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Beckers J, Bismuth Y, Sabate Ferris A, Godenèche A. Arthroscopic posterior capsulolabral repair grants adequate outcomes in shoulders with posterior instability without glenoid cartilage lesions. Arch Orthop Trauma Surg 2024; 144:1-6. [PMID: 37535130 DOI: 10.1007/s00402-023-04957-0] [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: 02/21/2023] [Accepted: 06/20/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Posterior capsulolabral repair (posterior Bankart) is effective to restore shoulder stability and relieve pain, though a recent meta-analysis reported recurrent instability in 9.5% of patients, and that only 62.7% were able to resume sports. The purpose of this study was to assess the outcomes of arthroscopic posterior capsulolabral repair in a population of unselected patients, in terms of recurrence of instability, clinical scores, and return to sports. METHODS The authors retrospectively studied a consecutive series of 22 patients that underwent posterior capsulolabral repair between 2009 and 2019. Patients were assessed before posterior capsulolabral repair and at a minimum follow-up of 24 months, in terms of subjective shoulder value (SSV), Western Ontario Shoulder Instability Index (WOSI), as well as level of sport. Following surgery, all complications, reoperations or episodes of instability were noted. RESULTS The cohort comprised 21 men (95%) and 1 woman (5%), aged 38.8 ± 12.5 years (range 17-61) at index surgery. Of the 20 patients that performed sports, only 2 (10%) stopped sports after surgery, while 18 resumed their main sport (90%). At a follow-up of 65.4 ± 34.8 months (range 25-146), the SSV was 85.1 ± 14.7, pain on VAS was 1.9 ± 2.1, and the Constant-Murley score was 71.6 ± 17.9. Five patients had subjective instability without dislocation (23%). Nine patients (41%) had no pain (0 points), 6 patients (27%) had mild pain (1-2 points), 4 patients (18%) had moderate pain (3 points), while 3 patients (14%) had severe pain (5-8 points). CONCLUSION Arthroscopic posterior capsulolabral repair prevented recurrent dislocation in patients with posterior shoulder instability at a minimum follow-up of 2 years, despite persistent pain in 32%, and subjective instability in 23%. These complications were mainly observed in patients with work-related accidents and glenoid cartilage lesions. LEVEL OF EVIDENCE III, case series.
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Affiliation(s)
- Joris Beckers
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France
- Department of Orthopaedics and Traumatology, AZ Sint-Lucas Brugge, Bruges, Belgium
| | - Yaniv Bismuth
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France
| | | | - Arnaud Godenèche
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France
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Sahu D, Shah D, Shetty G. Coracoid graft resorption after the Latarjet procedure does not depend on the preoperative glenoid defect. J Shoulder Elbow Surg 2023; 32:e94-e105. [PMID: 36252784 DOI: 10.1016/j.jse.2022.09.013] [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: 07/04/2022] [Revised: 09/08/2022] [Accepted: 09/20/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The primary purpose was to compare coracoid graft resorption after the Latarjet procedure in patients without preoperative glenoid bone loss vs. those with more than critical glenoid loss. The secondary purposes were to compare the functional outcomes and to investigate the association of graft position, angle of the screws, preoperative glenoid defect, age at surgery, and smoking status with graft resorption. METHODS Sixty consecutive patients with recurrent anterior instability were treated by the Latarjet procedure as the index procedure, irrespective of the glenoid bone loss between 2018 and 2021. Fifty-five patients were evaluated via computed tomography scans after a minimum of 1 year after surgery (range: 1-4 years). Twenty-five patients had no prior glenoid defect (No-defect group), 24 patients had preoperative glenoid defects ≥15% (Critical defect group), and 6 patients had glenoid defects between 5% and 15%. The No-defect group (n = 25) was compared with the Critical defect group (n = 24). Multivariate logistical regression was performed to evaluate the association of independent factors with the grade of resorption for all 55 patients in the cohort. RESULTS Major graft resorption at the level of the superior screw was observed in 72%-84% of patients in the No-defect group (n = 25) and in 75%-83% of patients in the Critical defect group (n = 24) (P = 1, P = 1; no significant difference). No to mild resorption at the level of the inferior screw was observed in 96% of patients in the No-defect group and 100% of patients in the Critical defect group (P = 1; no significant difference). Postoperative Rowe scores (100 [95-100] vs. 100 [95-100]; P = .8) and shoulder subjective value (87 [11] vs. 86 [9]; P = .9) were not significantly different between the 2 groups. None of the independent factors, including the corresponding screw angle, the mediolateral graft positioning, prior glenoid defect, age, and smoking status, were associated with graft resorption in multivariate logistical regression. CONCLUSIONS Graft resorption after the Latarjet procedure does not depend on the preoperative glenoid defect. The coracoid graft may be mostly resorbed around the superior screw but mildly or none at the level of the inferior screw, but this graft resorption is not dependent on the smoking status, age, prior glenoid defect, mediolateral graft positioning, and the angle of the screws.
