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宋 庆, 邵 振, 崔 国. [Research progress of Chinese unique Inlay Bristow (Cuistow surgery) using suture button fixation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:641-645. [PMID: 38918181 PMCID: PMC11190678 DOI: 10.7507/1002-1892.202403134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/23/2024] [Indexed: 06/27/2024]
Abstract
Objective To explore the research progress of the coracoid transfer surgery using suture button fixation, particularly focusing on the technique known as Chinese unique Inlay Bristow (Cuistow surgery). Methods Extensive literature review was conducted to summarize and analyze the utilization of suture button fixation in the Cuistow surgery, comparing its biomechanical and clinical outcomes with those of traditional screw fixation. Results Utilizing suture button fixation in coracoid transfer surgery helps circumvent certain metal-related complications associated with traditional screw fixation. While its biomechanical stability and effectiveness have been preliminarily confirmed, debates persist regarding its graft healing rate and postoperative recurrence rate compared to traditional screw fixation. The Cuistow surgery based on the Inlay structure is a solution to improve the healing rate of graft after suture button fixation. Conclusion Suture button fixation, as a novel approach in coracoid transfer surgery, remains to have its advantages and disadvantages compared to traditional screw fixation not entirely elucidated, underscoring the need for further in-depth clinical and fundamental research. Cuistow surgery is the Chinese experience of coracoid transfer surgery, and its biomechanical stability and clinical advantages have been preliminarily confirmed.
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Affiliation(s)
- 庆法 宋
- 北京大学第三医院运动医学科 北京大学运动医学研究所 运动医学关节伤病北京市重点实验室 运动创伤治疗技术与器械教育部工程研究中心(北京 100191)Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, 100191, P. R. China
| | - 振兴 邵
- 北京大学第三医院运动医学科 北京大学运动医学研究所 运动医学关节伤病北京市重点实验室 运动创伤治疗技术与器械教育部工程研究中心(北京 100191)Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, 100191, P. R. China
| | - 国庆 崔
- 北京大学第三医院运动医学科 北京大学运动医学研究所 运动医学关节伤病北京市重点实验室 运动创伤治疗技术与器械教育部工程研究中心(北京 100191)Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, 100191, P. R. China
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Rosenow CS, Leland DP, Camp CL, Barlow JD. Sutures, Screws, Buttons, and Anchors: A Review of Current Bone Graft Fixation Devices for Glenoid Bone Loss in the Unstable Shoulder. Curr Rev Musculoskelet Med 2024; 17:207-221. [PMID: 38587597 DOI: 10.1007/s12178-024-09895-x] [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] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE OF REVIEW Anterior shoulder instability is associated with concomitant injury to several stabilizing structures of the shoulder, including glenoid bone loss. While instability is most common in young athletes and patients with predisposing conditions of hyperlaxity, recurrent shoulder instability can occur throughout various age ranges and may lead to longer term effects including pain and shoulder arthritis. Glenoid bone loss exceeding certain thresholds is generally treated by glenoid reconstruction via bone block augmentation to adequately stabilize the glenohumeral joint. These procedures increase the width of the articular surface on which the humeral head can translate before dislocation and, based on the procedure performed, provide a sling effect via the conjoined tendon, and increase tension to support the anterior capsule. The purpose of this review is to summarize the available literature regarding bone block fixation techniques. RECENT DEVELOPMENTS Various fixation techniques have been utilized to secure bone block transfers. Though screw fixation has traditionally been used for bone block fixation, suture buttons, suture anchors, and all-suture techniques have been utilized in attempts to avoid complications associated with the use of screws. Biomechanical studies report variable force-resistance, displacement, and mode of failure when comparing screw to suture button-based fixation of glenoid bone blocks. Clinical and radiographic studies have shown these novel suture-based techniques to be comparable, and in some cases advantageous, to traditional screw fixation techniques. While screw fixation has long been the standard of care in glenoid bone block procedures, it is associated with high complication rates, leading surgeons to endeavor toward new fixation techniques. In available biomechanical studies, screw fixation has consistently demonstrated high maximal load-to-failure and displacement with cyclic loading. Studies have reported similar clinical and radiographic outcomes in both screw and suture-based fixation methods, with evidence of reduced bone resorption with suture fixation. While suture button fixation is associated with a higher rate of recurrent instability, overall complication rates are low. Future research should address biomechanical shortcomings of suture-based fixation techniques and continue to assess long-term follow-up of patients treated with each fixation method.
