxation or dislocation episodes were considered failures. Results: No statistically significant differences were found between groups in age, sex, sporting activity, preoperative Rowe score, or the presence of hyperlaxity or bony lesions. At revision arthroscopy, 20 shoulders showed a persistent Bankart lesion, 13 a medially healed labrum, and 6 a bony Bankart. In 6 patients, no abnormalities were present that could explain postoperative recurrence. In the Bankart repair group, 7 patients underwent isolated Bankart procedures; in the remaining 10 cases, a capsular shift was added. No significant differences were found between the Bankart and Latarjet groups in outcome scores, recurrence rate (11.8% vs 17.9%, respectively), or postoperative athletic activity level. The mean loss of passive external rotation at 0° and 90° of abduction was similar between groups. Conclusion: Arthroscopic Latarjet did not lead to superior results compared with repeated Bankart repair in patients with subcritical glenoid bone loss and recurrent anterior shoulder instability after Bankart repair.
Collapse
Affiliation(s)
- Emilio Calvo
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Gonzalo Luengo
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Diana Morcillo
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Antonio M Foruria
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - María Valencia
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| |
Collapse
|
|
40
|
Park I, Lee JH, Park JY, Shin SJ. Failure Rates After Revision Arthroscopic Stabilization for Recurrent Anterior Shoulder Instability Based on Anterior Capsulolabral Complex Conditions. Orthop J Sports Med 2021; 9:2325967121995891. [PMID: 33948442 PMCID: PMC8053759 DOI: 10.1177/2325967121995891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022] Open
Abstract
Background: A labral retear is an important contributing factor to surgical failure after arthroscopic soft tissue stabilization for recurrent anterior shoulder instability. However, surgeons frequently encounter poor tissue conditions in the anterior capsule, such as capsular tears, during revision surgery. Purpose: To analyze the clinical outcomes and failure rates of revision arthroscopic stabilization after failed Bankart repair based on the tissue conditions of the anterior capsule and the labrum. Outcomes were compared for revision after failed Bankart repair because of a labral retear versus a healed labrum but with capsular tears. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 55 patients who underwent revision arthroscopic stabilization after failed Bankart repair were included. Revision surgery was indicated if patients had a history of recurrent instability with positive apprehension test results, regardless of magnetic resonance imaging (MRI) findings of a labral retear. Patients were allocated into 2 groups based on arthroscopic findings at the time of revision surgery: group 1 consisted of patients who had a healed labrum with definite anterior capsular tears, and group 2 comprised patients who had labral retears without capsular tears. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons score, Rowe score, and surgical failure rate. Results: Overall, 10 patients were included in group 1, and 45 patients were included in group 2. No capsular tears were detected on preoperative MRI or magnetic resonance arthrography scans in either group, whereas all patients in group 2 had evidence of anterior labral retears on imaging scans. After revision surgery, 9 patients (16.4%) showed surgical failure by 25.6 months postoperatively. Patients in group 1 had a significantly higher surgical failure rate than did those in group 2 (4 patients [40.0%] vs 5 patients [11.1%], respectively; P = .04). The incidence of capsular tears was significantly higher in patients with surgical failure versus those without surgical failure (44.4% vs 13.0%, respectively; P = .04). Conclusion: A capsular tear of the anterior capsulolabral complex was an important indicator for surgical failure after revision arthroscopic stabilization. If patients demonstrate symptomatic instability after arthroscopic soft tissue stabilization without evidence of labral retears on imaging scans, an anterior capsular tear should be considered as a possible factor for recurrence.
