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Delgado C, Valencia M, Martínez-Catalán N, Calvo E. Management of the failed Latarjet procedure. J Shoulder Elbow Surg 2024:S1058-2746(24)00325-2. [PMID: 38735635 DOI: 10.1016/j.jse.2024.03.045] [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: 01/23/2024] [Revised: 03/17/2024] [Accepted: 03/25/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND To analyze the causes of failure after a Latarjet procedure and to evaluate the results of revision surgery. METHODS Single-cohort, retrospective, observational study. Fifteen patients (13 males, mean age at revision failed Latarjet 38.9 years [range, 20-57]) with anterior glenohumeral instability who underwent a revision surgery for a failed Latarjet procedure were reviewed. Failure was defined as subluxation or dislocation. Demographic features, the reason for failure, type of lesions observed, and postoperative clinical and functional status were recorded. Functional status was assessed with the Rowe score. Subjective clinical evaluation was performed using the Western Ontario Shoulder Instability Index (WOSI) and Subjective Shoulder Value (SSV). RESULTS Recurrence occurred in the first year following the Latarjet procedure in 11 patients (73.3%). The causes of failure were graft avulsion in 3 cases, fracture in 1, coracoid misposition in 2 cases, graft nonunion in 1, advanced osteolysis in 4 cases, and persistence of an off-track Hill-Sachs lesion in 1. In 3 cases, no identifiable cause of failure but generalized severe hyperlaxity was found. Regarding revision surgery after the Latarjet procedure, 8 patients underwent an arthroscopic Eden-Hybinette procedure and in 3 patients the graft was repositioned. In the remaining 4 patients, an extra-articular capsular reinforcement was performed. Regarding the latter, 1 patient suffered new dislocations and required an additional revision surgery consisting of an Eden-Hybinette procedure. All patients remained stable after the revision surgery at the latest follow-up, except 2 who reported subluxations after an arthroscopic Eden-Hybinette and an extra-articular capsular reinforcement, but no additional surgical procedure was required. Functional status after revision surgery was satisfactory, with a mean Rowe score of 78 (10-100), WOSI score of 829 (225-1425), and an SSV score of 67 points (40-90). CONCLUSION The causes of failure after a Latarjet procedure were poor bone graft due to mispositioning, avulsion, fracture or resorption, generalized hyperlaxity, and incomplete restoration of the glenoid track. Our study demonstrates that when the cause of failure is identified and addressed, stability is restored, and clinical and functional scores improved.
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Affiliation(s)
- Cristina Delgado
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Maria Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Natalia Martínez-Catalán
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
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Orgiu A, Boukebous B, Bouhali H, Riou P, Rousseau MA, Boyer P. Faster strength recovery and better strength ratio with arthroscopic Latarjet compared to the open technique: An observational study. Orthop Traumatol Surg Res 2024; 110:103815. [PMID: 38246492 DOI: 10.1016/j.otsr.2024.103815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The arthroscopic bone block has shown reliability and reproducibility regarding functional scores and shoulder mobility compared to the open bone block technique. The recovery of muscle strength, especially the strength ratio external rotator/internal rotator (ER/IR), is crucial to recovering satisfactory function. This ratio should be as near to 1 as possible, meaning a good strength balance. Little is known about the difference in strength recovery between the open and arthroscopic techniques. HYPOTHESIS Arthroscopic Latarjet reduces surgical stress and improves the strength recovery and strength ratio. OBJECTIVES To compare arthroscopic and open Latarjet procedures for shoulder muscle strength and functional outcomes. MATERIAL AND METHODS It was an observational longitudinal and prospective cohort follow-up. Two groups of patients