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Affiliation(s)
- Christian S Rosenow
- Mayo Clinic Department of Orthopedic Surgery, 200 First Street SW, Rochester, 55905, MN, USA
| | - Devin P Leland
- Mayo Clinic Department of Orthopedic Surgery, 200 First Street SW, Rochester, 55905, MN, USA
| | - Christopher L Camp
- Mayo Clinic Department of Orthopedic Surgery, 200 First Street SW, Rochester, 55905, MN, USA.
| | - Jonathan D Barlow
- Mayo Clinic Department of Orthopedic Surgery, 200 First Street SW, Rochester, 55905, MN, USA
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Maguire JA, Dhillon J, Sarna N, Keeter C, Scillia AJ, McCulloch PC, Kraeutler MJ. Screw Fixation for the Latarjet Procedure May Reduce Risk of Recurrent Instability but Increases Reoperation Rate Compared to Suture-Button Fixation: A Systematic Review. Arthroscopy 2024; 40:1882-1893.e1. [PMID: 38040391 DOI: 10.1016/j.arthro.2023.11.020] [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: 08/24/2023] [Revised: 11/02/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE To perform a systematic review to compare clinical outcomes, complications, and reoperation rates of patients undergoing the Latarjet procedure with screw vs suture-button fixation. METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies directly comparing screw vs suture-button fixation for the Latarjet procedure. The search terms used were shoulder screw suture button. Patients were evaluated based on reoperation rate, complication rate, recurrent instability, radiologic outcomes, and patient-reported outcomes. Graft and screw position were assessed via computed tomography. RESULTS Seven studies (1 Level II, 6 Level III) met inclusion criteria, with 845 patients undergoing the Latarjet procedure with screw fixation (screw group) and 279 patients with suture-button fixation (suture-button group). Mean patient age ranged from 21.2 to 29.6 years. Mean follow-up time ranged from 6.0 to 40.8 months. The recurrent instability rate ranged from 0% to 2.5% in the screw group and 0% to 8.3% in the suture-button group. The reoperation rate ranged from 0% to 7.7% in the screw group compared to 0% to 1.9% in the suture-button group. One study reported significantly lower visual analog scale pain scores in the suture-button group compared with the screw group (1.5 vs 1.2, P = .003). No other studies reported significant differences in any patient-reported outcomes. There was no significant difference in horizontal or vertical graft position, graft union rate, or complication rate between groups in any study. CONCLUSIONS The Latarjet procedure with screw fixation may result in a lower risk of recurrent instability compared to suture-button fixation, although screw fixation may also have a higher reoperation rate due to hardware-related complications. LEVEL OF EVIDENCE Level III, systematic review of Level II to III studies.
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Affiliation(s)
- James A Maguire
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A..
| | - Jaydeep Dhillon
- Rocky Vista University College of Osteopathic Medicine, Greenwood Village, Colorado, U.S.A
| | - Neil Sarna
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Carson Keeter
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Anthony J Scillia
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Patrick C McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Matthew J Kraeutler
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
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Hali NZ, Tahir M, Jordan RW, Laprus H, Woodmass J, D'Alessandro P, Malik SS. Suture Button Fixation in Latarjet Has Similar Load to Failure and Clinical Outcomes but Lower Bone Resorption Compared With Screw Fixation: A Systematic Review. Arthroscopy 2024; 40:1637-1654. [PMID: 37890545 DOI: 10.1016/j.arthro.2023.10.021] [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: 06/25/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE To compare the 2 Latarjet fixation techniques-screw fixation (SF) versus suture button (SB) -for clinical, biomechanical, and radiologic outcomes. METHODS A systematic review was conducted in accordance with Preferred Reporting Items for Systematic and Meta-Analyses guidelines using MEDLINE and Embase databases and was prospectively registered on PROSPERO. Only comparative clinical and biomechanical studies of Latarjet with SF and SB were included. Studies were appraised using the Methodical Index for Non-Randomised Studies (MINORS) tool. RESULTS Eleven studies met eligible criteria: 7 clinical studies (SB, n = 279; SF, n = 845) and 4 biomechanical. In total, 80.9% (SB) and 84.2% (SF) of patients were male. Follow-up ranged from 6 to 63.6 months. The overall recurrent instability rate for SB ranged from 0 to 8.3% and for SF ranged from 0 to 2.75%. Only one study demonstrated a greater recurrent instability rate with SB (P = .02). Overall SB complication rates ranged from 0 to 12.5% and SF ranged from 0 to 27%. Two studies reported greater complications and reoperations with SF related to hardware. Summary forest plots from 4 studies showed no significant difference in Walch Duplay score (mean difference, range -5.00 to 1.20 [95% confidence interval {CI} -12.13 to 8.56], I2 inconsistency = 0%), Rowe score (mean difference, range -2.00 to 4.00 [95% CI -7.37 to 7.66], I2 inconsistency = 45%), and VAS for pain (mean difference, range -0.10 to 0.60 [95% CI -0.72 to 1.33], I2 inconsistency = 0%). There was no statistically significant difference between SB and SF in the postoperative range of motion. Radiologically, there was no significant difference in graft positioning and union at final follow-up, but graft resorption was greater in SF (range 25.2%-47.6%) compared with SB (range 10.1%-18.5%). Biomechanical studies showed no significant difference in maximum load to failure (SB, range 184-266 N vs SF, range 148-288 N). CONCLUSIONS Clinically, SB fixation demonstrated similar functional outcome and range of motion when compared with SF, with the potential benefit of lower rates of graft resorption and hardware-related complications. Biomechanically there was no difference in maximum load to failure. LEVEL OF EVIDENCE Level III, systematic review of Level III and biomechanical studies.