Collapse
Affiliation(s)
- In Park
- Department of Orthopedic Surgery, College of Medicine, Seoul Hospital, Ewha Womans University, Seoul, Republic of Korea
| | - Jae-Hyung Lee
- Center for Shoulder, Elbow & Sports Medicine, Neon Orthopaedic Clinic, Seoul, Republic of Korea
| | - Jin-Young Park
- Center for Shoulder, Elbow & Sports Medicine, Neon Orthopaedic Clinic, Seoul, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, College of Medicine, Seoul Hospital, Ewha Womans University, Seoul, Republic of Korea
| |
Collapse
|
|
41
|
The Influence of Exposure in Training to the Open Bankart on the Declining Current Use of the Procedure. J Am Acad Orthop Surg 2021; 29:e287-e296. [PMID: 33677458 DOI: 10.5435/jaaos-d-20-00368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/03/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The purpose of this study was to assess the influence of exposure to the open Bankart during residency and fellowship on the trend toward obsolescence of the procedure. Our hypothesis was that the open Bankart would be used with decreasing frequency and that this would be related to lack of exposure to the procedure during training. METHODS A survey consisting of 10 questions about their experience with the open Bankart procedure in residency, fellowship, and practice, as well as their current usage of it and other operations, was sent to members of the American Shoulder and Elbow Surgeons. Respondents were divided into groups based on the year of completion of training. RESULTS Statistical analysis of the responses revealed a notable trend of progressively diminished use of the open Bankart by those trained before 2000 compared with those completing training between 2001 and 2017. Ancillary findings included more surgeons using the open Bankart for revision cases than as a primary procedure and many using the Latarjet for patients with less than 15% or even no glenoid bone loss. CONCLUSION We concluded that a statistically notable trend of the decreasing use of the open Bankart was observed despite excellent reported outcomes and that its current role is most likely as a revision procedure. Lack of exposure to the operation in training is a major factor in its decline, and this decreasing exposure is self-perpetuating. LEVEL OF EVIDENCE Survey.
Collapse
|
|
42
|
Parvaresh KC, Vargas-Vila M, Bomar JD, Pennock AT. Anterior Glenohumeral Instability in the Adolescent Athlete. JBJS Rev 2021; 8:e0080. [PMID: 32015270 DOI: 10.2106/jbjs.rvw.19.00080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Glenohumeral instability is multifactorial and has both static and dynamic elements. The initial management of first-time dislocations has become increasingly controversial, although recent evidence supports operative treatment for adolescents who participate in contact sports. Risk factors for recurrent glenohumeral instability include adolescent age, hyperlaxity, glenoid bone loss, off-track Hill-Sachs lesions, and fixation with <=3 anchors. High rates of return to sport can be expected when the surgical plan is tailored to individual pathology.
Collapse
Affiliation(s)
| | | | | | - Andrew T Pennock
- University of California, San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
| |
Collapse
|
|
43
|
Lau BC, Pineda LB, Johnston TR, Gregory BP, Wu M, Fletcher AN, Ledbetter L, Riboh JC. Return to Play After Revision Anterior Shoulder Stabilization: A Systematic Review. Orthop J Sports Med 2021; 9:2325967120982059. [PMID: 33748304 PMCID: PMC7940729 DOI: 10.1177/2325967120982059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022] Open
Abstract
Background Revision shoulder stabilizations are becoming increasingly common. Returning to play after revision shoulder stabilizations is important to patients. Purpose To evaluate the return-to-play rate after revision anterior shoulder stabilization using arthroscopic, open, coracoid transfer, or free bone block procedures. Study Design Systematic review; Level of evidence, 4. Methods All English-language studies published between 2000 and 2020 that reported on return to play after revision anterior shoulder stabilization were reviewed. Clinical outcomes that were evaluated included rate of overall return to play, level of return to play, and time to return to play. Study quality was evaluated using the Downs and Black quality assessment score. Results Eighteen studies (1 level 2; 17 level 4; mean Downs and Black score, 10.1/31) on revision anterior shoulder stabilization reported on return to play and met inclusion criteria (7 arthroscopic, 5 open, 3 Latarjet, and 3 bony augmentation), with a total of 564 revision cases (mean age, 27.9 years; 84.1% male). The weighted mean length of follow-up was 52.5 months. The overall weighted rate of return to play was 80.1%. The weighted mean rate of return to play was 84.0% (n = 153) after arthroscopic revision, 91.5% (n = 153) after open revision, 88.1% (n = 149) after Latarjet, and 73.8% (n = 65) after bone augmentation. The weighted mean rate of return to same level of play was 69.7% for arthroscopic revision, 70.0% for open revision, 67.1% for Latarjet revision, and 61.8% after bone block revision. There were 5 studies that reported on time to return to play, with a weighted mean of 7.75 months (4 arthroscopic) and 5.2 months (1 Latarjet). The weighted mean rates of complication (for studies that provided it) were 3.3% after arthroscopic revision (n = 174), 3.5% after open revision (n = 110), 9.3% after Latarjet revision (n = 108), and 45.8% after bone block revision (n = 72). Conclusion Revision using open stabilization demonstrated the highest return-to-play rate. Revision using Latarjet had the quickest time to return to play but had higher complication rates. When evaluated for return to same level of play, arthroscopic, open, and Latarjet had similar rates, and bone block had lower rates. The choice of an optimal revision shoulder stabilization technique, however, depends on patient goals. Higher-quality studies are needed to compare treatments regarding return to play after revision shoulder stabilization.