were accessible for comparison: 35 in an arthroscopy group and 38 in an open group. The main outcome was the muscle strength of shoulder muscles measured with a dynamometer and expressed in Newton (N) at day 21 (D21), D45, D90, D180, and D365 in the operated and contralateral shoulders. The measurements were made for the pectoralis major, the three deltoid fascicles, and the subscapularis. The shoulder ER/IR strength ratio was calculated. Other variables were the range of motion (ROM), the Walch-Duplay (WD), the Western Ontario Shoulder Instability score (WOSI), and the Visual Analogic Scale for pain assessment. The strength, ROM, and functional scores were compared between open and arthroscopy with linear mixed models. RESULTS The median strengths at 52 weeks were significantly higher than at 3 weeks (P<10-4): anterior deltoid (AD) 8N (Q1:7, Q3: 9) versus 4N (Q1:2, Q3: 5), lateral deltoid (LD) 9N (Q1:9, Q3: 11) versus 6N (Q1:4, Q3: 7), posterior deltoid (PD) 14N (Q1:12, Q3: 15) versus 9N (Q1:8, Q3: 10), subscapularis 10N (Q1:9, Q3: 12) versus 7N (Q1:5, Q3: 8), and pectoralis major (PM) 11N (Q1:9, Q3: 12) versus 7N (Q1:5, Q3: 10). The overall strengths were lower in the open group compared to the arthroscopy group: AD -2.1N (CI95%[-3.1--1.2], p=0.0005), LD -1.3N (CI95% [-2.4--0.15], p=0.03), PD -0.35N (CI95% [-1-0.9], p=0.52), subscapularis -2.1N (CI95% [-3.3--0.7], p=0.006), and PM -1.4N (CI95% [-2.2--0.02], p=0.03). The ER/IR ratio was stable throughout the follow-up for both the operated and contralateral shoulders (p>0.5). The overall mean ratio was 1.3 (median 1.2, Q1: 1, Q3:1.45) for the operated shoulder and 1.1 (median 1, Q1: 0.9, Q3:1.3) for the contralateral shoulder (p=0.0004). The average ER/IR ratio was 0.27 points higher in the open group (CI95% [0.1-0.46], p=0.003). The ROM was similar between the two groups, and there was no correlation between the ER/IR ratio and the ROM (p>0.5). The VAS < 3 weeks and WD > 12 weeks were significantly poorer in the open group: +0.61 (CI95% [0.03-1.16] p=0.02), and -7.3 points (CI95% [-13--0.01], p=0.05), on average, respectively. CONCLUSION The patients in the arthroscopy group had a better ER/IR strength ratio (closer to 1) and better WOSI after 12 weeks. The strength and the ROM were not correlated with each other. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Antoni Orgiu
- Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, Université Paris Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - Baptiste Boukebous
- Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, Université Paris Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France; Université Paris Cité, Équipe ECAMO, CRESS (Centre of Research in Epidemiology and Statistics), INSERM, UMR 1153, Paris, France.
| | - Haroun Bouhali
- Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, Université Paris Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - Pierre Riou
- Masseur kinésithérapeute, 750018 Paris, France
| | - Marc-Antoine Rousseau
- Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, Université Paris Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - Patrick Boyer
- Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, Université Paris Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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Wang D, Ni J, Wang D, Wei W, Li R, Feng M, Shi Z. Arthroscopic Autologous Iliac Bone Grafting With Double-Row Elastic Fixation and Double Antirotating Anchors for Recurrent Anterior Shoulder Dislocation With Massive Glenoid Bone Defect. Arthrosc Tech 2024; 13:102961. [PMID: 38835459 PMCID: PMC11144960 DOI: 10.1016/j.eats.2024.102961] [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: 10/31/2023] [Accepted: 01/16/2024] [Indexed: 06/06/2024] Open
Abstract
The management of recurrent anterior shoulder dislocations with massive glenoid bone defects typically involves arthroscopic intervention. Autologous iliac bone grafting with double-row elastic fixation reportedly yields excellent outcomes. In this article, we introduce a specialized technique for iliac bone grafting that uses double-row elastic fixation and double antirotating anchors. Implementation of this technique prevents the occurrence of iliac graft rotation.