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Affiliation(s)
- Nayeem Z Hali
- Worcestershire Acute Hospitals NHS Trust, Worcestershire, United Kingdom.
| | - Muaaz Tahir
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Robert W Jordan
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - Peter D'Alessandro
- Orthopaedic Research Foundation of Western Australia, Perth, Western Australia; Medical School, Discipline of Surgery, University of Western Australia, Perth, Western Australia
| | - Shahbaz S Malik
- Worcestershire Acute Hospitals NHS Trust, Worcestershire, United Kingdom
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Chakrabarti MO, Khan M. Editorial Commentary: Suture Button Fixation for the Latarjet Procedure Is Superior to Screw Fixation. Arthroscopy 2024; 40:1655-1657. [PMID: 38219100 DOI: 10.1016/j.arthro.2023.11.035] [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: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/15/2024]
Abstract
An increasing body of evidence suggests that suture button fixation is comparable with screw fixation in Latarjet and potentially associated with reduced graft resorption. Suture button fixation may facilitate performing the Latarjet procedure, particularly when done in an arthroscopic manner. The use of suture button fixation technique theoretically facilitates improved positioning of the graft on the glenoid, as it frees the surgeon from the potential of the soft-tissue envelope to impact positioning of the graft, which can occur with screw-based guides. The bone graft can be shuttled into an optimal position and then tensioned with relative ease in comparison with screw-based techniques. Suture button fixation results in lower complication rates compared with screw fixation; almost one third of the screw fixation complications are hardware-related, and screw fixation results in a high rate of hardware removal. Moreover, the arthroscopic Latarjet suture button literature is published by experienced surgeons. Arthroscopic Latarjet has a significant learning curve, reducing the translatability of studies that report superior findings with any one technique. The generalizability of results reminds us that evidence-based medicine should be practiced through the lens of not only patient preferences, but also through an honest appraisal of a surgeon's own ability.
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Jackson GR, Brusalis CM, Schundler SF, Sachdev D, Obioha OA, McCormick JR, Mameri ES, Kaplan DJ, Knapik DM, Chahla J, Verma NN. Isolated Primary Latarjet Procedures for Anterior Shoulder Instability Results in High Rates of Graft Resorption and Glenohumeral Degenerative Changes With Low Rates of Failure at a Minimum 2-Year Follow-Up: A Systematic Review. Arthroscopy 2024; 40:581-591.e1. [PMID: 37270111 DOI: 10.1016/j.arthro.2023.05.024] [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: 01/25/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To evaluate the incidence of postoperative complications after an isolated primary Latarjet procedure for anterior shoulder instability at a minimum 2-year follow-up. METHODS A systematic review was performed in accordance with 2020 PRISMA guidelines. EMBASE, Scopus, and PubMed databases were queried from database inception through September 2022. The literature search was limited to human clinical studies reporting on postoperative complications and adverse events after a primary Latarjet procedure with a minimum 2-year follow-up. Risk of bias was measured using the Newcastle-Ottawa Scale. RESULTS Twenty-two studies, consisting of 1,797 patients (n = 1,816 shoulders), with a mean age of 24 years were identified. The overall postoperative complication rate ranged from 0% to 25.7%, with the most common complication being persistent shoulder pain (range: 0%-25.7%). Radiological changes included graft resorption (range: 7.5%-100%) and glenohumeral degenerative changes (range: 0%-52.5%). Recurrent instability following surgery was documented in 0% to 35% of shoulders, while the incidence of bone block fractures ranged from 0% to 6% of cases. Postoperative nonunion, infection, and hematomas had a reported incidence rate ranging from 0% to 16.7%, 0% to 2.6%, and 0% to 4.4%, respectively. Overall, 0% to 7.5% of surgeries were reported failures, and 0% to 11.1% of shoulders required reoperation, with a revision rate ranging from 0% to 7.7%. CONCLUSIONS The incidence of complications following the primary Latarjet procedure for shoulder instability was variable, ranging from 0% to 25.7%. High rates of graft resorption, degenerative changes, and nonunion were present while failure and revision rates remained low at a minimum 2-year follow-up. LEVEL OF EVIDENCE Level III, systematic review of Level I-III studies.
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Affiliation(s)
- Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Christopher M Brusalis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Sabrina F Schundler
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Divesh Sachdev
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Obianuju A Obioha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Johnathon R McCormick
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Instituto Brasil de Tecnologia da Saúde, Rio de Janeiro, Brazil; Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Daniel J Kaplan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, Missouri, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Thamrongskulsiri N, Limskul D, Tanpowpong T, Kuptniratsaikul S, Itthipanichpong T. Clinical Outcomes, Union Rates, and Complications of Screw Versus Button Fixation in the Bristow-Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review and Meta-Analysis. Clin Orthop Surg 2023; 15:1000-1012. [PMID: 38045573 PMCID: PMC10689233 DOI: 10.4055/cios23154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/24/2023] [Accepted: 07/14/2023] [Indexed: 12/05/2023] Open
Abstract
Background The Latarjet procedure is a common procedure for treating critical glenoid bone loss in anterior shoulder instability. Implants such as the screw and cortical button are widely used. The aim of this study was to compare studies on screw versus button fixation techniques in the Bristow-Latarjet procedure for anterior shoulder instability in terms of clinical outcomes, union rates, and complications. Methods The PubMed, Scopus, and Embase databases were searched to find comparative studies that reported outcomes of using screw versus button fixation in the Bristow-Latarjet procedure following the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies that directly compared the screw and button fixation techniques and provided postoperative patient-reported outcomes, union rates, or complications were included. The Methodology Index for Non-Randomized Research (MINORS) criteria were used to assess the quality of the included studies. Odds ratios (ORs) were calculated for dichotomous outcomes whereas mean differences were calculated for continuous outcomes. Results Five articles included a total of 877 shoulders. All five studies had level 3 evidence. There was no statistically significant difference between the two techniques using the Walch-Duplay score, visual analog scale for pain, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, range of motion, and graft union rates. However, the button fixation technique had statistically significantly higher recurrence rates than the screw fixation technique (OR, 0.24; 95% confidence interval, 0.10-0.58; p = 0.001). Conclusions The screw fixation technique had statistically significantly lower recurrence rates than the button fixation technique. However, there was no significant difference between screw and button fixation techniques regarding postoperative patient-reported outcomes, range of motion, graft union rates, nerve injury rates, infection rates, and reoperation rates.