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Affiliation(s)
- Dipit Sahu
- Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India; Mumbai Shoulder Institute, Mumbai, Maharashtra, India; Department of Orthopaedics, Jupiter Hospital, Thane, Maharashtra, India.
| | - Darshil Shah
- Sports Medicine Unit, Sportsmed, Mumbai, Maharashtra, India
| | - Gautam Shetty
- Knee and Orthopaedic Clinic, Mumbai, Maharashtra, India
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Rogowski I, Nové-Josserand L, Godenèche A, Colotte P, Franger G, Vigne G, Vieira TD, Blache Y, Neyton L. Functional Deficits After Open Latarjet Procedure and Dominance of the Operated Shoulder: An Analysis of 133 Patients. Am J Sports Med 2023; 51:1277-1285. [PMID: 36847281 DOI: 10.1177/03635465231156181] [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: 03/01/2023]
Abstract
BACKGROUND Return to sport after stabilization surgery using the open Latarjet procedure remains challenging. Additional knowledge is needed about postoperative shoulder functional deficits in order to better design return-to-sport programs. PURPOSE To investigate the effects of the dominance status of the operated shoulder on the shoulder functional profile recovery at 4.5 months after open Latarjet procedure. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A retrospective analysis of prospectively collected data was performed. All patients who underwent the open Latarjet procedure between December 2017 and February 2021 were eligible for the study. Functional assessment at 4.5 months after the surgery was performed using the following tests: maximal voluntary isometric contractions in glenohumeral internal and external rotation, upper-quarter Y balance test, unilateral seated shot-put test, and modified closed kinetic chain upper extremity stability test, leading to 10 outcome measures. Patients whose dominant side had undergone surgery and those whose nondominant side had undergone surgery were compared with a group of 68 healthy control participants. RESULTS A total of 72 patients who underwent an open Latarjet procedure on the dominant side and 61 patients who underwent open Latarjet on the nondominant side were compared with 68 healthy control athletes. In patients whose dominant shoulder had undergone surgery, significant deficits for the dominant side (P < .001) and for the nondominant side (P < .001) were found in 9 of 10 functional outcome measures. Among patients whose operations were on the nondominant shoulder, significant deficits for the nondominant side (P < .001) and for the dominant side (P < .001) were found in 9 and 5 of the 10 functional outcome measures, respectively. CONCLUSION Regardless of dominance of the stabilized shoulder, persistent deficits in strength, stability, mobility, power, and stroke frequency were observed at 4.5 months postoperatively. Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides. However, stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder. REGISTRATION NCT05150379 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Isabelle Rogowski
- Université de Lyon, Université Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité-EA 7424, Villeurbanne Cedex, France
| | - Laurent Nové-Josserand
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | - Arnaud Godenèche
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | - Philippe Colotte
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | - Gabriel Franger
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | | | - Thais Dutra Vieira
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | - Yoann Blache
- Université de Lyon, Université Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité-EA 7424, Villeurbanne Cedex, France
| | - Lionel Neyton
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
