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Anjum I, Ullah U, Fazli Maula A, Haroon H, Ahmad Y, Hassan RE, Shahid K, Hussain S, Haider W, Ullah R. Comparison of the Latarjet Procedure With the Modified Putti-Platt Surgery for Recurrent Anterior Shoulder Dislocation With Respect to Functional Outcome. Cureus 2024; 16:e57270. [PMID: 38686270 PMCID: PMC11056818 DOI: 10.7759/cureus.57270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Shoulder dislocation is the most common injury encountered in orthopedic outpatient department. The choice of procedure depends on the expertise of surgeons. The objective of this study was to compare the Latarjet procedure with the modified Putti-Platt surgery for recurrent anterior shoulder dislocation in terms of functional outcomes. Materials and methods A quasi-experimental study evaluated 60 patients with recurrent anterior shoulder instability. Patients were assigned to either Latarjet or modified Putti-Platt surgery. Functional outcomes were assessed at six months using the Constant-Murley shoulder score. Results This study encompassed 60 patients (mean age: 23.93±5.88 years) undergoing shoulder procedures. Functional outcomes exhibited a majority of 55% excellent, 35% good, 6.7% fair, and 3.3% poor outcomes. No significant differences in functional outcomes were found between the procedures. Conclusion Both procedures may be viable options for recurrent shoulder instability. The choice may depend on patient factors and surgeon preference. Further research is needed to refine techniques and identify ideal candidates.
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Affiliation(s)
- Ihtisham Anjum
- Orthopaedics and Trauma, Khyber Teaching Hospital Medical Teaching Institution (MTI), Peshawar, PAK
| | - Ubaid Ullah
- Orthopaedics and Trauma, Khyber Teaching Hospital Medical Teaching Institution (MTI), Peshawar, PAK
| | - Aimen Fazli Maula
- Emergency Medicine, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, GBR
| | - Hamza Haroon
- Surgery, Ayub Teaching Hospital, Abbottabad, PAK
| | - Yaseen Ahmad
- Surgery, Ayub Teaching Hospital, Abbottabad, PAK
| | - Rao E Hassan
- Orthopaedics and Trauma, Khyber Teaching Hospital Medical Teaching Institution (MTI), Peshawar, PAK
| | - Kashan Shahid
- Orthopaedics and Trauma, Khyber Teaching Hospital Medical Teaching Institution (MTI), Peshawar, PAK
| | - Saddam Hussain
- Orthopaedics and Trauma, Khyber Teaching Hospital Medical Teaching Institution (MTI), Peshawar, PAK
| | - Waseem Haider
- Orthopaedics and Trauma, Khyber Teaching Hospital Medical Teaching Institution (MTI), Peshawar, PAK
| | - Rizwan Ullah
- Orthopaedics and Trauma, Khyber Teaching Hospital Medical Teaching Institution (MTI), Peshawar, PAK
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Hirose T, Tanaka M, Nakai H, Hanai H, Kotani Y, Kuratani K, Hayashida K. Association Between Preoperative Glenoid Bone Loss and Postoperative Outcomes After Coracoid Transfer Combined With Open Bankart Repair: Comparison of the Bristow and Latarjet Techniques. Orthop J Sports Med 2023; 11:23259671231172219. [PMID: 37260581 PMCID: PMC10227879 DOI: 10.1177/23259671231172219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/26/2023] [Indexed: 06/02/2023] Open
Abstract
Background Whether the extent of glenoid bone loss (GBL) affects clinical outcome after coracoid process transfer (CPT) is still unclear. Purpose To evaluate postoperative outcomes after CPT combined with open Bankart repair in young rugby players in terms of the extent of GBL and between the Bristow and Latarjet techniques. Study Design Cohort study; Level of evidence, 3. Methods The authors investigated 101 shoulders in 91 competitive rugby players who underwent CPT combined with open Bankart repair by the Bristow (group B; 66 shoulders) or Latarjet (group L; 35 shoulders) procedure between 2007 and 2017. The extent of GBL was calculated from the en face view of the glenoid on preoperative 3-dimensional computed tomography scans and was used to categorize shoulders into 4 grades (grade 0, 0%; grade 1, >0% and ≤10%; grade 2, >10% and ≤20%; grade 3, >20%). At the minimum 2-year follow-up, the authors analyzed the relationship between GBL or GBL grade and postoperative outcome scores (American Shoulder and Elbow Surgeons score, Rowe score, Western Ontario Shoulder Instability Index, and patient satisfaction), return-to-play (RTP) times, graft failure (insufficient union or translocation), and recurrence. Results The mean GBL in all shoulders was 10.9% ± 9.2% and was not significantly different between the 2 groups. There were no significant correlations between GBL and any outcome measure in either group. The mean RTP time was significantly shorter in group L versus group B (4.8 ± 1.1 vs 5.8 ± 1.8 months, respectively; P = .002), but it was not associated with GBL. In group B, the rate of graft failure was not significantly higher in shoulders with grade 0 or 1 GBL versus grade 2 or 3 GBL (8 [25.0%] vs 4 [11.8%], respectively; P = .21). In group B, graft failure was confirmed in 12 shoulders (18.2%), compared with 1 shoulder (2.9%) in group L. Postoperative recurrence occurred in significantly fewer shoulders in group B than in group L (2 [3.0%] vs 5 [14.3%], respectively; P = .047). Conclusion The extent of GBL did not affect outcome scores after CPT, regardless of operative procedure.