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Affiliation(s)
- Dazhi Wang
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
| | - Jianlong Ni
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
| | - Dongjian Wang
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
| | - Wang Wei
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
| | - Ruiying Li
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
| | - Meng Feng
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
| | - Zhibin Shi
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
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Baur A, Satalich J, O'Connell R, Vap A. Surgical management of recurrent instability following Latarjet procedure - A systematic review of salvage procedures. Shoulder Elbow 2024; 16:24-32. [PMID: 38435040 PMCID: PMC10902410 DOI: 10.1177/17585732231226123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 03/05/2024]
Abstract
Background Failed Latarjet procedures pose a surgical challenge due to complex anatomical issues. This systematic review investigates salvage techniques for recurrent instability following a Latarjet procedure. Methods A search was conducted on MEDLINE and PubMed Central following the methodology registered to International Prospective Register of Systematic Reviews. Inclusion criteria focused on identifying revision procedures following a Latarjet procedure. Exclusion criteria filtered out irrelevant studies, such as those focused on Bankart procedures. After a multistage selection process, 10 eligible studies were included for data extraction. Results The most frequently utilized technique for salvage was variations of the Eden-Hybinette procedure. Complications associated with these salvage procedures include graft-related problems and donor site morbidity. Patients reported significant improvements in multiple patient-reported outcome scores, and multiple studies indicated high rates of return to sports activities. However, it is noteworthy that there remains an average recurrence rate of 7%. Discussion The review emphasizes the limited therapeutic options available largely due to shoulder anatomy alterations. Despite promising trends in patient-reported outcomes, recurrence remains possible post-salvage surgeries. Conclusion Addressing recurrent instability after a Latarjet procedure continues to be a unique surgical challenge. However, this systematic review highlights encouraging indications, with positive trends evident in patient-reported outcomes.
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Affiliation(s)
- Alexander Baur
- Liberty University College of Osteopathic Medicine, Lynchburg, VA, USA
| | - James Satalich
- PGY-5, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Robert O'Connell
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Alexander Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Alkhelaifi K, Alzobi OZ, Mahmoud SA, Zikria BA. Recurrent Instability after the Latarjet Procedure. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202312000-00001. [PMID: 38011051 PMCID: PMC10664849 DOI: 10.5435/jaaosglobal-d-23-00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023]
Abstract
The Latarjet procedure is a favored approach for managing chronic and recurrent dislocation, especially in the presence of bone loss. Although generally yielding excellent results, the procedure carries a 15 to 30% complication rate. Although recurrent instability is a major concern, various complications such as infection, nerve injuries, and hardware impingement can also necessitate revision after a Latarjet procedure. Strategies for addressing this issue include glenoid bone grafting, using autogenous bone grafts from the iliac crest or distal clavicle, and allografts, with fresh lateral distal tibial allografts offering advantages because of their osteochondral nature. In addition, soft-tissue procedures offer another solution for recurrent instability, suitable for patients lacking substantial bone loss or those experiencing multidirectional instability. This review aims to provide a comprehensive overview of the causes and management strategies for recurrent instability following a failed Latarjet procedure.