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Affiliation(s)
- Napatpong Thamrongskulsiri
- Department of Anatomy, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Danaithep Limskul
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanathep Tanpowpong
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somsak Kuptniratsaikul
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thun Itthipanichpong
- Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Shin SJ, Kim JH, Ahn J. Arthroscopic Latarjet procedure: current concepts and surgical techniques. Clin Shoulder Elb 2023; 26:445-454. [PMID: 37442776 DOI: 10.5397/cise.2022.01396] [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: 11/30/2022] [Accepted: 01/25/2023] [Indexed: 07/15/2023] Open
Abstract
The Latarjet procedure is a surgical procedure that can effectively restore glenohumeral stability, especially in patients with anterior shoulder instability and glenoid bone loss. Many studies have shown comparable clinical outcomes between patients undergoing the arthroscopic Latarjet procedure and those undergoing traditional open methods or other glenohumeral joint stabilization procedures. However, the arthroscopic Latarjet procedure is a challenging technique due to the unfamiliar portal placements, proximity of neurovascular structures, and serious postoperative complications. The arthroscopic Latarjet procedure has not yet been widely applied, and a clear understanding of the anatomical structure and the precise methods is required prior to operation performance. Satisfactory clinical outcomes can be achieved by thorough preoperative planning and proper implant fixation methods.
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Affiliation(s)
- Sang-Jin Shin
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jae Hyung Kim
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jonghyun Ahn
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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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: 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: 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.
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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
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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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Shao Z, Zhao Y, Luo H, Jiang Y, Song Q, Cheng X, Cui G. Clinical and Radiologic Outcomes of All-Arthroscopic Latarjet Procedure With Modified Suture Button Fixation: Excellent Bone Healing With a Low Complication Rate. Arthroscopy 2022; 38:2157-2165.e7. [PMID: 35093498 DOI: 10.1016/j.arthro.2022.01.020] [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: 08/23/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the clinical outcomes and radiologic evaluation of an all-arthroscopic Latarjet procedure with modified button fixation. METHODS Patients who received all-arthroscopic Latarjet procedure with modified suture button fixation between September 2015 to September 2016 were retrospectively reviewed. Indications for surgery were recurrent anterior shoulder dislocation with any 1 of these 3 conditions: glenoid defect >15%, contact-sport athlete, or failure after Bankart repair. Inclusion criteria included cases who received this surgery. Clinical outcomes were evaluated by University of California Los Angeles, ASES and Rowe score with a minimal follow-up of 3 years. Radiologic assessment on 3D computed tomography scan was performed preoperatively and postoperatively at different time points. Complications were also recorded. RESULTS A total of 30 patients were eventually included in this study. The mean follow-up time was 38.0 ± 2.5 months. There were 25 patients who performed contact sports. Of them, 10 patients were without glenoid defect >15% or failed Bankart repair. The remaining 20 patients had glenoid defect >15%, including 2 failed Bankart cases. Ten patients had glenoid defect < 13.5%, and the rest 20 patients had > 13.5%. UCLA, American Shoulder and Elbow Surgeons, and Rowe score significantly improved during follow-up, and the improvement exceeded MCID for all patients. No severe complications were noted. In total, 86.7% of the graft positioning was measured as flush and 13.3% as medial. The bone union rate was 96.7% at 3 months postoperatively and at final follow-up. The remodeling process for the restoration of the normal anatomy of the lower part of glenoid was noted. CONCLUSIONS All-arthroscopic Latarjet with modified suture button fixation can achieve stable fixation of the coracoid, good clinical outcomes (all patients with improvement exceeding MCID), low complications rate. Furthermore, the bone remodeling process contributes to the recovery of the normal anatomy of anteroinferior glenoid. STUDY DESIGN Case series; Level of evidence, 4.
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Affiliation(s)
- Zhenxing Shao
- Department of Sports Medicine, Peking University Third Hospital, Beijing, P.R. China
| | - Yuqing Zhao
- Radiology Department, Peking University Third Hospital, Beijing, P.R. China
| | - Hao Luo
- Department of Sports Medicine, Peking University Third Hospital, Beijing, P.R. China
| | - Yanfang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, P.R. China
| | - Qingfa Song
- Department of Sports Medicine, Peking University Third Hospital, Beijing, P.R. China
| | - Xu Cheng
- Department of Sports Medicine, Peking University Third Hospital, Beijing, P.R. China
| | - Guoqing Cui
- Department of Sports Medicine, Peking University Third Hospital, Beijing, P.R. China.