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Affiliation(s)
- Takehito Hirose
- Department of Orthopaedic Surgery,
Daini Osaka Police Hospital, Osaka, Japan
| | - Makoto Tanaka
- Department of Orthopaedic Surgery,
Daini Osaka Police Hospital, Osaka, Japan
- Center for Sports Medicine, Daini Osaka
Police Hospital, Osaka, Japan
| | - Hidekazu Nakai
- Department of Orthopaedic Surgery,
Daini Osaka Police Hospital, Osaka, Japan
| | - Hiroto Hanai
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuki Kotani
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kosuke Kuratani
- Department of Orthopaedic Surgery, JCHO
Osaka Hospital, Osaka, Japan
| | - Kenji Hayashida
- Department of Orthopaedic Surgery,
Osaka Central Hospital, Osaka, Japan
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Calvo E, Delgado C. Management of off-track Hill-Sachs lesions in anterior glenohumeral instability. J Exp Orthop 2023; 10:30. [PMID: 36943508 PMCID: PMC10030712 DOI: 10.1186/s40634-023-00588-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/14/2023] [Indexed: 03/23/2023] Open
Abstract
Bone loss has been identified as a risk factor for recurrent shoulder dislocations or failure after soft tissue repair. Although the range for "critical" bone loss is yet to be determined, glenoid and humeral bone defects should not be regarded as independent problems, but the interaction between them during shoulder motion should be evaluated as suggested by the glenoid track concept. The glenoid track concept is now widely accepted and considered essential for making decisions about surgery. Soft-tissue procedures usually work well in patients with on-track Hill-Sachs lesions but in off-track lesions do not. In this situation additional procedures should be performed.Different surgical options have been described to address off-track Hill-Sachs lesions, most commonly remplissage, Latarjet or free bone block procedures. Coracoid graft and free bone grafts convert the off-track Hill-Sachs lesion into on-track by lengthening the glenoid-track, whereas remplissage fill-in the humeral lesion so that it does not engage. In the setting of a Hill-Sachs lesion with little or no glenoid bone loss, remplissage has demonstrated satisfactory outcomes with a low complications and recurrence rate. Favorable results have been reported with glenoid bone grafting when managing isolated Hill-Sachs or bipolar lesions. Studies analyzing Latarjet and Eden-Hybinette procedures show that both procedures are safe and effective in the management of anterior glenohumeral instability. Attention should be paid to those patients with large bone defects not amenable to be restored with an isolated Latarjet that may be better addressed with an Eden-Hybinnete or adding a remplissage to the Latarjet procedure.
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Affiliation(s)
- Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Hospital Universitario Fundacion Jimenez Diaz, Universidad Autonoma, Avda Reyes Católicos, 2, Madrid, 28040, Spain.
| | - Cristina Delgado
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Hospital Universitario Fundacion Jimenez Diaz, Universidad Autonoma, Avda Reyes Católicos, 2, Madrid, 28040, Spain
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Xu J, Wu C, Han K, Zhang X, Ye Z, Jiang J, Yan X, Su W, Zhao J. Radiological and Histological Analyses of Nonrigid Versus Rigid Fixation for Free Bone Block Procedures in a Rabbit Model of Glenoid Defects. Am J Sports Med 2023; 51:743-757. [PMID: 36752692 DOI: 10.1177/03635465221145695] [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: 02/09/2023]
Abstract
BACKGROUND Nonrigid fixation techniques have been recently introduced in free bone block (FBB) procedures to treat substantial glenoid bone loss in patients with anterior shoulder instability. However, the radiological and histological effectiveness of nonrigid fixation versus conventional rigid fixation have not been comprehensively understood in vivo. PURPOSE To (1) explore the radiological and histological characteristics of nonrigid fixation for FBB procedures in a rabbit model of glenoid defects and (2) further compare them with those of conventional rigid fixation. STUDY DESIGN Controlled laboratory study. METHODS Unilateral shoulder glenoid defects were created in 36 mature New Zealand White rabbits, of which 24 underwent FBB procedures using allogenic iliac crest bone and were randomly divided into rigid fixation (RF) and nonrigid fixation (N-RF) groups, with the remaining divided into 2 control groups: 6 with sham surgery for glenoid defects (GD group) and 6 native glenoids (normal group). In the RF and N-RF groups, 6 rabbits were sacrificed at 6 or 12 weeks postoperatively for radiological and histological analyses of the reconstructed glenoid, and all rabbits in the GD and normal groups were sacrificed at 12 weeks. The radiological glenoid morphology was evaluated via micro-computed tomography. Moreover, the graft-glenoid healing and graft remodeling processes were determined using histological staining. RESULTS At 6 weeks, both the N-RF and RF groups had similarly improved radiological axial radian and en face area of the glenoid compared with the GD group, but the N-RF group showed superiority in restoration of the glenoid radian and area compared with the RF group at 12 weeks, with the native glenoid as the baseline. Histologically, the bone graft in both groups was substantively integrated into the deficient glenoid neck at 6 and 12 weeks, showing similar osseous healing processes at the graft-glenoid junction. Moreover, the bone graft histologically presented similar regenerated vascular density, total graft bone, and integrated graft bone in both groups. In contrast, the N-RF group had a different remodeling profile on radiological and histological analyses regarding regional bone resorption, mineralization, and fibrous tissue replacement during osseointegration. CONCLUSION Compared with rigid fixation, nonrigid fixation resulted in superior reconstructed glenoid morphology radiologically and similar graft-glenoid osseous healing histologically, showing different graft remodeling profiles of regional bone resorption, mineralization, and fibrous tissue replacement. CLINICAL RELEVANCE The nonrigid fixation technique can be feasible for FBB procedures to treat glenoid bone loss in anterior shoulder instability. More clinical evidence is required to determine its pros and cons compared with conventional rigid fixation.