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Affiliation(s)
- Khalid Alkhelaifi
- From the Orthopaedic Surgeon, Aspetar-Qatar Orthopaedic and Sports Medicine Hospital, Qatar (Dr. Alkhelaifi and Dr. Zikria), and the Department of Orthopeadic (Dr. Alzobi and Dr. Mahmoud), Hamad General Hospital, Qatar
| | - Osama Z. Alzobi
- From the Orthopaedic Surgeon, Aspetar-Qatar Orthopaedic and Sports Medicine Hospital, Qatar (Dr. Alkhelaifi and Dr. Zikria), and the Department of Orthopeadic (Dr. Alzobi and Dr. Mahmoud), Hamad General Hospital, Qatar
| | - Shady A. Mahmoud
- From the Orthopaedic Surgeon, Aspetar-Qatar Orthopaedic and Sports Medicine Hospital, Qatar (Dr. Alkhelaifi and Dr. Zikria), and the Department of Orthopeadic (Dr. Alzobi and Dr. Mahmoud), Hamad General Hospital, Qatar
| | - Bashir A. Zikria
- From the Orthopaedic Surgeon, Aspetar-Qatar Orthopaedic and Sports Medicine Hospital, Qatar (Dr. Alkhelaifi and Dr. Zikria), and the Department of Orthopeadic (Dr. Alzobi and Dr. Mahmoud), Hamad General Hospital, Qatar
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Pugliese M, Loppini M, Vanni E, Longo GU, Castagna A. Cost-effectiveness analysis of arthroscopic Bankart repair versus open Latarjet reconstruction in anterior shoulder instability. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05736-7. [PMID: 36973428 DOI: 10.1007/s00264-023-05736-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/13/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE The ideal surgical treatment for anterior shoulder instability is still under debate. In the healthcare setting, both clinical and economic factors must be considered for optimal resource allocation. From the clinical perspective, the Instability Severity Index Score (ISIS) is a helpful and validated tool for surgeons, although a gray area between 4 and 6 exists. In fact, patients with an ISIS < 4 and > 6 can be treated effectively with arthroscopic Bankart repair and open Latarjet, respectively. The purpose of this study was to conduct a cost-effectiveness analysis of arthroscopic Bankart repair versus open Latarjet in patients with an ISIS between 4 and 6. METHODS A decision-tree model was constructed to simulate the clinical scenario of an anterior shoulder dislocation patient with an ISIS between 4 and 6. Based on previously published literature, outcome probabilities and utility values in the form of Western Ontario Instability Score (WOSI) were assigned to each branch of the tree, alongside institutional cost. The primary outcome assessed was an Incremental cost-effectiveness ratio (ICER) of the two procedures. Eden-Hybbinette was also considered in the model as a salvage procedure for failed Latarjet. A two-way sensitivity analysis was performed to identify the most impactful parameters on the ICER upon their variation within a pre-determined interval. RESULTS Base case cost was 1245.57 € (1220.48-1270.65 €) for arthroscopic Bankart repair, 1623.10 € (1580.82-1665.39 €) for open Latarjet and 2.373.95 € (1940.81-2807.10 €) for Eden-Hybbinette. Base-case ICER was 9570.23 €/WOSI. Sensitivity analysis showed that the most impactful parameters were the utility of arthroscopic Bankart repair, the probability of success of open Latarjet, the probability of undergoing surgery after post-operative recurrence of instability and the utility of Latarjet. Of these, utility of arthroscopic Bankart repair and Latarjet had the most significant impact on the ICER. CONCLUSION From a hospital perspective, open Latarjet was more cost-effective than arthroscopic Bankart repair in preventing further shoulder instability in patients with an ISIS between 4 and 6. Despite its several limitations, this is the first study to analyze this subgroup of patients from a European hospital setting from both an economic and clinical perspective. This study can help surgeons and administrations in the decision-making process. Further clinical studies are needed to prospectively analyze both aspects to further delineate the best strategy.
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Affiliation(s)
- Mattia Pugliese
- Trauma & Orthopaedics Department, Ospedale Maggiore C.A. Pizzardi, Bologna, Italy.