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Arthroscopic Latarjet Procedure Using FiberTape Cerclage With a Simplified Technique for Suture Passage and Coracoid Fixation. Arthrosc Tech 2022; 11:e1277-e1287. [PMID: 35936836 PMCID: PMC9353334 DOI: 10.1016/j.eats.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/08/2022] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic Latarjet has evolved as a reproducible procedure to address significant anterior glenoid bone loss in recurrent anterior instability of the shoulder joint. While arthroscopic Bankart procedure for anterior shoulder instability has changed from metal anchors to absorbable or soft all-suture anchors to avoid metal-ware and subsequent abrasion in cases of osteolysis or backout, Latarjet procedure, until recently couple of titanium screws were used to fix the coracoid bone to the anterior glenoid. Arthroscopic techniques for Latarjet procedure of coracoid bone transfer have shown results similar to the open technique in many recent studies. We use an all-arthroscopic technique that is different and easier from the currently described technique using FiberTape cerclage loops, with 2 ultrabraid tapes fixing the coracoid bone to the prepared anteroinferior glenoid surface. The repair is completed using all-suture anchors to fix the anterior capsule over the attached coracoid, thus exteriorizing the transferred bone and preventing contact with the moving humeral head.
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Zhang JA, Lam PH, Beretov J, Murrell GAC. A review of bone grafting techniques for glenoid reconstruction. Shoulder Elbow 2022; 14:123-134. [PMID: 35265177 PMCID: PMC8899324 DOI: 10.1177/17585732211008474] [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] [Received: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Traumatic anterior shoulder dislocations can cause bony defects of the anterior glenoid rim and are often associated with recurrent shoulder instability. For large glenoid defects of 20-30% without a mobile bony fragment, glenoid reconstruction with bone grafts is often recommended. This review describes two broad categories of glenoid reconstruction procedures found in literature: coracoid transfers involving the Bristow and Latarjet procedures, and free bone grafting techniques. METHODS An electronic search of MEDLINE and PubMed was conducted to find original articles that described glenoid reconstruction techniques or modifications to existing techniques. RESULTS Coracoid transfers involve the Bristow and Latarjet procedures. Modifications to these procedures such as arthroscopic execution, method of graft attachment and orientation have been described. Free bone grafts have been obtained from the iliac crest, distal tibia, acromion, distal clavicle and femoral condyle. CONCLUSION Both coracoid transfers and free bone grafting procedures are options for reconstructing large bony defects of the anterior glenoid rim and have had similar clinical outcomes. Free bone grafts may offer greater flexibility in graft shaping and choice of graft size depending on the bone stock chosen. Novel developments tend towards minimising invasiveness using arthroscopic approaches and examining alternative non-rigid graft fixation techniques.
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Affiliation(s)
- Jeffrey A Zhang
- George AC Murrell, Orthopaedic Research Institute, Level 2, 4-10 South Street Kogarah, Sydney, NSW 2217, Australia.
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Song Q, Zhang S, Cheng X, Xiao J, Lin L, Liu Q, Shao Z, Cui G. Clinical and Radiographic Outcomes After Arthroscopic Inlay Bristow Surgery With Screw Versus Suture Button Fixation: A Comparative Study of 117 Patients With 3.3-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221076048. [PMID: 35284584 PMCID: PMC8908399 DOI: 10.1177/23259671221076048] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Some studies have advocated the use of suture button fixation during Bristow-Latarjet surgery to reduce complications associated with screw fixation. However, data comparing these fixation methods are relatively incomplete. Purpose: To investigate the efficacy of modified arthroscopic Bristow-Latarjet surgery and compare the clinical and radiographic outcomes using screw versus suture button fixation. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 136 patients with traumatic anterior shoulder instability who underwent the modified arthroscopic Bristow-Latarjet surgery between June 2015 and February 2018. Of these patients, 117 who met the inclusion criteria were enrolled at a mean follow-up of 3.3 ± 0.7 years. Shoulders were separated into 2 groups based on fixation technique: screw fixation (group A; n = 63) or suture button fixation (group B; n = 54). Computed tomography imaging findings and clinical results were assessed preoperatively; immediately after operation; and postoperatively at 3 months, 6 months, 1 year, and final follow-up. Results: There were no significant differences between the groups in terms of postoperative clinical scores, the level of return to sports, range of motion, graft position, or reoperation rates. Bone healing was observed in 97.4% of the cases overall (114/117), with 98.4% bone union in group A and 96.3% in group B at final follow-up. Bone absorption was more common in group A (n = 30; 47.6%) compared with group B (n = 10; 18.5%) (P = .003). There were no hardware-related complications in group B, compared with 7.9% of patients in group A (P = .034). One patient in group B had a recurrent dislocation due to an unexpected event, and there were no recurrent dislocations in group A. Conclusion: After the modified arthroscopic Bristow-Latarjet procedure, both suture button and screw fixation methods demonstrated high bony healing rates and low risk of recurrence. Less coracoid graft resorption and no hardware-related complications were seen with suture button fixation.