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Affiliation(s)
- Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kang Han
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueying Zhang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyu Yan
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Falbo R, Moore A, Singleton A, Steffenson A, Levine J, Miller R. Glenoid bone augmentation: a contemporary and comprehensive systematic review of open procedures. Orthop Rev (Pavia) 2022; 14:37834. [PMID: 36045697 DOI: 10.52965/001c.37834] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction There is a trend towards arthroscopically treating shoulder instability with glenoid deficiency. Despite this, there remains the option for treatment through an open technique. Multiple bone augmentation options are available for recurrent anterior shoulder instability. Objective To provide a systematic review of recent studies for recurrent anterior shoulder instability necessitating glenoid bone augmentation specifically through open procedures using coracoid bone or free bone blocks [iliac crest bone autograft/allograft or distal tibia allograft (DTA)]. Methods PubMed, Cochrane, EMBASE, and Google Scholar were searched for studies reporting open glenoid bone augmentation procedures with iliac crest, tibia, or coracoid bones within 10 years. Extracted data included study/patient characteristics, techniques, prior surgeries, prior dislocations, radiographic findings, range of motion (ROM), recurrent instability, patient-reported outcomes, and complications. Results 92 met inclusion criteria (5693 total patients). Six were studies of iliac crest bone, four of DTA, and 84 using the coracoid bone. 29 studies measured postoperative arthritis showing no development or mild arthritis. 26 studies reported postoperative graft position. 62 studies reported ROM noting decline in internal/external rotation. 87 studies measured postoperative instability with low rates. Rowe Scores with noted improvement across 31/59 (52.5%) studies were seen. Common post operative complications included infection, hematoma, graft fracture, nerve injury, pain, and screw-related irritation. Conclusion Despite a trend towards arthroscopic management of recurrent anterior shoulder instability with glenoid deficiency, open procedures continue to provide satisfactory outcomes. Additionally, studies have demonstrated safe and efficacious use of free bone block graft options in the primary and revision setting.
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Affiliation(s)
- Ryan Falbo
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | - Austin Moore
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | - Amy Singleton
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | | | - Jason Levine
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | - Richard Miller
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
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Boutsiadis A, Bampis I, Swan J, Barth J. Best implant choice for coracoid graft fixation during the Latarjet procedure depends on patients' morphometric considerations. J Exp Orthop 2020; 7:15. [PMID: 32185534 PMCID: PMC7078396 DOI: 10.1186/s40634-020-00230-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess the anthropometric dimensions of the coracoid process and the glenoid articular surface and to determine possible implications with the different commercially available Latarjet fixation techniques. METHODS In a total of 101 skeletal scapulae the glenoid length (GL), the glenoid width (GW), the coracoid length (CL), the coracoid width (CW) and the coracoid thickness (CTh) were measured. In order to assess the ability of the transferred coracoid to restore the glenoid anatomy we created a hypothetical model of 10%, 15%, 20%, 25% and 30% glenoid bone loss. We analyzed four common surgical fixation techniques for the Latarjet procedure (4.5 mm screws, 3.75 mm screws, 3.5 mm screws, and 2.8 mm button). The distances from the superior-inferior and medio-lateral limits of the coracoid using the four different fixation methods were calculated. We hypothesized that the "safe distance" between the implant and the coracoid osteotomy should be at least equal to the diameter of the implant. RESULTS The intra and inter-observer reliability tests were almost perfect for all measurements. The mean GH was 36.8 ± 2.5 mm, the GW 26.4 ± 2.2 mm, the CL 23.9 ± 3 mm, the CW 13.6 ± 2.mm, and the mean CTh was 8.7 ± 1.3 mm. The CL was < 25 mm in 46% of the cases. In cases with 25% and 30% bone loss, the coracoid graft restored the glenoid anatomy in 96% and 79.2% of the cases. With the use of the 4.5 mm screws the "safe distance" was present in 56% of the cases, with the 3.75 mm screws in 85%, with the 3.5 mm screws in 87%, and with the 2.8 mm button in 98% of the cases. The distance from the medio-lateral limit of the coracoid could be significantly increased (up to 9 mm) when smaller-button implants are used. CONCLUSIONS The coracoid graft could not always restore glenoid defects of 30%. Larger implants could be positioned too close to the osteotomy and the "medio-lateral offset" of the coracoid could be increased with smaller implants.