| | - Mattia Loppini
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Elena Vanni
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Giuseppe Umile Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Alessandro Castagna
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Clinical and Research Center, Humanitas University, IRCCS, HumanitasRozzano, Milan, Italy
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7
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Rutgers C, Verweij LPE, Schuit AA, Sierevelt IN, Jamaludin FS, van der Woude HJ, van den Bekerom MPJ. High resorption rates following glenoid augmentation procedures do not seem to lead to higher recurrence rates or worse clinical outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07267-x. [PMID: 36515733 DOI: 10.1007/s00167-022-07267-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] [Received: 09/20/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Bone augmentation techniques show a relatively high complication rate, which might be due to graft non-union and resorption. It is unclear which augmentation techniques demonstrate the highest amount of non-union and resorption and whether this leads to worse clinical or functional outcomes. Therefore, the aim of this review was (i) to compare non-union and resorption rates between surgical approaches, procedures, graft types, donor sites and fixation methods regarding clinical and functional outcomes and (ii) determine whether high non-union or resorption rates lead to less favorable clinical or functional outcomes. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements were followed. PubMed, EMBASE (Ovid) and Cochrane Library were searched on December 15th 2021 for studies examining bone graft non-union or resorption using radiograph or CT following glenoid augmentation to treat anterior shoulder dislocation. RESULTS The search resulted in 103 inclusions, comprising 5,128 glenoid augmentations. When comparing pooled proportions of bony union, graft fracture rate, hardware failure rate, recurrence rate, return to sports and Rowe score, most results were similar between approaches, procedures, graft types, donor sites and fixation methods. High resorption rates were seen for allograft augmentation (74.3; 95% CI: 39.8-92.7) compared to autograft augmentation (15.5; 95% CI 10.1-23.2), but this was not associated with higher recurrence rates or worse clinical outcomes. Meta-analyses (8 studies; 494 patients) demonstrated no difference in incomplete and complete non-union rates between arthroscopic and open procedures; however, both analyses showed substantial heterogeneity. Higher partial resorption rates were observed on CT (48.0; 95% CI 43.3-52.7) compared to radiograph (14.1; 95% CI 10.9-18.1). Three studies comprising 267 shoulders demonstrated a higher rate of non-union and recurrence in smokers, whereas one study comprising 38 shoulders did not. CONCLUSION Non-union and resorption rates were similar among procedures, grafts and fixation methods. Higher resorption rates were observed in allografts, but this was not associated with higher recurrence rates or worse clinical outcomes. Pooling data demonstrated substantial heterogeneity and definitions varied among studies, warranting more standardized measuring. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Cain Rutgers
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. .,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, The Netherlands.
| | - Lukas P E Verweij
- Amsterdam UMC, Location AMC, Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Musculoskeletal Health Program, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Jan Tooropstraat 164, Amsterdam, The Netherlands
| | - Alexander A Schuit
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Xpert Clinics, Laarderhoogtweg 12, Amsterdam, The Netherlands.,Orthopedic Department, Spaarnegasthuis Academy, Spaarnepoort 1, Hoofddorp, The Netherlands
| | - Faridi S Jamaludin
- Amsterdam UMC, Location AMC, Research Support, Medical Library AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Henk-Jan van der Woude
- Shoulder and Elbow Unit, Joint Research, OLVG Hospital, Oosterpark 9, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.,Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Jan Tooropstraat 164, Amsterdam, The Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, The Netherlands
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Chaudhury S, Rupani N, Woolley L, Gwilym S. The management of traumatic shoulder instability. ORTHOPAEDICS AND TRAUMA 2022; 36:159-165. [DOI: 10.1016/j.mporth.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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9
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Huang J, Huang D, Wang J, Ye Z, Liu H. Arthroscopic Subscapularis Augmentation Using the Long Head of the Biceps Tendon for Anterior Shoulder Instability. Arthrosc Tech 2022; 11:e805-e811. [PMID: 35646585 PMCID: PMC9134250 DOI: 10.1016/j.eats.2021.12.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/22/2022] [Indexed: 02/03/2023] Open
Abstract
The limitations of transferring the coracoid process along with the conjoined tendon are coracoacromial arch damage, technical difficulty, and nerve injury. The long head of the biceps tendon (LHBT) proximal transposition technique has a weaker sling effect and a risk of nerve injury. The arthroscopic subscapularis augmentation technique may have risks of shoulder external rotation restriction and subscapularis transection. Herein, we introduce an arthroscopic technique for the transfer of the LHBT for subscapularis augmentation to address these risks. Indications of this technique were patients younger than 45 years of age who engage in competitive sports, require forceful external rotation and abduction, have a related capsule-ligament insufficiency, and have a glenoid bone loss <25%. The steps include detaching the LHBT at the upper edge of the pectoralis major, transecting and braiding the LHBT, establishing a scapular tunnel, placing a guide suture through the upper third of the subscapular and scapular tunnel, passing the LHBT through the established tunnels, and fixating the LHBT. This technique achieves stability of the anterior shoulder by transecting and transferring the distal end of the LHBT to press on the upper third of the subscapularis muscle.