Collapse
Affiliation(s)
- Brian C Lau
- Duke Sports Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Lorena Bejarano Pineda
- Duke Sports Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Tyler R Johnston
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Irvine, California, USA
| | - Bonnie P Gregory
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Texas Health Science Center, Houston, Texas, USA
| | - Mark Wu
- Duke Sports Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Amanda N Fletcher
- Duke Sports Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Leila Ledbetter
- Medical Center Library, Duke University, Durham, North Carolina, USA
| | | |
Collapse
|
|
44
|
Two-year results of arthroscopic conjoint tendon transfer procedure for the management of failed anterior stabilization of the shoulder. JSES Int 2021; 5:519-524. [PMID: 34136864 PMCID: PMC8178602 DOI: 10.1016/j.jseint.2020.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Management of failed anterior stabilization is difficult. There are two main options for revision either a revision labral repair which has published high failure rates because of poor quality capsulolabral tissues or a bone block/Latarjet procedure with associated morbidity and complication rates. On this background, the senior author (D.T.) has developed a new procedure to treat this difficult to manage clinical scenario. Aim The aim of this study was to evaluate the 2-year results of an arthroscopic conjoint tendon transfer procedure. The procedure has previously been developed to provide a potential solution for active patients with a failed labral repair, subcritical glenoid bone loss, and an on-track Hill-Sachs lesion. Methods Consecutive patients who fulfilled the inclusion criteria were prospectively recruited. Inclusion criteria were active patients with recurrent shoulder instability owing to failed labral repair, less than 10% anterior glenoid bone loss, and an on-track Hill Sachs lesion. Patients were fully consented and offered a choice of revision with an arthroscopic labral repair, a Latarjet procedure or the arthroscopic conjoint tendon transfer procedure. Preoperative and postoperative Western Ontario Shoulder Instability Index and Oxford Instability Score were collected. Results Eight patients met the inclusion criteria and opted for the conjoint tendon transfer procedure. Mean age was 35 with a male:female ratio of 7:1. No patients had hyperlaxity clinically. At median follow-up of 31 months (range 24-41), there was a significant improvement in both the median Western Ontario Shoulder Instability Index (53.7 to 13.4, P = .0003) and Oxford Instability Score (27 to 44.5, P = .0017) scores. No patient had a further dislocation, and all were able to resume contact and noncontact sports. Conclusion Our results at a minimum of 2-year follow-up demonstrate that the arthroscopic transfer of the conjoint tendon confers clinical stability in patients with a failed primary labral repair who have minimal bone loss.