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Goetti P, Martinho T, Seurot A, Bothorel H, Lädermann A. Is sling immobilization necessary after open Latarjet surgery for anterior shoulder instability? A randomized control trial. Trials 2023; 24:148. [PMID: 36850012 PMCID: PMC9969622 DOI: 10.1186/s13063-023-07180-9] [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: 07/09/2022] [Accepted: 02/17/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND There is a current lack of knowledge regarding optimal rehabilitation and duration of sling immobilization after an open Latarjet procedure. A shift towards immediate self-rehabilitation protocols in shoulder surgery is observed to avoid postoperative stiffness and fasten return to sport. Avoiding sling immobilization could further simplify rehabilitation and provide an even faster return to activities of daily living and enhance patient satisfaction. METHODS This study is a single-center, randomized control trial. Sixty-eight patients will be instructed with the same standardized immediate postoperative self-rehabilitation protocol. Patients will be allocated 1:1 between a sling immobilization group for the first three postoperative weeks and no sling group without postoperative immobilization. The primary endpoint will be functional outcome at 6 months postoperative evaluated by the disease-specific Rowe score. Secondary endpoints will include baseline, 1.5-, 6-, and 12-month single assessment numeric evaluation (SANE) of instability score and visual analog pain scale (VAS). At the 6-month time point, graft bony union and position will be assessed by computed tomography. Motion capture technology will evaluate the baseline and 6-month postoperative range of motion. Finally, time to return to work and sport during the first postoperative year, along with patient satisfaction at one postoperative year, will also be recorded. DISCUSSION This study will allow further insights into the optimal rehabilitation protocol after open Latarjet surgery and enhance patient care by helping identify rehabilitation and coracoid graft-related factors influencing functional outcomes, bony union, range of motion, and patient satisfaction. TRIAL REGISTRATION The protocol was approved by the ethical committee board (CCER 2019-02,469) in April 2020 and by ClinicalTrials.gov (Identifier: NCT04479397 ) in July 2020.
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Affiliation(s)
- Patrick Goetti
- grid.8515.90000 0001 0423 4662Department of Orthopedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre Decker 4, 1005 Lausanne, Switzerland
| | - Tiago Martinho
- grid.413934.80000 0004 0512 0589Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.-D. Maillard 3, CH-1217 Meyrin, Switzerland
| | - Antoine Seurot
- grid.413934.80000 0004 0512 0589Department of Physiotherapy, La Tour Hospital, 1217 Meyrin, Switzerland
| | - Hugo Bothorel
- grid.413934.80000 0004 0512 0589Research Department, La Tour Hospital, 1217 Meyrin, Switzerland
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.-D. Maillard 3, CH-1217, Meyrin, Switzerland. .,Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland. .,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
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Bauwens PH, Fayard JM, Tatar M, Abid H, Freychet B, Sonnery-Cottet B, Thaunat M. Evaluation of a smartphone application for self-rehabilitation after anterior cruciate ligament reconstruction during a COVID-19 lockdown. Orthop Traumatol Surg Res 2023; 109:103342. [PMID: 35660080 DOI: 10.1016/j.otsr.2022.103342] [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: 03/26/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rehabilitation after surgery is a crucial process that governs the final functional outcome. The self-rehabilitation smartphone application Doct'up (Healing SAS, Lyon, France) is designed for patients who have had anterior cruciate ligament (ACL) reconstruction surgery. In France in the spring of 2020, the lockdown mandated due to the COVID-19 pandemic prevented patients from seeing their physiotherapists for 2 months. The objective of this study was to compare the clinical outcomes in two groups of patients who underwent ACL reconstruction surgery: in one group, surgery performed before the lockdown was followed by standard in-person physiotherapy while, in the other, surgery was done just before the lockdown and rehabilitation was performed by the patients themselves using the phone application. HYPOTHESIS Using a self-rehabilitation smartphone app limits the negative effects of not receiving physiotherapist rehabilitation after ACL reconstruction. MATERIAL AND METHODS We performed a case-control study involving the retrospective analysis of prospectively collected data from two groups of patients who had undergone ACL reconstruction surgery. Patients in the App group had surgery just before the 2-month COVID-19-related lockdown that started in France on March 17, 2020,and used only the smartphone app for rehabilitation. The standard-care group was composed of matched