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Paul RW, Perez AR, Windsor JT, Osman A, Romeo AA, Erickson BJ. Analysis of reasons for failure to return to sport after Latarjet surgery: a systematic review. J Shoulder Elbow Surg 2024; 33:1642-1649. [PMID: 38182027 DOI: 10.1016/j.jse.2023.11.006] [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: 08/28/2023] [Revised: 10/25/2023] [Accepted: 11/12/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND The purpose of this study was to perform a systematic review of the literature to identify Shoulder Instability Return to Sport after Injury (SIRSI) scores in athletes who underwent open Latarjet surgery, determine the reasons why athletes failed to return to play (RTP) after Latarjet surgery, and compare SIRSI scores of those who did vs. did not RTP. METHODS According to PRISMA guidelines, the PubMed, SportDiscus, and Ovid MEDLINE databases were queried to identify studies evaluating return to sport after Latarjet surgery. Study quality was assessed using the MINORS criteria. Studies were included if RTP after Latarjet surgery and a psychological factor were evaluated, with potential psychological factors including readiness to RTP and reasons for failure to RTP. RESULTS Fourteen studies, 10 of level III evidence and 4 of level IV evidence, with 1034 patients were included. A total of 978 athletes were eligible to RTP. Of these, 792 (79%) successfully returned to play and 447 (56.4%) returned to play at their previous level of play. Mean RTP time was 6.2 months. Postoperative SIRSI scores averaged 71.2 ± 8.8 at a mean of 21 months' follow-up. Postoperative SIRSI scores for those able to RTP was 73.2, whereas athletes unable to RTP scored an average of 41.5. Mean postoperative SIRSI scores for those in contact sports was 71.4, whereas those in noncontact sports was 86.5. There were 31 athletes with a documented reason why they did not RTP, with postoperative shoulder injury being the most common reason (54.5%). Fear of reinjury and feeling "not psychologically confident" each represented 6.5% of the total. CONCLUSION Athletes who RTP have higher average SIRSI scores than those who are unable to RTP. Of the athletes who documented why they did not RTP, more than half cited a shoulder injury as their reason for not returning to play, whereas fear of reinjury and lack of psychological readiness were other common reasons.
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Affiliation(s)
- Ryan W Paul
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA; Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Andres R Perez
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA; University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Alim Osman
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Anthony A Romeo
- Division of Sports Medicine, Duly Health and Care, Chicago, IL, USA
| | - Brandon J Erickson
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, New York, NY, USA; Department of Orthopedic Surgery, New York University Langone, New York, NY, USA.
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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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Mouchantaf M, Bastard C, Corsia S, Métais P, Nourissat G. High Rates of Return to Play and Low Recurrence Rate After Arthroscopic Latarjet Procedure for Anterior Shoulder Instability in Rugby Players. Arthrosc Sports Med Rehabil 2024; 6:100912. [PMID: 38590787 PMCID: PMC10999816 DOI: 10.1016/j.asmr.2024.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/09/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose To analyze the rate of return to play, changes in athletic level, and recurrence rate and to report subjective outcomes in a series of rugby players with anterior shoulder instability who underwent an arthroscopic Latarjet procedure. Methods A multicenter retrospective study done in 2 centers on rugby players who were operated on between January 2011 and December 2020 was performed. Rugby players who underwent arthroscopic Latarjet procedure for anterior shoulder stabilization with a minimum follow-up period of 2 years were included. Rugby players were grouped according to their competitive level in their country (recreational, regional, national, and international). Data