Collapse
|
|
45
|
Lin L, Zhang M, Song Q, Cheng X, Shao Z, Yan H, Cui G. Cuistow: Chinese Unique Inlay Bristow: A Novel Arthroscopic Surgical Procedure for Treatment of Recurrent Anterior Shoulder Instability with a Minimum 3-Year Follow-Up. J Bone Joint Surg Am 2021; 103:15-22. [PMID: 33165127 DOI: 10.2106/jbjs.20.00382] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prevalence of nonunion after the Latarjet procedure remains high. The purpose of the present study was to investigate healing and clinical outcomes after a novel arthroscopic coracoid process transfer procedure. METHODS Sixty-three patients who underwent the arthroscopic inlay Bristow procedure combined with Bankart repair were identified, and 51 patients who met the inclusion criteria were enrolled in this study. The key feature of this technique was that the coracoid process was trimmed and fixed into a trough (5 to 10 mm deep) in the glenoid neck with a metal screw. Bone graft union and positioning accuracy were assessed with use of postoperative computed tomography (CT) imaging. Clinical examinations, return to sport, and functional scores (American Shoulder and Elbow Surgeons [ASES] and Rowe scores) were recorded. RESULTS The mean duration of follow-up (and standard deviation) was 41.5 ± 7.7 months (range, 36 to 48 months). Postoperative CT scans showed that the position of coracoid graft was at 4:10 (from 3:50 to 5:00) (referencing the right shoulder) in the sagittal view. The α angle was 16.4° ± 9.5°, with 4 (7.8%) of 51 screws being over-angulated (α > 25°). On the axial view, the graft position was considered to be flush in 33 patients (64.7%), medial in 11 (21.6%), congruent in 7 (13.7%), and lateral or too medial in none. At 1 year, the coracoid graft had healed in 49 patients (96.1%) and had failed to unite in 2 patients. CT scanning, performed for 47 patients, showed grade-0 osteolysis in 9 patients, grade-1 osteolysis in 21 patients, and grade-2 osteolysis in 17 patients. At the time of the latest follow-up, there was a significant increase in the Rowe score (from 35.5 ± 8.3 to 95.7 ± 7.2) and the ASES score (from 71.2 ± 9.7 to 91.5 ± 4.4), and 87.0% of patients were able to return to sport. No arthropathy was observed in any patient. CONCLUSIONS After a minimum 3-year follow-up, the arthroscopic inlay Bristow procedure resulted in a high rate of graft healing, excellent clinical outcomes, and a high rate of return to sports. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Lin Lin
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Min Zhang
- Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, People's Republic of China
| | - Qingfa Song
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Xu Cheng
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Zhenxing Shao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Hui Yan
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Guoqing Cui
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| |
Collapse
|
|
46
|
Reeves JM, Athwal GS, Johnson JA. Double-screw and quadruple-button fixation for the glenoid: Latarjet versus bone block applications. JSES Int 2020; 4:780-785. [PMID: 33345215 PMCID: PMC7738581 DOI: 10.1016/j.jseint.2020.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The Latarjet and bone block procedures can be secured with screws or cortical buttons. The purpose of this biomechanical study was to compare quadruple buttons vs. double screws for fixation of anterior glenoid bone grafts. Methods Twelve cadaveric scapulae (6 pairs) were denuded, resected, and potted. Pairs were randomized to quadruple-button or double-screw fixation after creation of a 15% anterior glenoid defect. The specimens underwent cyclic uniaxial compressive glenoid loading between 50 and 200 N for 1000 cycles at 1 Hz. Testing was repeated for conjoint tendon loads of 0 N (simulating a bone block procedure), 10 N, and 20 N (simulating a Latarjet procedure). Peak resultant relative coracoid graft displacement was optically tracked at 3 points (superior, central, and inferior) on the edge of the coracoid. Results No significant differences were found between buttons and screws for bone block applications or with 10 N of conjoint tendon loading (P ≥ .095). At 20 N of conjoint tendon loading, however, the screws were significantly more stable than the buttons (P ≤ .023). During the initial 20-N conjoint load application, all 3 points displaced significantly more with the button reconstruction than with the screws (P ≤ .01). Overall, mean displacements did not exceed 1 mm at any position on the coracoid, regardless of testing condition. Conclusions The quadruple-button technique is comparable to screws when the coracoid is used as a bone block or when conjoint tendon loading is minimized. However, at higher conjoint tendon loads, the screws produced a more stable coracoid graft than the buttons.