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Affiliation(s)
- Achilleas Boutsiadis
- Department of Orthopedic Surgery, 401 Military Hospital of Athens, Athens, Greece
| | - Ioannis Bampis
- Department of Orthopedic Surgery, 401 Military Hospital of Athens, Athens, Greece
| | - John Swan
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Parc sud galaxie, 5 Rue Des Tropiques, 38130 Echirolles, Grenoble, France
| | - Johannes Barth
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Parc sud galaxie, 5 Rue Des Tropiques, 38130 Echirolles, Grenoble, France
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7
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Relationship between the Thickness of the Coracoid Process and Latarjet Graft Positioning-An Anatomical Study on 70 Embalmed Scapulae. J Clin Med 2020; 9:jcm9010207. [PMID: 31940885 PMCID: PMC7019441 DOI: 10.3390/jcm9010207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 01/27/2023] Open
Abstract
Background: The Latarjet procedure is a popular technique with the aim of the reconstruction of glenoid cavity bone defects in patients with chronic anterior shoulder instability. Studies have shown that the Congruent arc Latarjet procedure is better able to reconstruct larger defects than the Classic Latarjet, but there is a lack of information on the limitations of both methods. Methods: The dimensions of the glenoid width and the native coracoid process of two groups with 35 Formol-Carbol embalmed scapulae each were measured using a digital caliper. The relationship between the coracoid graft and the anterior-posterior diameter of the glenoid cavity was calculated to determine the maximum defect size of the glenoid cavity width, which can be treated by both Latarjet techniques. Results: The average restorable defect size of the anterior segment of the glenoid cavity was 28.4% ± 4.6% (range 19.2%–38.8%) in the Classic Latarjet group, and 45.6% ± 5.2% (range 35.7%–57.1%) in the Congruent arc Latarjet group. Based on our results, the feasibility of the Classic Latarjet procedure to reconstitute the anatomical width of the glenoid cavity was 86% in a 25% bone loss scenario, and only 40% in a 30% bone loss scenario. Conclusion: Based on our results we are unable to define a clear threshold for the optimal Latarjet graft position. In glenoid cavity defects <20%, the Classic Latarjet technique usually provides enough bone stock for anatomical reconstruction. Defects ≥35% of the glenoid cavity width should only be treated with a coracoid graft in the Congruent arc position. In the critical area between 20% and 35% of bone loss, we suggest the preoperative assessment of coracoid dimensions, based on which the graft position can be planned to restore the anatomical anterior-posterior diameter of the glenoid cavity.
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Flinkkilä T, Knape R, Nevalainen M, Sirniö K, Ohtonen P, Leppilahti J. Previous arthroscopic Bankart repair is an independent risk factor for an inferior outcome after Latarjet procedure. Orthop Traumatol Surg Res 2019; 105:1481-1485. [PMID: 31640915 DOI: 10.1016/j.otsr.2019.06.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/15/2019] [Accepted: 06/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is limited evidence that the Latarjet procedure has a worse outcome as a revision operation, after a failed stabilization surgery, compared with when it is the primary procedure for posttraumatic anteroinferior instability of the shoulder joint. PURPOSE To compare the results from Latarjet as a primary operation vs. revision surgery after a failed arthroscopic Bankart repair for posttraumatic anteroinferior shoulder instability. In addition, to assess the effect of preoperative bony pathology on outcome. PATIENTS AND METHODS Ninety-nine patients who underwent the Latarjet procedure (47 primary, 52 revision after failed Bankart repair) were analyzed after an average of 3.8 (SD 2.3, range 1-11) years of follow-up. All patients underwent either computed tomography or magnetic resonance imaging preoperatively. Glenoid and humeral bone defects were measured to assess whether the Hill-Sachs lesion was on- or off-track. Clinical outcome measures included the Western Ontario Shoulder Instability Index (WOSI), subjective shoulder value (SSV), and recurrence of instability (dislocation, subluxation, or any perception of instability). RESULTS There were no cases of recurrent dislocation in either group. Four patients in the primary surgery group and 13 in the revision group had at least one subluxation or perception of instability after the Latarjet procedure. Patients with a previous arthroscopic Bankart repair had worse outcomes than those undergoing primary Latarjet when assessed by the WOSI: 76 (SD 22) vs. 85 (SD 15), difference in means -9 (95% CI -17 to -1, p=0.02); SSV: 80 (SD 18) vs. 88 (SD 13), difference in means -8 (95% CI -15 to -2, p=0.01); and the recurrence percentage (25% vs. 9%, p=0.03). A multivariate linear regression model adjusted for the length of follow-up, glenoid bone defect size, Hill-Sachs lesion size, and the frequency of preoperative bipolar bone defects (on/off track Hill-Sachs lesions) further increased the difference in WOSI to -12 (95% CI -21 to -4, p=0.005). DISCUSSION A previous failed arthroscopic Bankart repair was a significant independent risk factor for inferior outcome. Preoperative bony pathology did not explain the worse outcome from the revision vs. primary Latarjet procedure. LEVEL OF EVIDENCE IV, cohort observational study.