controls who had surgery 1 year before the cases and received rehabilitation therapy during in-person physiotherapist visits. The ACL reconstruction technique was the same in the two groups. The primary outcome measure was extension lag 6 weeks after surgery. The secondary outcome measures were extension lag 3 weeks and 6 months after surgery, quadriceps muscle activation, knee extension locking 3 and 6 weeks after surgery, and the 6-month rate of surgical revision for cyclops syndrome. RESULTS We included 32 cases managed using only self-rehabilitation guided by the phone app, and we identified 101 matched controls managed using standard care. We found no significant between-group difference in extension lag after 6 weeks: 9.4% (28/32) vs. 4.6% (87/101), p=0.39. After 3 weeks, the App group had a higher proportions of patients with quadriceps activation (94% [30/32] vs. 73% [74/101], p=0.015) and extension control using canes (78.1% [25/32] vs. 40.6% [41/101], p=0.0002). None of the other measured outcomes differed significantly between the two groups (extension lag after 3 weeks: 12.5% [4/32] vs. 13.8% 14/101]; extension lag after 6 months: 3.2% [1/32] vs. 1% [1/101]; quadriceps activation after 6 weeks: 97% [31/32] vs. 99% [100/101]; extension locking with canes after 6 weeks: 96.9% [31/32] vs. 93.1% [94/101]; extension locking without canes after 3 weeks: 53.2% [17/32] vs. 47.5% [48/101]; extension locking without canes after 6 weeks: 93.7% [30/32] vs. 82.2% [83/101]; and surgery for cyclops syndrome (3.1% [1/32] vs. 1% [1/101]). DISCUSSION The use of a self-rehabilitation phone app after ACL reconstruction during a COVID-19 lockdown limited the adverse effects of not receiving in-person physiotherapy. The 6-month outcomes were similar to those seen with standard rehabilitation. The study results demonstrate the usefulness of self-rehabilitation after ACL reconstruction surgery. Self-rehabilitation guided by a phone app could be used as a complement to the protocols generally applied by physiotherapists. LEVEL OF EVIDENCE IV, single-centre retrospective case-control study.
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Affiliation(s)
- Paul-Henri Bauwens
- Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Maxime Tatar
- Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Hichem Abid
- Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Benjamin Freychet
- Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Lyon, France, Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
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Gómez DJ, Veloz Serrano D, Moya D, Crosa JI, Cullari ML, Taleb JP, Quiroga G, Maya XA, Muratore Á. Functional results and return to sports on recurrent anterior glenohumeral instability. Influence of the COVID-19 pandemic; Comparative retrospective study and short-term results. J Orthop Surg (Hong Kong) 2023; 31:10225536231160308. [PMID: 36856055 PMCID: PMC9982427 DOI: 10.1177/10225536231160308] [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] [Indexed: 03/02/2023] Open
Abstract
AIMS Our objective is to compare the functional results in patients that underwent surgery for recurrent anterior shoulder instability (RAGHI) during the COVID-19 pandemic with remotely-based rehabilitation, to those who had surgery before the pandemic and had in-person rehabilitation therapy. METHODS A retrospective case series of 68 patients were included and divided into two groups: In person-group and Home-based group. Western Ontario Shoulder Instability Index (WOSI) and Subjective Shoulder Value (SSV) scores were used to evaluate objective and subjective clinical parameters. Time and level of return to sports was studied by the Subjective Patient Outcome for Return to Sports (SPORTS) score. RESULTS The mean SSV score was 82% (40-100) on the In-Person group compared with 87% (65-100) for the Home-Based group. Results for WOSI score were similar, with an average of 210.42 (90%) for In-Person and 261.45 (88%) for the Home-Based group (p 0.12). Return to sports was carried out in an average of 6.6 (4-16) months for In-Person group, compared to 6.5 (5-8) months for Home-Based. CONCLUSION Follow-up and rehabilitation methods for patients who underwent surgery for RAGHI, during COVID-19 lockdown, were not significantly (p 0.12) affected on functional and athletic return in comparison to traditional methods according to WOSI scale. LEVEL OF EVIDENCE IV Retrospective series of cases.