Collapse
Affiliation(s)
- Jacob M Reeves
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, ON, Canada
| | - George S Athwal
- Roth
- McFarlane Hand and Upper Limb Clinic, London, ON, Canada
| | - James A Johnson
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, ON, Canada
| |
Collapse
|
|
47
|
Gilat R, Lavoie-Gagne O, Haunschild ED, Knapik DM, Parvaresh KC, Fu MC, Forsythe B, Verma N, Cole BJ. Outcomes of the Latarjet procedure with minimum 5- and 10-year follow-up: A systematic review. Shoulder Elbow 2020; 12:315-329. [PMID: 33123221 PMCID: PMC7545530 DOI: 10.1177/1758573220945318] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/13/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate mid- and long-term outcomes following the Latarjet procedure for anterior shoulder instability. METHODS PubMed, MEDLINE, Embase, and Cochrane libraries were systematically searched, in line with PRISMA guidelines, for studies reporting on outcomes following the Latarjet procedure with minimum five-year follow-up. Outcomes of studies with follow-up between 5 and 10 years were compared to those with minimum follow-up of 10 years. RESULTS Fifteen studies reporting on 1052 Latarjet procedures were included. Recurrent instability occurred in 127 patients, with an overall random summary estimates in studies with a minimum five-year follow-up of 0-18% (I2 = 90%) compared to 5-26% (I2 = 59%) for studies with a minimum 10-year follow-up. Overall rates for return to sports, non-instability related complications, and progression of arthritis estimated at 65-100% (I2 = 87%), 0-20% (I2 = 85%), and 8-42% (I2 = 89%) for the minimum five-year follow-up studies and 62-93% (I2 = 86%), 0-9% (I2 = 28%), and 9-71% (I2 = 91%) for the minimum 10-year follow-up studies, respectively. All studies reported good-to-excellent mean PRO scores at final follow-up. CONCLUSIONS The Latarjet is a safe and effective procedure for patients with shoulder instability. The majority of patients return to sport, though at long-term follow-up, a trend towards an increased incidence of recurrent instability is appreciated, while a significant number may demonstrate arthritis progression.
Collapse
Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA,Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel,Ron Gilat, 1611 W Harrison St, Chicago, IL 60612, USA.
| | | | - Eric D Haunschild
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kevin C Parvaresh
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Michael C Fu
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil Verma
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
|
48
|
Yapp LZ, Nicholson JA, McCallum C, Macdonald DJ, Robinson CM. Latarjet as a primary and revision procedure for anterior shoulder instability - A comparative study of survivorship, complications and functional outcomes in the medium to long-term. Shoulder Elbow 2020; 12:338-348. [PMID: 33123223 PMCID: PMC7545525 DOI: 10.1177/1758573219864926] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/17/2019] [Accepted: 06/27/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND This retrospective study aims to compare the outcome of the Latarjet procedure when used as a primary or revision procedure for recurrent anterior gleno-humeral instability. METHODS One hundred and ninety-seven patients underwent 205 open Latarjet procedures during the period 2006-2015 (mean follow-up 5.6 years). Sixty shoulders had failure of a previous stabilisation requiring revision to the Latarjet procedure. Outcomes were measured using the Western Ontario Shoulder Instability Index and Quick Disabilities of the Arm, Shoulder and Hand score. Survival analyses were performed using Kaplan-Meier curves, and multiple linear regression modelling was utilised to identify predictors of functional outcome (p < 0.05). RESULTS Two shoulders had recurrent dislocations in the cohort of 205 (1.0%). Six shoulders underwent further surgery for non-instability complications (2.9%). There were no significant differences in the clinical or functional outcome between patients undergoing a primary Latarjet procedure and those who required revision of a failed soft-tissue stabilisation. Ninety-two per cent of patients were satisfied with their shoulder following surgery. Patient-reported instability and satisfaction was significantly associated with poorer functional scores. DISCUSSION The Latarjet procedure successfully prevents recurrent anterior instability and is associated with high levels of satisfaction. Patient-reported outcome measures suggest no difference between primary and revision procedures.