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Affiliation(s)
- Tapio Flinkkilä
- Department of Surgery, Division of Orthopedic and Trauma Surgery, Oulu University Hospital and University of Oulu, PL 21, FIN-90029 OYS, Oulu, Finland.
| | - Rony Knape
- Department of Surgery, Division of Orthopedic and Trauma Surgery, Oulu University Hospital and University of Oulu, PL 21, FIN-90029 OYS, Oulu, Finland
| | - Mika Nevalainen
- Department of diagnostic radiology, Medical Research Center Oulu, Oulu, Finland
| | - Kai Sirniö
- Department of Surgery, Division of Orthopedic and Trauma Surgery, Oulu University Hospital and University of Oulu, PL 21, FIN-90029 OYS, Oulu, Finland
| | - Pasi Ohtonen
- Department of Surgery, Division of Orthopedic and Trauma Surgery, Oulu University Hospital and University of Oulu, PL 21, FIN-90029 OYS, Oulu, Finland
| | - Juhana Leppilahti
- Department of Surgery, Division of Orthopedic and Trauma Surgery, Oulu University Hospital and University of Oulu, PL 21, FIN-90029 OYS, Oulu, Finland
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Gowd AK, Liu JN, Cabarcas BC, Garcia GH, Cvetanovich GL, Provencher MT, Verma NN. Management of Recurrent Anterior Shoulder Instability With Bipolar Bone Loss: A Systematic Review to Assess Critical Bone Loss Amounts. Am J Sports Med 2019; 47:2484-2493. [PMID: 30148653 DOI: 10.1177/0363546518791555] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is increasing evidence to suggest that the amount of glenoid bone loss to indicate bone block procedures may be lower than previously thought, particularly in the presence of a Hill-Sachs defect. PURPOSE To better establish treatment recommendations for anterior shoulder instability among patients with bipolar bone lesions. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A systematic review of the literature was performed with PubMed, EMBASE, Cochrane Library, and Scopus databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies evaluating outcomes of operative management in anterior shoulder instability that also reported glenoid bone loss in the presence of Hill-Sachs defects were included. Recurrence rates, glenoid bone loss, and humeral bone loss were pooled and analyzed with forest plots stratified by surgical procedure. Methods of quantification were analyzed for each article qualitatively. RESULTS Thirteen articles were included in the final analysis, with a total of 778 patients. The mean ± SD age was 24.9 ± 8.6 years. The mean follow-up was 30.1 months (range, 11-240 months). Only 13 of 408 (3.2%) reviewed bipolar bone loss articles quantified humeral and/or glenoid bone loss. Latarjet procedures had the greatest glenoid bone loss (21.7%; 95% CI, 14.8%-28.6%), followed by Bankart repairs (13.1%; 95% CI, 9.0%-17.2%), and remplissage (11.7%; 95% CI, 5.5%-18.0%). Humeral bone loss was primarily reported as percentage bone loss (22.2%; 95% CI, 13.1%-31.3% in Bankart repairs and 31.7%; 95% CI, 21.6%-41.1% in Latarjet) or as volumetric defects (439.1 mm3; 95% CI, 336.3-541.9 mm3 in Bankart repairs and 366.0 mm3; 95% CI, 258.4-475.4 mm3 in remplissage). Recurrence rates were as follows: Bankart repairs, 19.5% (95% CI, 14.5%-25.8%); remplissage, 4.4% (95% CI, 1.3%-14.0%); and Latarjet, 8.7% (95% CI, 5.0%-14.7%). Bankart repairs were associated with significantly greater recurrence of instability in included articles (P = .013). CONCLUSION There exists a need for universal and consistent preoperative measurement of humeral-sided bone loss. The presence of concomitant Hill-Sachs defects with glenoid pathology should warrant more aggressive operative management through use of bone block procedures. Previously established values of critical glenoid bone loss are not equally relevant in the presence of bipolar bone loss.