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Affiliation(s)
- Diego J Gómez
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Daniel Veloz Serrano
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Daniel Moya
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Juan I Crosa
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Matias L Cullari
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Juan P Taleb
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gonzalo Quiroga
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Xavier A Maya
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Álvaro Muratore
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
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Rattier S, Druel T, Hirakawa Y, Gröger F, van Rooij F, Neyton L. Use of Cannulated Screws for Primary Latarjet Procedures. Orthop J Sports Med 2022; 10:23259671221117802. [PMID: 36051974 PMCID: PMC9425914 DOI: 10.1177/23259671221117802] [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: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background Rapid consolidation of the bone block is paramount for the success of the Latarjet procedure. Noncannulated screws have shown satisfactory long-term bone block fusion, while cannulated screws are challenged with inferior mechanical properties and fusion rates. Purpose To report outcomes of the Latarjet procedure using cannulated screws, notably bone block fusion and complication rates at 3 months, as well as clinical scores and return to sports at minimum 2 years postoperatively. Study Design Case series; Level of evidence, 4. Methods We reviewed the records of 124 consecutive patients (124 shoulders) who underwent primary Latarjet procedures using cannulated screws between 2015 and 2018. All patients underwent clinical examination at 3 months postoperatively, including range of motion and radiographs to assess graft fusion. The Walch-Duplay score, Rowe score, Subjective Shoulder Value, and visual analog scale for pain were collected at a minimum follow-up of 2 years. Results Overall, 9 patients (7%) required reoperation: 7 (6%) had screw removal for unexplained residual pain, 1 (0.8%) had lavage for deep infection, and 1 (0.8%) had evacuation to treat a hematoma. Furthermore, 3 patients (2.4%) had recurrent instability, none of whom underwent reoperation. At 3-month follow-up, all 124 shoulders showed complete radiographic graft fusion, and at 40 ± 11 months (mean ± SD; range, 24-64 months), 88% of patients had returned to sport (109/124), the Walch-Duplay score was 86 ± 14, Rowe was 84 ± 15, Subjective Shoulder Value was 88 ± 11, and visual analog scale for pain was 1 ± 1. Conclusion The clinical relevance of these findings is that 4.5-mm cannulated screws are safe and effective for primary Latarjet procedures and grant adequate graft healing, with low recurrence of instability and a high rate of return to sports.
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Affiliation(s)
- Simon Rattier
- Department of Orthopedic and Trauma Surgery, SOS Mains, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France
| | - Thibaut Druel
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France
| | - Yoshihiro Hirakawa
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Falk Gröger
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France
| | | | - Lionel Neyton
- Department of Orthopedic and Trauma Surgery, SOS Mains, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France
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Capsular repair is not an important part of the Latarjet-Walch procedure. J Shoulder Elbow Surg 2022; 31:948-956. [PMID: 34808352 DOI: 10.1016/j.jse.2021.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/14/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patte et al noted that the Latarjet procedure works by the triple blocking effect of (1) the conjoint tendon sling effect, (2) the bone block effect, and (3) the capsular repair. However, no clinical study has specifically investigated the role of capsular repair in the Latarjet procedure. AIMS The primary aim was to compare (1) the external rotation range of motion (ROM) achieved after the Latarjet procedure with and without the capsule to coracoacromial (CA-CAL) repair. The secondary aims were to compare the functional outcomes, forward elevation ROM, and internal rotation ROM after the Latarjet procedure with and without the CA-CAL repair. METHODS A prospective cohort of 30 patients who underwent the Latarjet-Walch procedure with a CA-CAL repair between October 2018 and February 2020 was compared with the preceding group of 31 patients who underwent the Latarjet-Walch procedure without any capsular repair between October 2016 and September 2018, at a minimum of 1-year of follow-up. RESULTS External rotation with the elbow abducted at 90° (ER2) deficit (compared to the normal opposite side) was significantly larger after the CA-CAL repair augmentation of the Latarjet procedure (mean difference = 6°, P = .03) than that after no repair. External rotation with the elbow adducted (ER1) deficit after the CA-CAL repair augmentation was not significantly different from that after no repair. ER2 deficit of more than 15° (minimum clinically important difference) was observed in 11 patients (38%) in the CA-CAL repair group and 3 patients (10%, P = .015) in the no repair group. Walch-Duplay score, Rowe score, and Subjective Shoulder Value were not significantly different between the CA-CAL repair group and the no repair group. Covariates of hand dominance, overhead sports, and glenoid defect size did not significantly affect the ER2 deficit and ER1 deficit outcomes. CONCLUSIONS This study disproved the long-held belief that capsular repair is an essential step of the Latarjet-Walch procedure. Capsular repair to the coracoacromial ligament in the Latarjet procedure leads to a clinically insignificant restriction of external rotation (with the arm abducted), no restriction of external rotation (with the arm adducted), but functional outcomes similar to those after Latarjet without a capsular repair in a nonoverhead athlete.