collected included return to sport after surgery, time to return to rugby, athletic level before and after surgery, patient satisfaction, and subjective scores. Recurrence and apprehension rates were also evaluated. Results A total of 73 subjects were included. Mean age at time of surgery was 23 ± 5 years. Mean duration of follow-up was 5 ± 2.6 years. Eighty-four percent of rugby players returned to rugby within a mean period of 6.6 months. Initial athletic level was a significant factor (P = .012) for not returning to sport, with 67% of patients who initially played at a recreational level not returning to rugby and 33% of patients who initially played at a regional league level not returning. All national and international players returned to play. Of the 12 non-returning rugby players, only 30% did not return because of their shoulder. Mean Subjective Shoulder Value was 90 ± 9%. Recurrence rate was 7%. Conclusions Arthroscopic Latarjet procedure proved its efficacy in managing recurrent anterior shoulder instability in rugby players. Return to play was achieved in almost all cases, with low recurrence rates. Despite high global return to the same level of sport, the higher the level of competition, the harder it is for rugby players to resume sport at the same level. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Mark Mouchantaf
- Clinique de l’épaule–Paris, Clinique Maussins-Nollet, Ramsay Sante, Paris, France
| | - Claire Bastard
- Service de Chirurgie Orthopedique–Hôpital Saint-Antoine, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Simon Corsia
- Service de Chirurgie Orthopédique–Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
| | | | - Geoffroy Nourissat
- Clinique de l’épaule–Paris, Clinique Maussins-Nollet, Ramsay Sante, Paris, France
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Bonnevialle N, Mattési L, Martinel V, Letartre R, Barret H, Mansat P. Outcomes at Long-term Follow-up After Open Latarjet Versus Open Bankart Repair in Rugby Players. Orthop J Sports Med 2023; 11:23259671231184394. [PMID: 37564951 PMCID: PMC10411275 DOI: 10.1177/23259671231184394] [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: 03/03/2023] [Accepted: 04/13/2023] [Indexed: 08/12/2023] Open
Abstract
Background Because rugby is a collision sport, it exposes players to a high risk of recurrence after anterior shoulder stabilization. Therefore, the choice of surgical procedure warrants close attention in order to optimize the time to return to sport and the stability of the shoulder throughout the player's career. Hypothesis The open Latarjet procedure would allow for a faster return to play and provide a lower rate of recurrence than the open Bankart repair at long-term follow-up. Study Design Cohort study; Level of evidence, 3. Methods The study retrospectively enrolled 62 competitive rugby players who had undergone an anterior shoulder instability procedure and had at least 5 years of follow-up data. A total of 32 players treated with an open Bankart repair (BK group) were compared with 30 players (31 shoulders) treated with an open Latarjet procedure (LT group). Outcomes between groups were compared with the Rowe score, Walch-Duplay score, recurrence rate, and osteoarthritis evaluation on plain radiograph (Samilson classification). Results The recurrence rate was significantly higher at 18.8% for the BK group (mean follow-up, 6.9 ± 1.7 years) compared with 3.3% for the LT group (mean follow-up, 6.2 ± 1.4 years) (P = .04). No postoperative complications occurred in the BK group, whereas 1 infection and 1 hematoma required a second surgery in the LT group (P = .14). In the BK and LT groups, 97% and 90% of players, respectively, were able to return to rugby at the same level or higher (P = .27), at a mean time of 8 and 6.3 months, respectively (P = .03). The mean Rowe and Walch-Duplay scores were not significantly different between the groups; however, the osteoarthritis rate was significantly higher in the BK versus the LT group (68% vs 38%, respectively; P = .03); 23% of patients, all in the BK group, had Samilson grade 2 osteoarthritis. Conclusion The open Latarjet procedure outperformed the open Bankart procedure in terms of stability, time to return to play, and radiological outcomes at long-term follow-up in competitive rugby players.