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Affiliation(s)
- Jianming Huang
- Address correspondence to Jianming Huang, M.D., and Haoyuan Liu, M.M., Department of Othopedics, the 73th Group Military Hospital of PLA, NO.94, Wenyuan Rd., Siming District, Xiamen City 361003, Fujian, China.
| | | | | | | | - Haoyuan Liu
- Address correspondence to Jianming Huang, M.D., and Haoyuan Liu, M.M., Department of Othopedics, the 73th Group Military Hospital of PLA, NO.94, Wenyuan Rd., Siming District, Xiamen City 361003, Fujian, China.
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Wei J, Lu M, Zhao L, Zeng X, He L. Free bone grafting improves clinical outcomes in anterior shoulder instability with bone defect: a systematic review and meta-analysis of studies with a minimum of 1-year follow-up. J Shoulder Elbow Surg 2022; 31:e190-e208. [PMID: 34801716 DOI: 10.1016/j.jse.2021.10.023] [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: 10/08/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Evidence on the efficacy and safety of the free bone grafting in treating anterior shoulder instability is limited. The purpose of this study was to systematically evaluate the clinical and imaging results of free bone grafting in treating anterior shoulder instability with glenoid bone defect and to explore the incidence of complications in clinically relevant subgroups. METHODS This systematic review was conducted per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The PubMed, Embase, and Cochrane Library databases were searched up to January 29, 2021, for studies that had reported on free bone grafting in treating anterior shoulder instability with glenoid bone defect with a minimum of 1-year follow-up. Two researchers independently screened studies and extracted data. A random-effects model was used to pool data on clinical function scores, imaging results, and incidence of complications (recurrent instability and non-instability-related complications). Meta-regression analysis was used to evaluate the incidence of complications in different subgroups and investigate the sources of heterogeneity. RESULTS A total of 29 studies were included in the meta-analysis, comprising 840 patients (845 shoulders) with average ages ranging from 21 to 34.6 years. Compared with preoperatively, free bone grafting increased the postoperative Rowe score, American Shoulder and Elbow Surgeons score, Constant score, Subjective Shoulder Value, and Oxford Shoulder Instability Score by 53.16, 31.80, 20.81, 38.63, and 4.07 points, respectively, and reduced the visual analog scale pain score by 3 points on average. During the postoperative follow-up period, the rates of return to sport and return to preoperative levels were 84.2% and 73.1%, respectively. The imaging results showed that the free bone healing rate was 98.9% and the incidence of osteoarthritis was 10.9%. The incidence rates of recurrent instability and non-instability-related complications were 3.4% and 5.6%, respectively. Meta-regression analysis showed no evidence of effect modification by the year, follow-up time, proportion of male patients, autograft or allograft, and arthroscopy or open surgery on the incidence of complications. Subgroup analysis showed that the incidence rates of recurrent instability for open surgery, arthroscopy, allograft, autograft, Latarjet revision, and non-bone block revision were 4.1%, 2.3%, 1.5%, 4.4%, 10.3%, and 3.5%, respectively. CONCLUSION The application of free bone grafting in treating anterior shoulder instability with glenoid bone defect can effectively improve shoulder joint function and is associated with a high return-to-sport rate and a low overall recurrence rate, but there were some differences in the complications of recurrent instability and non-instability-related complications among the subgroups. Given that these results need to be confirmed via head-to-head comparisons, we recommend that future clinical and biomechanical studies focus on comparing and investigating the advantages and disadvantages of different surgical approaches, thus providing a basis for orthopedic surgeons to make reliable choices.