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Affiliation(s)
- Anirudh K Gowd
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Brandon C Cabarcas
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Grant H Garcia
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory L Cvetanovich
- Department of Orthopaedics, the Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | | | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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10
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Frank RM, Romeo AA, Richardson C, Sumner S, Verma NN, Cole BJ, Nicholson GP, Provencher MT. Outcomes of Latarjet Versus Distal Tibia Allograft for Anterior Shoulder Instability Repair: A Matched Cohort Analysis. Am J Sports Med 2018; 46:1030-1038. [PMID: 29389219 DOI: 10.1177/0363546517744203] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior glenoid reconstruction with fresh distal tibia allograft (DTA) has been described for management of recurrent shoulder instability, with encouraging early outcomes; however, no comparative data with the Latarjet procedure are available. PURPOSE The purpose of this study was to compare the clinical outcomes between patients undergoing DTA and a matched cohort of patients undergoing Latarjet. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A review was conducted of prospectively collected data for patients with a minimum 15% anterior glenoid bone loss who underwent shoulder stabilization via either the DTA or Latarjet procedure and had a minimum follow-up of 2 years. Consecutive patients undergoing DTA were matched in a 1-to-1 format to patients undergoing Latarjet by age, body mass index, history of contact sports, and number of previous shoulder operations. Patients were evaluated pre- and postoperatively with a physical examination and the following outcome assessments: Simple Shoulder Test, visual analog scale, American Shoulder and Elbow Surgeons, Western Ontario Shoulder Instability Index, and Single Assessment Numeric Evaluation. Complications, reoperations, and episodes of recurrent instability were analyzed. Statistical analysis was performed with Student t tests, with P < .05 considered significant. RESULTS A total of 100 patients (50 Latarjet, 50 DTA) with a mean ± SD age of 25.6 ± 6.1 years were analyzed at 45 ± 20 months (range, 24-111) after surgery. Thirty-two patients (64%) in each group underwent prior ipsilateral shoulder surgery (range, 1-3). Patients undergoing DTA had significantly greater glenoid bone loss defects when compared with patients undergoing Latarjet (28.6% ± 7.4% vs 22.4% ± 10.3%, P = .001). Patients in both groups experienced significant improvements in all outcome scores after surgery ( P < .05 for all). No significant differences were found in postoperative scores between the Latarjet and DTA groups: visual analog scale (0.67 ± 0.97 vs 1.83 ± 2.31), American Shoulder and Elbow Surgeons (91.06 ± 8.78 vs 89.74 ± 12.66), Western Ontario Shoulder Instability Index (74.30 ± 21.84 vs 89.69 ± 5.50), or Single Assessment Numeric Evaluation (80.68 ± 7.21 vs 90.08 ± 13.39) ( P > .05 for all). However, patients in the Latarjet group had superior Simple Shoulder Test outcomes ( P = .011). There were 10 complications (10%) for the entire cohort, including 5 in the Latarjet group (3 of which required reoperation) and 5 in the DTA group (3 of which required reoperation). The overall recurrent instability rate was 1% (1 patient). CONCLUSION Fresh DTA reconstruction for recurrent anterior shoulder instability results in a clinically stable joint with similar clinical outcomes as the Latarjet procedure. Longer-term studies are needed to determine if these results are maintained over time.
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Affiliation(s)
- Rachel M Frank
- CU Sports Medicine, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Catherine Richardson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shelby Sumner
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Kwapisz A, Fitzpatrick K, Cook JB, Athwal GS, Tokish JM. Distal Clavicular Osteochondral Autograft Augmentation for Glenoid Bone Loss: A Comparison of Radius of Restoration Versus Latarjet Graft. Am J Sports Med 2018; 46:1046-1052. [PMID: 29382209 DOI: 10.1177/0363546517749915] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone loss in shoulder instability is a well-recognized cause of failure after stabilization surgery. Many approaches have been described to address glenoid bone loss, including coracoid transfer. This transfer can be technically difficult and has been associated with high complication rates. An ideal alternative to coracoid transfer would be an autologous source of fresh osteochondral graft with enough surface area to replace significant glenoid bone loss. The distal clavicle potentially provides such a graft source that is readily available and low-cost. PURPOSE To evaluate distal clavicular autograft reconstruction for instability-related glenoid bone loss, specifically comparing the width of the clavicular autograft with the width of an ipsilateral coracoid graft as prepared for a Latarjet procedure. Further, we sought to compare the articular cartilage thickness of the distal clavicle graft with that of the native glenoid. STUDY DESIGN Controlled laboratory study. METHODS Twenty-seven fresh-frozen cadaver specimens were dissected, and an open distal clavicle excision was performed. The coracoid process in each specimen was prepared as has been described for a classic Latarjet coracoid transfer. In each specimen, the distal clavicle graft was compared with the coracoid graft for size and potential of glenoid articular radius of restoration. The distal clavicle graft was also compared with the native glenoid for cartilage thickness. RESULTS In all specimens, the distal clavicle grafts provided a greater radius of glenoid restoration than the coracoid grafts ( P < .0001). On average, the clavicular graft was able to reconstruct 44% of the glenoid diameter, compared with 33% for the coracoid graft ( P < .0001). The articular cartilage of the glenoid was significantly thicker (1.4 mm thicker, P < .0001) than that of the distal clavicular autograft (average ± SD, 3.5 ± 0.6 mm vs 2.1 ± 0.8 mm, respectively). When specimens with osteoarthritis were excluded, this difference decreased to 0.97 mm when compared with the clavicular cartilage ( P = .0026). CONCLUSION The distal clavicle autograft can restore a significantly greater glenoid bone deficit than the Latarjet procedure and has the additional benefit of restoring articular cartilage to the glenoid. The articular cartilage thickness of the distal clavicle is within 1.4 mm of that of the native glenoid. CLINICAL RELEVANCE The distal clavicular autograft may be a suitable option for reconstruction of instability-related glenoid bone loss. This graft provides a structural osteochondral autograft with a broader radius of reconstruction than that of a coracoid graft, is locally available, has minimal donor site morbidity, is anatomic, and provides articular cartilage.