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Sahu D, Rathod V, Phadnis A, Bansal SS. Telehealth for consultation and shoulder rehabilitation: a preliminary study on the perspectives of 30 patients during the COVID-19 lockdown. Clin Shoulder Elb 2021; 24:156-165. [PMID: 34488296 PMCID: PMC8423527 DOI: 10.5397/cise.2021.00248] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aimed to determine: the perspectives of the patient cohort that underwent telehealth consultation and shoulder rehabilitation during coronavirus disease 2019 (COVID-19) and the differences in the patients' perspectives with the two different telehealth video applications (apps) used in the study. METHODS This is a prospective study carried out during the COVID lockdown period of April to July 2020. Thirty consecutive patients from the orthopedics department of a tertiary institute in India underwent their first-ever session of a video app-based (Zoom or WhatsApp) telehealth consultation with shoulder rehabilitation exercises on a handheld mobile, tablet, or laptop device. After the virtual consultation, the patients were sent a validated telehealth usability questionnaire (TUQ) to evaluate their perspectives. Scores obtained from the TUQ were the primary outcome measure. RESULTS The study was completed by 30 patients (16 men and 14 women) with an average age of 56 years (range, 20-77 years). The patients who contacted us during the lockdown period with either a stiff shoulder or a conservatively treated shoulder fracture were included in the study. The average TUQ score was 13.6 (median, 14.5; range, 6-21) out of a maximum of 21 points. Eighty percent of the patients were satisfied and found the telehealth service useful. Use of the Zoom app scored significantly higher (median, 17; average, 15.6) than the WhatsApp app (median, 8.5; average, 9.6) (p=0.004). CONCLUSIONS Patients who received telehealth consultation and shoulder rehabilitation were overall satisfied. Telehealth apps with advanced video calling features such as Zoom should be preferred for higher patient satisfaction.
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Affiliation(s)
- Dipit Sahu
- Department of Orthopaedics, Jupiter Hospital, Thane, India.,Mumbai Shoulder Institute, Mumbai, India
| | | | - Ashish Phadnis
- Department of Orthopaedics, Jupiter Hospital, Thane, India
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Sinha S, Kar S, Naik AK, Kumar J, Goyal R, Jain VK, Arya RK. Decreased motion with normal strength after Latarjet procedure has minimal impact on return to activity. Knee Surg Sports Traumatol Arthrosc 2021; 29:2579-2586. [PMID: 33459831 DOI: 10.1007/s00167-020-06414-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 12/10/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE The Latarjet procedure can affect the range of motion (ROM) and strength of the shoulder, which determine the time to return to the preinjury level of activity. This study prospectively assessed whether the Latarjet procedure leads to a decrease in range of motion and muscle strength, affecting the time to return to the previous level of activity. METHODS Fifty-one consecutive patients who underwent the Latarjet procedure for recurrent dislocation of the shoulder were included prospectively. The ROM, strength, Walch-Duplay score, and Rowe score were measured every 3 months for 1 year and then every 6 months for 2 years. Radiological assessments were performed to confirm the graft location, union, and the humeral head position in abduction and external rotation (ER). RESULTS Out of 51 patients, 49 completed all follow-ups. The median age was 27 years (17-45 years), and the dominant side was involved in 36 patients. The median number of dislocations was 11 (5-50). Twelve patients were sleep dislocators. There was a significant loss (p < 0.0001) of abduction, forward flexion (FF), ER, and internal rotation (IR) in the affected shoulder compared to the contralateral shoulder. Recovery plateaued at 12 months. There was near complete recovery of muscle strength after the Latarjet procedure, and the difference between the affected and contralateral shoulders was not significant (n.s.). The modified Rowe score was excellent in 44 (90%) patients, and the Walch-Duplay score was excellent in 43 patients (88%) at 24 months. Suboptimal results were associated with non-compliance with rehabilitation in two (4%) patients and neglected unreduced dislocation in one (2%) patient. The coracoid graft position was below the equator in 44 patients (90%). Forty-six patients (94%) could return to the previous level of activity. CONCLUSION The Latarjet procedure results in a restricted ROM of the shoulder, but there is no loss of muscle strength. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Skand Sinha
- Sports Injury Centre, Safdarjung & VMMC, New Delhi, 110029, India.