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Affiliation(s)
- Jinqiang Wei
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingfeng Lu
- Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Lilian Zhao
- Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China.
| | - Xianzhong Zeng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lilei He
- Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
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Matache BA, Hurley ET, Wong I, Itoi E, Strauss EJ, Delaney RA, Neyton L, Athwal GS, Pauzenberger L, Mullett H, Jazrawi LM. Anterior Shoulder Instability Part III-Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up-An International Consensus Statement. Arthroscopy 2022; 38:234-242.e6. [PMID: 34332051 DOI: 10.1016/j.arthro.2021.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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 revision surgery, rehabilitation and return to play, and clinical follow-up for anterior shoulder instability. METHODS A consensus process on the treatment using 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 primary relative indications for revision surgery include symptomatic apprehension or recurrent instability, additional intra-articular pathologies, and symptomatic hardware failure. In revision cases, the differentiating factors that dictate treatment are the degree of glenohumeral bone loss and rotator cuff function/integrity. The minimum amount of time before allowing athletes to return to play is unknown, but other factors should be considered, including restoration of strength, range of motion and proprioception, and resolved pain and apprehension, as these are prognostic factors of reinjury. Additionally, psychological factors should be considered in the rehabilitation process. Patients should be clinically followed up for a minimum of 12 months or until a return to full, premorbid function/activities. Finally, the following factors should be included in anterior shoulder instability-specific, patient-reported outcome measures: function/limitations impact on activities of daily living, return to sport/activity, instability symptoms, confidence in shoulder, and satisfaction. CONCLUSION Overall, 92% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were indications and factors affecting decisions for revision surgery, as well as how prior surgeries impact procedure choice. Furthermore, there was unanimous consensus on the role of psychological factors in the return to play, considerations for allowing return to play, as well as prognostic factors. Finally, there was a lack of unanimous consensus on recommended timing and methods for clinical follow-up. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
| | - Eoghan T Hurley
- NYU Langone Health, New York, New York, USA; Sports Surgery Clinic, Dublin, Ireland.
| | - Ivan Wong
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eiji Itoi
- Tohoku University School of Medicine, Sendai, Japan
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12
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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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Buda M, D'Ambrosi R, Bellato E, Blonna D, Cappellari A, Delle Rose G, Merolla G. Failed Latarjet procedure: a systematic review of surgery revision options. J Orthop Traumatol 2021; 22:24. [PMID: 34155563 PMCID: PMC8217356 DOI: 10.1186/s10195-021-00587-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/03/2021] [Indexed: 12/14/2022] Open
Abstract
Background Revision surgery after the Latarjet procedure is a rare and challenging surgical problem, and various bony or capsular procedures have been proposed. This systematic review examines clinical and radiographic outcomes of different procedures for treating persistent pain or recurrent instability after a Latarjet procedure. Methods A systematic review of the literature was performed using the Medline, Cochrane, EMBASE, Google Scholar and Ovid databases with the combined keywords “failed”, “failure”, “revision”, “Latarjet”, “shoulder stabilization” and “shoulder instability” to identify articles published in English that deal with failed Latarjet procedures. Results A total of 11 studies (five retrospective and six case series investigations), all published between 2008 and 2020, fulfilled our inclusion criteria. For the study, 253 patients (254 shoulders, 79.8% male) with a mean age of 29.6 years (range: 16–54 years) were reviewed at an average follow-up of 51.5 months (range: 24–208 months). Conclusions Eden–Hybinette and arthroscopic capsuloplasty are the most popular and safe procedures to treat recurrent instability after a failed Latarjet procedure, and yield reasonable clinical outcomes. A bone graft procedure and capsuloplasty were proposed but there was no clear consensus on their efficacy and indication. Level of evidence Level IV Trial registration PROSPERO 2020 CRD42020185090—www.crd.york.ac.uk/prospero/