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Affiliation(s)
| | - Lucas Mattési
- Clinique Universitaire du Sport, CHU de Toulouse, Toulouse, France
| | | | | | - Hugo Barret
- Clinique Universitaire du Sport, CHU de Toulouse, Toulouse, France
| | - Pierre Mansat
- Clinique Universitaire du Sport, CHU de Toulouse, Toulouse, France
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Lacouture-Suarez JD, Azar M, Brusalis CM, Ranieri R, Brotat-Rodriguez M, Boileau P. Screw-Related Complications May Occur at a Greater Rate After Arthroscopic Versus Open Latarjet Procedure: A Systematic Review. Arthrosc Sports Med Rehabil 2023; 5:100726. [PMID: 37645398 PMCID: PMC10461157 DOI: 10.1016/j.asmr.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/18/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To determine the rate of complications attributable to the use of screw fixation during the Latarjet procedure and to delineate screw-related complications for open and arthroscopic Latarjet surgery. Methods A systematic review of the literature was performed by querying MEDLINE and EMBASE computerized databases for relevant articles that reported clinical outcomes associated with the Latarjet procedure. Clinical studies of open and/or arthroscopic Latarjet surgery that employed screw fixation of the coracoid were included in our analysis. Results From 692 articles identified initially, 32 studies met eligibility criteria. The study cohort comprised 2,758 shoulders, with a mean age of patients ranged from 17 to 62 years, and the mean duration of follow-up ranged from 0.3 to 25.6 years. Twenty-two studies reported outcomes of an open Latarjet technique whereas 10 studies reported on an arthroscopic Latarjet technique. Across all studies, the overall complication rate ranged from 1.4% to 36%. The rate of screw-related complications ranged from 0% to16%, and the rate of screw removal ranged from 0% to 18%. Among the subset of studies that reported specific indications for screw removal, the most common indications were pain and screw loosening. Reported rates of screw-removal among arthroscopic Latarjet procedures range from 0% to 18% and among open procedures range from 0% to 7.3%. Conclusions (1) Up to one-third of the overall surgical complications associated with the Latarjet procedure may be related to the use of screw fixation, (2) arthroscopic Latarjet procedure did not decrease the rate of screw related complications. The reported rate of screw-removal may be higher after the arthroscopic Latarjet procedures (up to 18%) than after open procedures (up to 7,3%), and is mainly indicated for persistent shoulder pain and/or screw loosening. Level of Evidence Level IV, systematic review of Level III-IV studies.
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Affiliation(s)
- Juan David Lacouture-Suarez
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| | - Michel Azar
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| | | | - Riccardo Ranieri
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| | - Maria Brotat-Rodriguez
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| | - Pascal Boileau
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
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Sahu D, Shah D, Shetty G. Coracoid graft resorption after the Latarjet procedure does not depend on the preoperative glenoid defect. J Shoulder Elbow Surg 2023; 32:e94-e105. [PMID: 36252784 DOI: 10.1016/j.jse.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/08/2022] [Accepted: 09/20/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The primary purpose was to compare coracoid graft resorption after the Latarjet procedure in patients without preoperative glenoid bone loss vs. those with more than critical glenoid loss. The secondary purposes were to compare the functional outcomes and to investigate the association of graft position, angle of the screws, preoperative glenoid defect, age at surgery, and smoking status with graft resorption. METHODS Sixty consecutive patients with recurrent anterior instability were treated by the Latarjet procedure as the index procedure, irrespective of the glenoid bone loss between 2018 and 2021. Fifty-five patients were evaluated via computed tomography scans after a minimum of 1 year after surgery (range: 1-4 years). Twenty-five patients had no prior glenoid defect (No-defect group), 24 patients had preoperative glenoid defects ≥15% (Critical defect group), and 6 patients had glenoid defects between 5% and 15%. The No-defect group (n = 25) was compared with the Critical defect group (n = 24). Multivariate logistical regression was performed to evaluate the association of independent factors with the grade of resorption for all 55 patients in the cohort. RESULTS Major graft resorption at the level of the superior screw was observed in 72%-84% of patients in the No-defect group (n = 25) and in 75%-83% of patients in the Critical defect group (n = 24) (P = 1, P = 1; no significant difference). No to mild resorption at the level of the inferior screw was observed in 96% of patients in the No-defect group and 100% of patients in the Critical defect group (P = 1; no significant difference). Postoperative Rowe scores (100 [95-100] vs. 100 [95-100]; P = .8) and shoulder subjective value (87 [11] vs. 86 [9]; P = .9) were not significantly different between the 2 groups. None of the independent factors, including the corresponding screw angle, the mediolateral graft positioning, prior glenoid defect, age, and smoking status, were associated with graft resorption in multivariate logistical regression. CONCLUSIONS Graft resorption after the Latarjet procedure does not depend on the preoperative glenoid defect. The coracoid graft may be mostly resorbed around the superior screw but mildly or none at the level of the inferior screw, but this graft resorption is not dependent on the smoking status, age, prior glenoid defect, mediolateral graft positioning, and the angle of the screws.