Collapse
Affiliation(s)
- Liam Z Yapp
- Royal Infirmary of
Edinburgh, NHS Lothian, Edinburgh, UK,Liam Z Yapp, Department of Trauma and
Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent,
Edinburgh EH16 4SY, UK.
| | - Jamie A Nicholson
- Royal Infirmary of
Edinburgh, NHS Lothian, Edinburgh, UK,Department of Orthopaedics and Trauma,
University of Edinburgh, Edinburgh, UK
| | - Charlotte McCallum
- Department of Orthopaedics and Trauma,
University of Edinburgh, Edinburgh, UK
| | - Deborah J Macdonald
- Department of Orthopaedics and Trauma,
University of Edinburgh, Edinburgh, UK
| | | |
Collapse
|
|
49
|
Abstract
Primary arthroscopic Bankart repair is a common procedure that is increasing in popularity; however, failure rates can approach up to 6% to 30%. Factors commonly attributed to failure include repeat trauma, poor or incomplete surgical technique, humeral and/or glenoid bone loss, hyperlaxity, or a failure to identify and address rare pathology such as a humeral avulsion of the glenohumeral ligament lesion. A thorough clinical and radiographic assessment may provide insight into the etiology, which can assist the clinician in making treatment recommendations. Surgical management of a failed primary arthroscopic Bankart repair without bone loss can include revision arthroscopic repair or open repair; however, in the setting of bone loss, the anterior-inferior glenoid can be reconstructed using a coracoid transfer, tricortical iliac crest, or structural allograft, whereas posterolateral humeral head bone loss (the Hill-Sachs defect) can be addressed with remplissage, structural allograft, or partial humeral head implant. In addition to the technical demands of revision stabilization surgery, patient and procedure selection to optimize outcomes can be challenging. This review will focus on the etiology, evaluation, and management of patients after a failed primary arthroscopic Bankart repair, including an evidence-based treatment algorithm.
Collapse
|
|
50
|
Ernstbrunner L, De Nard B, Olthof M, Beeler S, Bouaicha S, Gerber C, Wieser K. Long-term Results of the Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Instability in Patients Older Than 40 Years: A Comparison With the Open Latarjet Procedure. Am J Sports Med 2020; 48:2090-2096. [PMID: 32579397 DOI: 10.1177/0363546520931090] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Long-term results of the arthroscopic Bankart repair in patients older than 40 years are unknown and may be favorable in terms of postoperative glenohumeral arthritis as opposed to the long-term results of the open Latarjet procedure in patients older than 40 years. PURPOSE To analyze our long-term results of the arthroscopic Bankart repair for recurrent anterior shoulder instability in patients older than 40 years of age and to compare these results with previously published long-term results of the Latarjet procedure in a cohort of similar age. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 35 consecutive patients (36 shoulders) with a mean age of 47 years (range, 40-69) at time of the arthroscopic Bankart repair were studied at a mean 13.2 years (range, 8-18) after surgery. Clinical and radiographic results were then compared with those of our previous study of 39 consecutive patients (40 shoulders) of a same age group who had been treated for the same pathology with an open Latarjet procedure. RESULTS Six shoulders (17%) sustained a recurrent shoulder dislocation after a mean 5.3 years; subluxation occurred in 3 shoulders (8%); and apprehension persisted in 3 shoulders (8%). Revision surgery was performed in 8 patients (22%): 2 Bankart and 6 open Latarjet. The relative preoperative Constant score and Subjective Shoulder Value were significantly improved (P < .001) at final follow-up. Arthropathy of stabilization was advanced in the shoulders of 16 patients (47%) and had progressed by at least 2 grades in 21 patients (62%). There were significantly higher rates of redislocation and subluxation when compared with the open Latarjet procedure (9 vs 3; P = .037), and the mean final Subjective Shoulder Value was significantly lower in the Bankart group (86% vs 91%; P = .011). There were no significant differences in final advanced arthropathy (16 vs 14; P = .334) and revision rates (8 vs 7; P = .409) when compared with the Latarjet procedure. CONCLUSION Arthroscopic Bankart repair for recurrent anterior shoulder instability in patients older than 40 years was associated with reliable pain relief and patient satisfaction similar to that after the open Latarjet procedure. Restoration of stability was significantly less successful and development of arthropathy no better than the open Latarjet procedure in patients older than 40 years.
Collapse
Affiliation(s)
- Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Bianca De Nard
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Maurits Olthof
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Silvan Beeler
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Samy Bouaicha
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|