| | - Santanu Kar
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi, 110001, India
| | - Ananta K Naik
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi, 110001, India
| | - Jaswant Kumar
- Sports Injury Centre, Safdarjung & VMMC, New Delhi, 110029, India
| | - Rakesh Goyal
- Sports Injury Centre, Safdarjung & VMMC, New Delhi, 110029, India
| | - Vijay K Jain
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi, 110001, India
| | - Rajendra K Arya
- Sports Injury Centre, Safdarjung & VMMC, New Delhi, 110029, India
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Juré D, Blache Y, Degot M, Vigne G, Nové-Josserand L, Godenèche A, Collotte P, Franger G, Borel F, Rogowski I, Neyton L. The S-STARTS Test: Validation of a Composite Test for the Assessment of Readiness to Return to Sport After Shoulder Stabilization Surgery. Sports Health 2021; 14:254-261. [PMID: 33834924 DOI: 10.1177/19417381211004107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The time elapsed since surgery is the primary criterion for allowing athletes to return to sport after shoulder stabilization surgery using the Latarjet procedure. The objective assessment of shoulder functional status through the return-to-sport continuum demands a scoring instrument that includes psychological and physical dimensions. This study aimed to statistically validate the Shoulder-SanTy Athletic Return To Sport (S-STARTS) score in patients who have undergone primary shoulder stabilization surgery. HYPOTHESIS The S-STARTS score fulfils the criteria for statistical validation for assessing return-to-sport readiness after shoulder stabilization surgery. STUDY DESIGN Diagnostic study. LEVEL OF EVIDENCE Level 4. METHODS Fifty patients and 50 controls completed the Shoulder Instability-Return to Sport after Injury questionnaire and performed 4 physical performance tests, from which 8 outcome measures were extracted to provide a composite score, named S-STARTS, according to a scoring procedure. The statistical validation of the S-STARTS score was based on construct validity, discriminant validity, sensitivity to change, internal consistency, reliability, agreement, and feasibility. RESULTS The 8 components of the S-STARTS score provided additional information (0.01 ≤ |r| ≤ 0.59). The S-STARTS score exhibited good reliability (intraclass coefficient of correlation [3,k] = 0.74), no ceiling or floor effects, and high discrimination and sensitivity to change. The S-STARTS score was significantly lower in patients than in controls (13.5 ± 3.8 points vs 16.1 ± 2.7 points, respectively; P < 0.001). A significant increase was reported between 4.5 and 6.5 months postoperatively (12.8 ± 2.3 points vs 17.2 ± 2.4 points, respectively; P < 0.001). CONCLUSIONS The S-STARTS score meets statistical validation criteria for the assessment of shoulder functional status after shoulder stabilization surgery using the Latarjet procedure. CLINICAL RELEVANCE Using an S-STARTS score-based assessment to monitor an athlete's progression through the return-to-sport continuum may help clinicians and strength and conditioning coaches in return-to-sport decision-making.
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Bohu Y, Abadie P, van Rooij F, Nover L, Berhouet J, Hardy A. Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores. Knee Surg Sports Traumatol Arthrosc 2021; 29:2606-2615. [PMID: 33743029 PMCID: PMC8298242 DOI: 10.1007/s00167-021-06475-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Systematic reviews report return to play (RTP) within 5.8 months (range, 3-8) following the Latarjet procedure, but the factors that influence RTP remain unknown. The present study aimed to report the rate and time of return to play (RTP) during the first 8 months following the Latarjet procedure, and to determine the influence of sport type or patient characteristics. METHODS The authors retrospectively collected the records of patients that underwent Latarjet procedures for anterior shoulder instability between 2015 and 2017. Patients were excluded if they had any concomitant rotator cuff tendon lesions, or previous ipsilateral shoulder surgery. The authors retrieved patient demographics, time from injury to surgery, type of sport practiced (overhead/non-overhead, contact/non-contact), as well as pre- and postoperative Western Ontario Shoulder Instability index (WOSI), Shoulder Instability-Return to Sport After Injury index (SIRSI), and Rowe score. RESULTS A total of 217 patients (217 shoulders) were eligible for inclusion, comprising 184 males and 33 females, aged 26.8 ± 7.3 years at index surgery. The main sport practiced prior to surgery involved overhead (n = 173, 80%) and/or contact (n = 152, 70%) activities. By 8 month follow-up, 158 patients (73%) resumed their main sport, at a mean of 5.1 ± 1.5 months. Multivariable analysis revealed that RTP was more likely in patients with higher preoperative Rowe score (OR, 1.02; p = 0.024) and SIRSI score (OR, 1.02; p = 0.008). CONCLUSIONS By 8 months following the Latarjet procedure, 73% of patients had resumed their main sport. The likelihood of RTP was significantly associated with preoperative Rowe and SIRSI scores, but not with sport type. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yoann Bohu
- Clinique du Sport Paris V, Ramsay Santé, Paris, France.
