Identification of a Remodeled Neo-tendon After Arthroscopic Latarjet Procedure

Effect of Modified Arthroscopic Latarjet on Acromiohumeral Distance at 5-Year Follow-up

Background:

It is unclear whether coracoacromial ligament release during the Latarjet procedure will increase superior translation of the shoulder joint.

Purpose:

To evaluate whether a modified suture button Latarjet procedure can decrease the acromiohumeral distance (AHD).

Study Design:

Case series; Level of evidence, 4.

Methods:

A retrospective analysis was conducted among 155 patients who underwent a modified suture button Latarjet procedure between 2013 and 2015. AHD was measured on bilateral computed tomography scans taken preoperatively and on scans of the affected shoulder taken on postoperative day 1 and postoperative month (POM) 6, POM 36, and POM 60. At each time point, we recorded pain on a visual analog scale (VAS) and objective shoulder function using the American Shoulder and Elbow Surgeons, Rowe, and Walch-Duplay scores. Preoperative and final follow-up VAS and functional scores were compared using the paired t test. Pairwise comparison of AHD values at each follow-up time point were compared with the preoperative intact side using the paired t test. Intra- and interobserver reproducibility of the AHD measurements was evaluated using the intraclass correlation coefficient.

Results:

A total of 104 patients who met the criteria completed the final follow-up, which occurred at 62.6 ± 2.4 months (mean ± SD). When compared with presurgery, the VAS and all functional scores improved significantly at the last follow-up (P < .001 for all). Intra- and interobserver intraclass correlation coefficients indicated good reliability for the ADH measurements. Preoperatively, there were no differences in AHD values between the intact and affected shoulders (7.8 ± 0.8 mm for both; P = .851). The AHD values at postoperative day 1 and POM 6, POM 36, and POM 60 were 9.6 ± 0.7 mm, 8.6 ± 0.9 mm, 8.0 ± 0.8 mm, and 7.9 ± 0.8 mm, respectively, all of which were larger than those of the preoperative intact side (P < .001 for all).

Conclusion:

The modified suture button Latarjet procedure not only offered satisfactory therapeutic effects but also did not decrease the AHD at 5-year follow-up.

Arthroscopic All-Intra-articular Revision Eden-Hybinette Procedure for Recurrent Instability After Coracoid Transfer

Failure, in the form of recurrent shoulder instability, following a coracoid transfer procedure presents a challenging problem. Successful treatment with a revision Eden-Hybinette procedure, by both an open and arthroscopic approach using screws to secure the bone graft, has previously been reported. However, both the open and arthroscopic approach have required careful dissection through the distorted soft-tissue anatomy in the anterior compartment in front of subscapularis to gain access to the front of the glenoid through a muscle split. In this article, we describe a modification of an arthroscopic Eden-Hybinette technique that is undertaken intra-articularly and only requires portals through the rotator interval. This technique avoids having to undertake any extra-articular dissection in the anterior compartment and can address potential problems with retained metalwork and pre-existing anchor voids within the glenoid. In this Technical Note, we describe and highlight the pearls and pitfalls of an all-intra-articular arthroscopic revision Eden-Hybinette procedure.

Editorial Commentary: Arthroscopic Latarjet Shoulder Stabilization: Where Are We? Where Are We Going?

Arthroscopic Latarjet procedure has shown satisfactory clinical outcomes in the treatment of anteroinferior shoulder instability. Although as of today there is no proven advantage of the arthroscopic procedure over an open one, it is too early to give up. At the same time, crucial to understand the causes of failure, to find the solutions to every single difficulty to simplify this surgery and to make it as accessible as possible.

Editorial Commentary: The Ever-Revealing Role of the Arthroscope-Arthroscopic Latarjet Procedure

The treatment of instability continues to evolve, and the Latarjet procedure performed arthroscopically epitomizes the complexity of shoulder procedures that can be accomplished in such a manner. Clinical and surgical observations will continue to spur further research.