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Affiliation(s)
- Qingfa Song
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Shuhan Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xu Cheng
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jian Xiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Lin Lin
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Qiang Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Zhenxing Shao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Guoqing Cui
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
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[Analysis of influencing factors of early pain after arthroscopic rotator cuff repair]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:284-290. [PMID: 35293168 PMCID: PMC8923925 DOI: 10.7507/1002-1892.202111020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the influencing factors that affect early pain after arthroscopic rotator cuff repair. METHODS A clinical data of 592 patients who met the selection criteria and underwent arthroscopic rotator cuff repair between June 2018 and October 2020 were retrospectively analyzed. There were 239 males and 353 females, with an average age of 58.1 years (range, 32-81 years). Before operation and at 3 days, 6 weeks, and 3 months after operation, the pain degree of patients was evaluated by visual analogue scale (VAS) score; and the patients were divided into no pain or mild pain group and moderate to severe pain group according to the postoperative VAS score. Preoperative and intraoperative related factors were included for univariate analysis, including age, gender, body mass index, preoperative VAS score, history of frozen shoulder, history of hypertension, history of diabetes, history of smoking, affected tendons (supraspinatus, infraspinatus, or subscapularis tendon injury), supraspinatus muscle atrophy, fatty infiltration, operation time, degree of rotator cuff tear, number of anchors, and whether to perform acromioplasty. The influencing factors of postoperative pain were screened; further logistic regression was used to conduct multivariate analysis to screen for risk factors. RESULTS Moderate to severe pain occurred in 440 patients (74.3%) at 3 days after operation, 382 patients (66.2%) at 6 weeks, and 141 patients (23.8%) at 3 months. Multivariate analysis showed that the women, partial-thickness rotator cuff tear, and acromioplasty were risk factors for pain at 3 days after operation ( P<0.05); the women, combined with fatty infiltration, partial-thickness rotator cuff tear, and acromioplasty were the risk factors at 6 weeks ( P<0.05); and the women, combined with fatty infiltration, and partial-thickness rotator cuff tear were risk factors at 3 months ( P<0.05). CONCLUSION Among patients undergoing arthroscopic rotator cuff repair, women, those with smaller rotator cuff tears, combined with fatty infiltration, and acromioplasty have more severe pain within 3 months after operation, and attention should be paid to postoperative analgesia in these patients management, providing an individualized approach to rehabilitation, and closer follow-up.
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Anterior Shoulder Instability Part II-Latarjet, Remplissage, and Glenoid Bone-Grafting-An International Consensus Statement. Arthroscopy 2022; 38:224-233.e6. [PMID: 34332052 DOI: 10.1016/j.arthro.2021.07.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to establish consensus statements via a modified Delphi process on the Latarjet procedure, remplissage, and glenoid-bone grafting for anterior shoulder instability. METHODS A consensus process on the treatment utilizing a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability. RESULTS The technical approaches identified in the statements on the Latarjet procedure and glenoid bone-graft were that a subscapularis split approach should be utilized, and that it is unclear whether a capsular repair is routinely required. Furthermore, despite similar indications, glenoid bone-grafting may be preferred over the Latarjet in patients with bone-loss greater than can be treated with a coracoid graft, and in cases of surgeon preference, failed prior Latarjet or glenoid bone-grafting procedure, and epilepsy. In contrast, the primary indications for a remplissage procedure was either an off-track or engaging Hill-Sachs lesion without severe glenoid bone loss. Additionally, in contrast to the bone-block procedure, complications following remplissage are rare, and loss of shoulder external rotation can be minimized by performing the tenodesis via the safe-zone and not over medializing the fixation. CONCLUSION Overall, 89% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were the prognostic factors that are important to consider in those undergoing a glenoid bone-grafting procedure including age, activity level, Hill-Sachs Lesion, extent of glenoid bone-loss, hyperlaxity, prior surgeries, and arthritic changes. Furthermore, there was unanimous agreement that it is unclear whether a capsular repair is routinely required with a glenoid bone graft, but it may be beneficial in some cases. There was no unanimous agreement on any aspect related to the Latarjet procedure or Remplissage. LEVEL OF EVIDENCE Level V, expert opinion.
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Arthroscopic "Double-Inlay" Eden-Hybinette Procedure with Modified Suture Button Fixation for the Revision of Failed Bristow-Latarjet. Arthrosc Tech 2021; 10:e2619-e2625. [PMID: 35004140 PMCID: PMC8719054 DOI: 10.1016/j.eats.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/05/2021] [Indexed: 02/03/2023] Open
Abstract
Bristow-Latarjet procedure has been widely regarded as a reliable and satisfactory operation for recurrent anterior glenohumeral instability, especially for patients with significant glenoid bone loss or high sports demand. Once failed, however, the subsequent revision surgery could be challenging. Eden-Hybinette procedure is the most common operation for revision of failed Bristow-Latarjet. It can perfectly restore the bone defect of the failed Bristow-Latarjet by harvesting a proper size of iliac bone block. Furthermore, several studies have shown the advantages of using suture button fixation in the revision surgery for failed Bristow-Latarjet procedure. However, the potential inferior biomechanical strength of suture button fixation is still a concern. This Technical Note introduced an arthroscopic "double-inlay" Eden-Hybinette procedure with modified suture button fixation for the revision of failed Bristow-Latarjet. With its "quadruple" reinforcement effect, this procedure can achieve an excellent biomechanical strength of fixation.