| | - Pierre Abadie
- Clinique du Sport de Bordeaux-Merignac, Mérignac, France
| | | | - Luca Nover
- ReSurg SA, 22 Rue Saint Jean, 1260 Nyon, Switzerland
| | | | | | - Alexandre Hardy
- Clinique du Sport Paris V, Ramsay Santé, Paris, France ,Ambroise Paré Hospital, Boulogne-Billancourt, France
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Godenèche A, Merlini L, Roulet S, Le Chatelier M, Delgrande D, Saffarini M, Métais P, Métais P. Screw Removal Can Resolve Unexplained Anterior Pain Without Recurrence of Shoulder Instability After Open Latarjet Procedures. Am J Sports Med 2020; 48:1450-1455. [PMID: 32301621 DOI: 10.1177/0363546520916171] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior shoulder instability can be successfully treated using Latarjet procedures, although a small proportion of patients report unexplained pain. PURPOSE/HYPOTHESIS The purpose was to report the prevalence and characteristics of patients with unexplained pain without recurrent instability after open Latarjet procedures and to determine whether screw removal can alleviate pain. The hypothesis was that unexplained pain without recurrent instability might be due to soft tissue impingements against the screw heads and that the removal of screws would alleviate or reduce pain. STUDY DESIGN Case series; Level of evidence, 4. METHODS We retrospectively reviewed the clinical and radiographic records of 461 consecutive shoulders treated by open Latarjet procedures for anterior instability between 2002 and 2014. Unexplained anterior pain was present in 21 shoulders (4.6%) and treated by screw removal at 29 ± 37 months (mean ± SD). Postoperative assessment at >12 months after screw removal included complications, visual analog scale for pain (pVAS), subjective shoulder value, Rowe score, Walch-Duplay score, and ranges of motion. The study cohort comprised the shoulders of 20 patients (9 women, 11 men) aged 25 ± 6 years (median, 25 years; range, 16-34 years) at screw removal and involved the dominant arm in 13 (62%) shoulders. RESULTS Screw removal alleviated pain completely in 14 shoulders (67%; pVAS improvement, 6.4 ± 1.8; median, 6; range, 3-8) and reduced pain in the remaining 7 (33%; pVAS improvement, 2.4 ± 1.4; median, 2; range, 1-5). At 38 ± 23 months after screw removal, 2 recurrences of instability unrelated to screw removal occurred. The subjective shoulder value was 79% ± 22% (median, 90%; range, 0%-95%); Rowe score, 85 ± 20 (median, 95; range, 30-100); and Walch-Duplay score, 82 ± 19 (median, 85; range, 25-100). Mobility improved in active forward elevation (171°± 14°), external rotation with the elbow at the side (61°± 12°), and external rotation with the arm at 90° of abduction (67°± 13°) and especially in internal rotation, with only 2 shoulders (10%) limited to T12 spine segment. CONCLUSION The present findings confirm that unexplained anterior pain after Latarjet procedures can be related to the screws used to fix bone blocks, which can safely be alleviated or reduced by screw removal.
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Affiliation(s)
- Arnaud Godenèche
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Lorenzo Merlini
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Steven Roulet
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Morgane Le Chatelier
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Damien Delgrande
- Clinique AXIUM, Institut de chirurgie orthopédique de Provence, Aix-en-Provence, France
| | | | - Pierre Métais
- Elsan, Etablissements du Puys-de-Dôme Pôle Chirurgical du Membre Supérieur, Beaumont, France
| | - Pierre Métais
- Elsan, Etablissements du Puys-de-Dôme Pôle Chirurgical du Membre Supérieur, Beaumont, France
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