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Affiliation(s)
- Dipit Sahu
- Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India; Mumbai Shoulder Institute, Mumbai, Maharashtra, India; Department of Orthopaedics, Jupiter Hospital, Thane, Maharashtra, India.
| | - Darshil Shah
- Sports Medicine Unit, Sportsmed, Mumbai, Maharashtra, India
| | - Gautam Shetty
- Knee and Orthopaedic Clinic, Mumbai, Maharashtra, India
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Menendez ME, Barth J, Tokish JM. Clinical Faceoff: Latarjet Versus Free Bone Block Procedures for Anterior Shoulder Instability. Clin Orthop Relat Res 2022; 480:1657-1661. [PMID: 35857346 PMCID: PMC9384910 DOI: 10.1097/corr.0000000000002324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/24/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Mariano E. Menendez
- Oregon Shoulder Institute at Southern Oregon Orthopedics, Medford, OR, USA
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | | | - John M. Tokish
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Callegari JJ, McGarry M, Crook L, Adamson NA, Fraipont GM, Provencher M, Lee TQ, Denard PJ. The Addition of Remplissage to Free Bone Block Restores Translation and Stiffness Compared to Bone Block Alone or Latarjet in a Bipolar Bone Loss Model. Arthroscopy 2022; 38:2609-2617. [PMID: 35346773 DOI: 10.1016/j.arthro.2022.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare glenohumeral stability following a Latarjet, a free bone block (FBB), and a FBB with remplissage for bipolar bone loss. METHODS Nine matched pairs of fresh frozen cadavers were tested in a custom biomechanical apparatus with rotation and progressive translational loading. The free bone block group consisted of a distal tibial allograft with an all-suture tape construct. The Latarjet group was performed with the native coracoid and two partially threaded cannulated screws. A bipolar bone loss model was created with 20% glenoid bone loss and an off-track Hill-Sachs lesion. Testing conditions included the 1) native state, 2) bipolar bone loss model, 3) Latarjet, 4) FBB with distal tibial allograft secured with cerclage sutures, and 5) FBB with remplissage. Each condition was tested for translation, humeral head apex shift, stiffness, and dislocation force. RESULTS There were no differences in translation, stiffness, or dislocation forced between the FBB alone and Latarjet groups. The FBB with remplissage group demonstrated the lowest anterior-inferior translation at 90° of ER, which was statistically significant compared to Latarjet 20N (P = .013) and compared to the FBB alone at 40N (P = .024) and 50N (P = .011). The FBB with remplissage group was significantly stiffer compared to FBB alone at 90° ER with approximately 60% change in stiffness (P = .028). The force required to dislocate the humeral head after treatment was highest in the FBB with remplissage group, which was statistically significant compared to the FBB alone (P = .003) and Latarjet groups (P = .018). CONCLUSION The addition of remplissage to a FBB restores translation and stiffness closer to the intact state compared to a FBB alone or Latarjet in a bipolar bone loss model with an off-track Hill-Sachs lesion. In this model, dislocation force significantly increased with the addition of remplissage to the FBB. CLINICAL RELEVANCE This biomechanical study provides evidence that Latarjet and FBB are both acceptable forms of treatment for bipolar bone loss, but stability can be enhanced with the addition of remplissage following glenoid reconstruction.