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Affiliation(s)
- Matteo Buda
- Division of Orthopaedics and Trauma, Madre Teresa Di Calcutta Hospital, Monselice, Padova, Italy
| | | | - Enrico Bellato
- Department of Surgical Sciences, San Luigi Gonzaga Hospital, University of Turin Medical School, Turin, Italy
| | - Davide Blonna
- Orthopaedic and Traumatology Department, University of Turin Medical School, Turin, Italy
| | - Alessandro Cappellari
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Giacomo Delle Rose
- Shoulder and Elbow Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Merolla
- Shoulder and Elbow Unit, Cervesi Hospital, Cattolica, AUSL Romagna, Cattolica, Italy.,Doctorate School in Clinical and Experimental Medicine, UNIMORE, Modena, Italy
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14
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Mittal R, Jain S. Eden-Hybinette Procedure for Revision Surgery in Recurrent Anterior Shoulder Instability in Epilepsy. Indian J Orthop 2021; 55:728-733. [PMID: 33995880 PMCID: PMC8081779 DOI: 10.1007/s43465-021-00401-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/27/2021] [Indexed: 02/04/2023]
Abstract
AIMS The purpose of this study was to analyze the clinical outcomes after Eden-Hybinette procedure for revision surgery in recurrent anterior shoulder instability in patients with epilepsy. MATERIALS AND METHODS We retrospectively evaluated eight such patients between 2015 and 2018. Four patients had failed Latarjet/Bristow procedure and two had failed arthroscopic Bankart procedure, while two had history of both the procedures. After medical control of epilepsy, Eden-Hybinette procedure was performed in all patients. WOSI score and Rowe shoulder score was recorded preoperatively and in subsequent post-operative follow-up. A paired t test was used to analyze and compare preoperative and postoperative outcomes and was considered significant if p value was < 0.05. RESULTS The average follow-up was 30 months (range 24-48 months). There was no recurrence of shoulder instability. The mean WOSI score before surgery was 77.3 (range 70-83), which improved to 24.2 (range 19-30) at 24-month follow-up. The mean Rowe score before surgery was 11.3 (range 5-15), which improved to 81.8(range 65-90) at 24-month follow-up. The improvement in WOSI and Rowe score was found to be statistically significant [p value < 0.05]. CONCLUSIONS We conclude that Eden-Hybinette is a useful revision procedure to manage recurrent anterior shoulder dislocation in patients with epilepsy. Optimum medical control of seizure is also an important factor in preventing recurrent shoulder instability.
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Affiliation(s)
- Ravi Mittal
- grid.413618.90000 0004 1767 6103Department of Orthopaedics, AIIMS, New Delhi, India
| | - Siddarth Jain
- grid.413618.90000 0004 1767 6103Department of Orthopaedics, AIIMS, New Delhi, India
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Sun Y, Wei Z, Xiang X. [The causes of Latarjet surgery failure and the revision surgeries]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:246-251. [PMID: 33624482 DOI: 10.7507/1002-1892.202005105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the causes of Latarjet surgery failure and various revision surgeries, in order to provide the reference for the revision of treatment options for Latarjet surgery failure. Methods Literature on the causes of Latarjet surgery failure and revision surgeries was extensively reviewed and analyzed. Results Latarjet surgery is widely used in clinical practice for recurrent anterior dislocation of shoulder with glenoid defects, especially for the defects of more than 25%. The main reasons for its failure are ununion, bone resorption, graft dislocation, trauma, and graft fracture, etc. The revision surgeries are diverse, the standard treatment has not yet been formed. The revision surgeries include open iliac bone grafting, microscopic Eden-Hybinette surgery, soft tissue reconstruction, open or arthroscopic bone grafting, etc. The differences among the revisions are mainly reflected in grafts, complications, and their costs. Conclusion Latarjet surgery is difficult to operate and requires high technical requirements for the surgeons. It is necessary to continuously improve the surgical technology to reduce the complications related to Latarjet surgery and its revision surgery.
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Affiliation(s)
- Youqiang Sun
- Institute of Sports Medicine, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Zhihua Wei
- Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Xiaobing Xiang
- Institute of Sports Medicine, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
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