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Short-term complications of the Latarjet procedure: a systematic review. J Shoulder Elbow Surg 2021; 30:1693-1699. [PMID: 33607332 DOI: 10.1016/j.jse.2021.01.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the short-term complication rate following the open and arthroscopic Latarjet procedures and to meta-analyze the studies comparing the 2 approaches. METHODS PubMed was searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to find clinical and biomechanical studies comparing complication rates in open and arthroscopic Latarjet procedures. A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the PRISMA guidelines. Clinical studies reporting on the complications following the open or arthroscopic Latarjet were included. Meta-analysis was performed for comparative studies using Review Manager, version 5.3. A P value of <.05 was considered statistically significant. RESULTS Overall, 89 studies (Level of Evidence [LOE] I: 2, LOE II: 2, LOE III: 24, LOE IV: 61) met inclusion criteria, with 7175 shoulders. Following the open Latarjet procedure, the overall complication rate was 6.1%, with a 1.9% occurrence of graft-related complications, 1.1% hardware, 1.1% wound, 0.9% nerve, and 1.2% other complications. Following the arthroscopic Latarjet procedure, the overall complication rate was 6.8%, with a 3.2% occurrence of graft-related complications, 1.9% hardware, 0.5% wound, 0.7% nerve, and 0.5% other complications. Complications were reported in 7 studies comparing 379 patients treated with the open Latarjet and 531 treated with the arthroscopic Latarjet, with no statistically significant difference between the two (P = .81). CONCLUSION Our study established that the overall complication rate following the Latarjet procedure was 6%-7%, with the most common complication being graft-related. Furthermore, based on the current evidence, there is no significant difference in the complication rate between the open and arthroscopic Latarjet procedures.
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No difference in 90-day complication rate following open versus arthroscopic Latarjet procedure. Knee Surg Sports Traumatol Arthrosc 2021; 29:2333-2337. [PMID: 33025054 DOI: 10.1007/s00167-020-06301-0] [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: 06/30/2020] [Accepted: 09/21/2020] [Indexed: 02/08/2023]
Abstract
The purpose of this study was to compare the 90-day complication rate between the open and arthroscopic Latarjet procedure. A retrospective review of patients who underwent an open or arthroscopic Latarjet procedure at NYU Langone Health between 2012 and 2019 was performed. The complications, readmissions, and reoperations within 90 days were assessed. Outcomes were compared between the two approaches, and a p value of < 0.05 was considered to be statistically significant. The study included 150 patients (open: 110; arthroscopic: 40), with no patients lost to follow-up within the first 90 days. Both cohorts were similar in terms of patient demographics. No intra-operative complications were observed in either group. Overall, there were 4 post-operative complications with the open approach and 2 with the arthroscopic approach (3.6% and 5.0%, respectively; n.s.) during the study period. Three patients required a readmission within the 90-day period; one patient in both groups required a revision Latarjet for graft fracture, and one patient in the open Latarjet required irrigation and debridement for deep infection (n.s.). With the open approach, there were 2 (2.3%) wound complications, 1 graft complication, and 1 (1.1%) nerve injury. With the arthroscopic approach, there was 1 (2.8%) wound complication and 1 (2.8%) hardware complication. The safety, and 90-day complication and readmission profile of arthroscopic Latarjet is similar to open Latarjet procedure. LEVEL OF EVIDENCE: Level III.
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Sharareh B, Edwards TB, Shah A, Shybut T. Variation in technique and postoperative management of the Latarjet procedure among orthopedic surgeons. J Shoulder Elbow Surg 2021; 30:e157-e164. [PMID: 32763383 DOI: 10.1016/j.jse.2020.07.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Latarjet procedure has become a treatment of choice for glenohumeral instability in the setting of large glenoid osseous defects (>20%) and for prior failed soft tissue repairs. However, surgical techniques and postoperative rehabilitation protocols vary among expert shoulder surgeons. The purpose of this survey study was to characterize the variation in current practice patterns among fellowship-trained orthopedic shoulder surgeons and identify factors related to variation. METHODS A 9-question survey was created (SurveyMonkey, San Mateo, CA, USA) and distributed to orthopedic surgeons who are active members of the American Shoulder and Elbow Surgeons or American Orthopaedic Society for Sports Medicine. The survey asked questions regarding surgeon experience with the Latarjet procedure, fellowship training, open vs. arthroscopic approach, method of coracoid-to-glenoid fixation, period of sling use postoperatively, and time before clearance to return to sport. Subgroup analysis was performed to determine whether further variation was evident between surgeons who completed sports medicine vs. shoulder and elbow fellowship training. RESULTS In total, 242 surgeons completed the survey. Of these, 55% indicated performing a sports medicine fellowship and 39% indicated completing a shoulder and elbow fellowship. Among all surgeons, the classic open Latarjet procedure was the strongly preferred technique (79%), followed by the open congruent-arc (17%) and all-arthroscopic (3%) techniques. With respect to fixation, 98% used screw fixation and only 1% indicated cortical button use. With respect to the postoperative course, >85% of surgeons preferred immobilization for 3-6 weeks after the procedure and 42% of respondents stated they waited ≥6 months prior to clearing their patients to return to sport. Subgroup analysis revealed that surgeons who completed a shoulder and elbow fellowship performed the classic open technique 89% of the time compared with 63% of those who completed a sports medicine fellowship (P < .001). CONCLUSION The results of our survey study indicate an overall strong preference for the open classic Latarjet technique as well as an overall strong preference for screw fixation of the coracoid graft to the glenoid among all surgeons. Shoulder and elbow fellowship-trained surgeons are significantly more likely to perform open surgery with a classic technique compared with sports medicine fellowship-trained surgeons. Furthermore, the significant variation in postoperative sling use and return to sport suggests that further research is needed to develop an evidence-based postoperative Latarjet rehabilitation protocol.