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Affiliation(s)
- Adam Kwapisz
- The Hawkins Foundation, Greenville, South Carolina, USA.,Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Łódź, Poland
| | | | - Jay B Cook
- Winn Army Community Hospital, Fort Stewart, Georgia, USA
| | | | - John M Tokish
- Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA.,Mayo Clinic, Phoenix, Arizona, USA
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Return to sports after the latarjet procedure: high return level of non-collision athletes. Knee Surg Sports Traumatol Arthrosc 2018; 26:919-925. [PMID: 29134252 DOI: 10.1007/s00167-017-4775-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to compare the clinical outcomes, including the level of return to sport, of collision and non-collision athletes who had the Latarjet procedure. METHODS A total of 56 shoulders of 29 collision and 27 non-collision athletes were retrospectively analyzed. All study participants underwent the Latarjet procedure between 2007 and 2014. Median age at the time of surgery was 26.5 years(18-43) and follow-up duration was 67.0 months(24-113). RESULTS At the final follow-up, 54 (96.4%) patients returned to sports. Nine patients (16.1%) returned to the same level of sports. In a group of collision athletes, 1 patient (3.4%) returned to the same level, 16 (55.2%) returned to lower level, 10 (34.5%) changed sports, and 2 (6.9%) quit sports. In a group of noncollision athletes, 8 (29.6%) returned to same level, 11 (40.7%) returned at a lower level and 8 (29.6%) changed sports. The level of return to sports in collision group was statistically different from that in noncollision group (p = 0.046). The mean VAS, Rowe and UCLA scores improved significantly in both groups (p < 0.001) with no statistically significant difference between both groups. CONCLUSIONS Although the clinical outcomes were not significantly different between collision and non-collision athletes, the level of return to sports was significantly higher in the non-collision group than in the collision group. The result suggests that the level of physical demand according to sport type is an important prognostic factor which predicts the level of return to sport after the Lartarjet procedure in athletes. LEVEL OF EVIDENCE IV.
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Fate of coracoid grafts after the Latarjet procedure: will be analogous to the original glenoid by remodelling. Knee Surg Sports Traumatol Arthrosc 2018; 26:926-932. [PMID: 29198018 DOI: 10.1007/s00167-017-4808-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the location, magnitude, and change over time of osteolysis of coracoid grafts after Latarjet procedure. METHODS This is a retrospective study of 54 patients (55 shoulders) who underwent the Latarjet procedure. Three-dimensional computed tomography (CT) scans were performed preoperatively, immediately postoperatively, and at follow-up (mean 7.7 and 31.7 months postoperative). "En face" views of the glenoid, size of glenoid defect and changes in the glenoid surface area postoperatively were measured relative to the area of an assumed outer-fitting circle. On the oblique sagittal planes, location and subsequent severity of osteolysis of the graft at follow-up were documented. RESULTS The mean glenoid surface area increased significantly from 79.7 ± 4.8% of the original circle preoperatively to 111.3 ± 8.0% immediately postoperatively. At 7.7 and 31.7 months of follow-up, glenoid surface area decreased to 102.2 ± 6.0% and 100.3 ± 5.3%, respectively. Osteolysis occurred on the outer side of the graft in all cases, but did not occur on the inner side. Maximum osteolysis was observed in the superior third of the graft (78.5 ± 17.1%), followed by the middle third (15.8 ± 10.4%), and the inferior third (8.0 ± 5.1%). No significant difference in magnitude of osteolysis was observed between 7.7 and 31.7 months of follow-up. CONCLUSION Osteolysis of the grafted coracoid mainly occurred on the outer side of the superior portion, resulting in reshaping of the rectangular shape of graft coracoids after Latarjet procedure. Coracoid graft remodelling was almost completed approximately 8 months postoperatively to reach the original glenoid dish with no further changes thereafter. These results may help surgeons to understand changes of grafts after the surgery. LEVEL OF EVIDENCE IV.
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Harmsen K, Huijsmans PE. Management of Glenoid Defects in Anterior Shoulder Instability: A Review of Current Concepts. Open Orthop J 2018; 11:934-945. [PMID: 29403566 PMCID: PMC5780676 DOI: 10.2174/1874325001711010934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/22/2016] [Accepted: 10/28/2016] [Indexed: 11/24/2022] Open
Abstract
Background: Bone defects of the glenoid are often found in patients with traumatic
anterior glenohumeral instability. There is no consensus regarding which
glenoid defects need to be treated surgically. The aim of this review is to
describe the management of glenoid defects in anterior shoulder instability
in patients with traumatic anterior glenohumeral instability. Methods: We conducted a review of the literature through a Pubmed search. Results: The management of glenoid defects in anterior shoulder instability consists
of conservative or operative treatment. There is a wide variety in the
treatment options. Also, the diagnostics of the presence and size of a
glenoid bone defect is still debated on in literature. Conclusion: Based on the current available literature, we advise to begin management of
traumatic anterior shoulder instability combined with glenoid defects with
conservative treatment. Operative treatment can be used when the bone
fragment consists of a large glenoid surface and the patient is active, or
in the case of a chronic defect or recurrent instability.