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Affiliation(s)
| | - Michelle McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | | | - Nicholas A Adamson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Genevieve M Fraipont
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | | | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
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Rattier S, Druel T, Hirakawa Y, Gröger F, van Rooij F, Neyton L. Use of Cannulated Screws for Primary Latarjet Procedures. Orthop J Sports Med 2022; 10:23259671221117802. [PMID: 36051974 PMCID: PMC9425914 DOI: 10.1177/23259671221117802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background Rapid consolidation of the bone block is paramount for the success of the Latarjet procedure. Noncannulated screws have shown satisfactory long-term bone block fusion, while cannulated screws are challenged with inferior mechanical properties and fusion rates. Purpose To report outcomes of the Latarjet procedure using cannulated screws, notably bone block fusion and complication rates at 3 months, as well as clinical scores and return to sports at minimum 2 years postoperatively. Study Design Case series; Level of evidence, 4. Methods We reviewed the records of 124 consecutive patients (124 shoulders) who underwent primary Latarjet procedures using cannulated screws between 2015 and 2018. All patients underwent clinical examination at 3 months postoperatively, including range of motion and radiographs to assess graft fusion. The Walch-Duplay score, Rowe score, Subjective Shoulder Value, and visual analog scale for pain were collected at a minimum follow-up of 2 years. Results Overall, 9 patients (7%) required reoperation: 7 (6%) had screw removal for unexplained residual pain, 1 (0.8%) had lavage for deep infection, and 1 (0.8%) had evacuation to treat a hematoma. Furthermore, 3 patients (2.4%) had recurrent instability, none of whom underwent reoperation. At 3-month follow-up, all 124 shoulders showed complete radiographic graft fusion, and at 40 ± 11 months (mean ± SD; range, 24-64 months), 88% of patients had returned to sport (109/124), the Walch-Duplay score was 86 ± 14, Rowe was 84 ± 15, Subjective Shoulder Value was 88 ± 11, and visual analog scale for pain was 1 ± 1. Conclusion The clinical relevance of these findings is that 4.5-mm cannulated screws are safe and effective for primary Latarjet procedures and grant adequate graft healing, with low recurrence of instability and a high rate of return to sports.
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Affiliation(s)
- Simon Rattier
- Department of Orthopedic and Trauma Surgery, SOS Mains, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France
| | - Thibaut Druel
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France
| | - Yoshihiro Hirakawa
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Falk Gröger
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France
| | | | - Lionel Neyton
- Department of Orthopedic and Trauma Surgery, SOS Mains, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France
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Jassim SS, Amaranath J, Taylor DM, Warby SA, Hoy G. Unicortical Fixation Does Not Compromise Bony Union in the Latarjet Procedure. JSES Int 2022; 6:555-562. [PMID: 35813149 PMCID: PMC9264013 DOI: 10.1016/j.jseint.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - David McD. Taylor
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
- The Austin Hospital, Melbourne, VIC, Australia
| | - Sarah Ann Warby
- Melbourne Shoulder Group, Melbourne, VIC, Australia
- La Trobe University, Department of Rehabilitation, Nutrition and Sport, Corner of Kingsbury Drive and Plenty Road Bundoora, Melbourne, VIC, Australia
- Corresponding author: Sarah Ann Warby, PhD, B.Physio (Hon), Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Gregory Hoy
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia
- Monash University, Department of Surgery, Melbourne, VIC, Australia