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Affiliation(s)
- Behnam Sharareh
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - T Bradley Edwards
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
| | - Anup Shah
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Theodore Shybut
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
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Hachem AI, Rondanelli S R, Rius X, Barco R. Latarjet Cerclage: The All-Arthroscopic Metal-Free Fixation. Arthrosc Tech 2021; 10:e437-e450. [PMID: 33680777 PMCID: PMC7917201 DOI: 10.1016/j.eats.2020.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/18/2020] [Indexed: 02/03/2023] Open
Abstract
The Bristow-Latarjet procedure has been one of the most recognized procedures for the treatment of recurrent shoulder dislocation with anterior glenoid bone loss, revision surgery after failed Bankart repair, contact and collision sport injuries, and patients with a high risk of recurrence. Open and arthroscopic approaches have recently shown similar outcomes by several authors. However, complications related to metal implants, despite being low, are still a matter of concern. We describe an all-arthroscopic Latarjet technique with a metal-free fixation method using 2 ultra-high-strength sutures, creating a cerclage construct through 2.4mm glenoid and coracoid tunnels with a final capsulolabral complex reconstruction.
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Affiliation(s)
- Abdul-ilah Hachem
- Shoulder Unit, Department of Orthopaedic and Trauma Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain,Address correspondence to Abdul-ilah Hachem, M.D., C/ Feixa Llarga S/ N Hospital de Bellvitge Pl. 10 Traumatology and Orthopedic Secretary, Hospital Universitari de Bellvitge (L’Hospitalet de Llobregat), Barcelona, Spain 08907.
| | - Rafael Rondanelli S
- Shoulder Unit, Department of Orthopaedic and Trauma Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Xavi Rius
- Shoulder Unit, Department of Orthopaedic and Trauma Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Raúl Barco
- Shoulder and Elbow Unit, Department of Orthopaedic and Trauma Surgery, Hospital Universitario la Paz, Madrid, Spain
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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: 8] [Impact Index Per Article: 2.0] [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.
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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
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Hachem AI, Costa D’O G, Rondanelli S R, Rius X, Barco R. Latarjet Cerclage: The Metal-Free Fixation. Arthrosc Tech 2020; 9:e1397-e1408. [PMID: 33024683 PMCID: PMC7528757 DOI: 10.1016/j.eats.2020.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/29/2020] [Indexed: 02/03/2023] Open
Abstract
The Latarjet technique is a widely used technique for anterior shoulder instability with glenoid bone defects, irreparable capsuloligamentous lesion, or in patients at greater risk of recurrence. The use of this technique has been reported to obtain satisfactory clinical and biomechanical results. Although other methods exist, the coracoid process is typically fixed with 2 metal screws. Complications related to metal fixation are very frequently reported. In an attempt to avoid these complications, we developed this arthroscopically assisted metal-free Latarjet technique in which we fix a coracoid graft using four cerclage tapes to achieve a strong, stable fixation, thus mimicking a plate.
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Affiliation(s)
- Abdul-ilah Hachem
- Department of Orthopedic and Traumatology Surgery, Hospital Universitari de Bellvitge (L'Hospitalet de Llo bregat), Barcelona, Spain,Address correspondence to Abdul-ilah Hachem, M.D., C/ Feixa Llarga S/ N Hospital de Bellvitge Pl. 10 Traumatology and Orthopedic Secretary, Hospital Universitari de Bellvitge (L’Hospitalet de Llobregat), Barcelona, Spain 08907.
| | - Gino Costa D’O
- University of Barcelona Shoulder Surgery Master Fellowship, Hospital Universitari de Bellvitge (L’Hospitalet de Llo bregat), Barcelona, Spain
| | - Rafael Rondanelli S
- University of Barcelona Shoulder Surgery Master Fellowship, Hospital Universitari de Bellvitge (L’Hospitalet de Llo bregat), Barcelona, Spain
| | - Xavier Rius
- Department of Orthopedic and Traumatology Surgery, Hospital Universitari de Bellvitge (L'Hospitalet de Llo bregat), Barcelona, Spain
| | - Raúl Barco
- Department of Orthopedic and Traumatology Surgery, Hospital Universitari de Bellvitge (L'Hospitalet de Llo bregat), Barcelona, Spain
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