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Affiliation(s)
- Kennard Harmsen
- Department of Orthopaedics, Haga Hospital, Sportlaan 600, 2566 MJ, The Hague, The Netherlands
| | - Polydoor E Huijsmans
- Department of Orthopaedics, Haga Hospital, Sportlaan 600, 2566 MJ, The Hague, The Netherlands
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van der Linde JA, Wessel RN, Trantalis JN, van den Bekerom MPJ. Review of Latarjet (1954) on the treatment of recurrent shoulder dislocations. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This classic discusses the original publication ‘Treatment of recurrent dislocation of the shoulder’ on the Latarjet procedure. This surgical technique that has become one of the basics in shoulder-stabilising surgery, introduced by Latarjet in 1954 in the journal Lyon Chirurgical. Inspired by publications of colleagues in the field of shoulder surgery, Latarjet introduced a technique that transfers the coracoid process to the anterior glenoid rim in patients with anterior shoulder instability. Although being outrun in popularity by the Bankart repair for several decades, improved knowledge regarding long-term outcomes, surgical techniques and patient characteristics such as bone loss and participation in contact sports has led to renewed interest in the Latarjet procedure. This especially accounts for patients with significant glenohumeral bone loss or patients with a previously failed soft tissue repairs. Whereas the increase in popularity has led to many studies focussing on various aspects, the 15 basics of the initial procedure have virtually remained unchanged.
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Kee YM, Kim HJ, Kim JY, Rhee YG. Glenohumeral arthritis after Latarjet procedure: Progression and it's clinical significance. J Orthop Sci 2017; 22:846-851. [PMID: 28712926 DOI: 10.1016/j.jos.2017.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/22/2017] [Accepted: 06/17/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The risk factors of glenohumeral arthritis after the Latarjet procedure remain relatively unexplored. The purposes of this study are to evaluate the clinical significance of glenohumeral arthritis after the Latarjet procedure, and to investigate risk factors associated with arthritis progression. METHODS We evaluated 110 patients (110 shoulders) who underwent the Latarjet procedure for recurrent anterior shoulder instability. Patients had a mean age of 23.8 years (range, 14-52 years) at the time of the operation, and the mean duration of follow-up was 31 months (range, 24-111 months). RESULTS At the last follow-up, the mean Visual Analog Scale (VAS), Rowe and University of California at Los Angeles (UCLA) scores significantly improved from 3.1, 36.5 and 23.6 points preoperatively to 1.6, 87.6 and 32.6 points (all P < 0.05, respectively). The postoperative rate of recurrence was 5.4%. Among the 14 shoulders with preoperative arthritis, 8 (57.1%) showed progression of arthritis at the last follow up. New occurrence or progression of arthritis after the Latarjet procedure was in 20 shoulders (18.2%). At the final, overall prevalence of arthritis was 23.6% (26 shoulders). The non-arthritis group showed significantly better functional outcomes (VAS score: 0.9, Rowe Score: 89.3, UCLA score: 33.5) than the arthritis group (2.1, 84.9, 29.2; all P < 0.05, respectively). Preoperative generalized laxity and lateral overhang were associated with glenohumeral arthritis progression after surgery. (all P < 0.05, retrospectively). CONCLUSION The Latarjet procedure yielded satisfactory functional outcomes with low recurrent rate at mid-term follow-up. Development or progression of arthritis was observed in 18.2% of patients, postoperatively. Glenohumeral arthritis after the Latarjet procedure had an adverse effect on clinical outcome. Generalized laxity and lateral overhang should be considered as risk factors of progression to glenohumeral arthritis after the Latarjet procedure.
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Affiliation(s)
- Young Moon Kee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hwan Jin Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Youn Kim
- Department of Orthopaedic Surgery, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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McHale KJ, Sanchez G, Lavery KP, Rossy WH, Sanchez A, Ferrari MB, Provencher MT. Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss. Arthrosc Tech 2017; 6:e791-e799. [PMID: 28706833 PMCID: PMC5495908 DOI: 10.1016/j.eats.2017.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 02/05/2017] [Indexed: 02/03/2023] Open
Abstract
Anterior glenohumeral instability is a common clinical entity, particularly among young athletic patient populations. Nonoperative management and arthroscopic treatment of glenohumeral instability have been associated with high rates of recurrence, particularly in the setting of glenohumeral osseous defects. Coracoid transfer, particularly the Latarjet procedure, has become the treatment of choice for recurrent anterior glenohumeral instability in the setting of osseous deficiencies greater than 20% to 30% of the glenoid surface area and may also be considered for the primary treatment of recurrent instability in the high-risk contact athlete, even in the setting of limited osseous deficiency. The following Technical Note provides a diagnostic approach for suspected glenohumeral instability, as well as a detailed description of the congruent-arc Latarjet procedure, performed with a deltoid split, with its postoperative management.
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Affiliation(s)
- Kevin J. McHale
- Penn Orthopaedics, Cape Regional Medical Center, Cape May Court House, New Jersey, U.S.A
| | - George Sanchez
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Kyle P. Lavery
- North County Orthopaedics, Leominster, Massachusetts, U.S.A
| | | | | | | | - Matthew T. Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- The Steadman Clinic, Vail, Colorado, U.S.A
- Address correspondence to Matthew T. Provencher, M.D., The Steadman Clinic, 181 W Meadow Dr, Vail, CO 81657, U.S.A.The Steadman Clinic181 W Meadow DrVailCO81657U.S.A.
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Lavery KP, McHale KJ, Rossy WH, Sanchez G, Provencher MT. Bony Augmentation for Anterior and Posterior Glenohumeral Instability in the Contact Athlete. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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