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[Analysis of influencing factors of early pain after arthroscopic rotator cuff repair]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:284-290. [PMID: 35293168 PMCID: PMC8923925 DOI: 10.7507/1002-1892.202111020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the influencing factors that affect early pain after arthroscopic rotator cuff repair. METHODS A clinical data of 592 patients who met the selection criteria and underwent arthroscopic rotator cuff repair between June 2018 and October 2020 were retrospectively analyzed. There were 239 males and 353 females, with an average age of 58.1 years (range, 32-81 years). Before operation and at 3 days, 6 weeks, and 3 months after operation, the pain degree of patients was evaluated by visual analogue scale (VAS) score; and the patients were divided into no pain or mild pain group and moderate to severe pain group according to the postoperative VAS score. Preoperative and intraoperative related factors were included for univariate analysis, including age, gender, body mass index, preoperative VAS score, history of frozen shoulder, history of hypertension, history of diabetes, history of smoking, affected tendons (supraspinatus, infraspinatus, or subscapularis tendon injury), supraspinatus muscle atrophy, fatty infiltration, operation time, degree of rotator cuff tear, number of anchors, and whether to perform acromioplasty. The influencing factors of postoperative pain were screened; further logistic regression was used to conduct multivariate analysis to screen for risk factors. RESULTS Moderate to severe pain occurred in 440 patients (74.3%) at 3 days after operation, 382 patients (66.2%) at 6 weeks, and 141 patients (23.8%) at 3 months. Multivariate analysis showed that the women, partial-thickness rotator cuff tear, and acromioplasty were risk factors for pain at 3 days after operation ( P<0.05); the women, combined with fatty infiltration, partial-thickness rotator cuff tear, and acromioplasty were the risk factors at 6 weeks ( P<0.05); and the women, combined with fatty infiltration, and partial-thickness rotator cuff tear were risk factors at 3 months ( P<0.05). CONCLUSION Among patients undergoing arthroscopic rotator cuff repair, women, those with smaller rotator cuff tears, combined with fatty infiltration, and acromioplasty have more severe pain within 3 months after operation, and attention should be paid to postoperative analgesia in these patients management, providing an individualized approach to rehabilitation, and closer follow-up.
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Rodriguez S, Mancini MR, Kakazu R, LeVasseur MR, Trudeau MT, Cote MP, Arciero RA, Denard PJ, Mazzocca AD. Comparison of the Coracoid, Distal Clavicle, and Scapular Spine for Autograft Augmentation of Glenoid Bone Loss: A Radiologic and Cadaveric Assessment. Am J Sports Med 2022; 50:717-724. [PMID: 35048738 DOI: 10.1177/03635465211065446] [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: 01/31/2023]
Abstract
BACKGROUND Glenohumeral instability caused by bone loss requires adequate bony restoration for successful surgical stabilization. Coracoid transfer has been the gold standard bone graft; however, it has high complication rates. Alternative autologous free bone grafts, which include the distal clavicle and scapular spine, have been suggested. STUDY DESIGN Controlled laboratory study. PURPOSE The purpose of this study was to determine the percentage of glenoid bone loss (GBL) restored via coracoid, distal clavicle, and scapular spine bone grafts using a patient cohort and a cadaveric evaluation. METHODS Autologous bone graft dimensions from a traditional Latarjet, congruent arc Latarjet, distal clavicle, and scapular spine were measured in a 2-part study using 52 computed tomography (CT) scans and 10 unmatched cadaveric specimens. The amount of GBL restored using each graft was calculated by comparing the graft thickness with the glenoid diameter. RESULTS Using CT measurements, we found the mean percentage of glenoid restoration for each graft was 49.5% ± 6.7% (traditional Latarjet), 45.1% ± 4.9% (congruent arc Latarjet), 42.2% ± 7.7% (distal clavicle), and 26.2% ± 8.1% (scapular spine). Using cadaveric measurements, we found the mean percentage of glenoid restoration for each graft was 40.2% ± 5.0% (traditional Latarjet), 53.4% ± 4.7% (congruent arc Latarjet), 45.6% ± 8.4% (distal clavicle), and 28.2% ± 7.7% (scapular spine). With 10% GBL, 100% of the coracoid and distal clavicle grafts, as well as 88% of scapular spine grafts, could restore the defect (P < .001). With 20% GBL, 100% of the coracoid and distal clavicle grafts but only 66% of scapular spine grafts could restore the defect (P < .001). With 30% GBL, 100% of coracoid grafts, 98% of distal clavicle grafts, and 28% of scapular spine grafts could restore the defect (P < .001). With 40% GBL, a significant difference was identified (P = .001), as most coracoid grafts still provided adequate restoration (congruent arc Latarjet, 82.7%; traditional Latarjet, 76.9%), but distal clavicle grafts were markedly reduced, with only 51.9% of grafts maintaining sufficient dimensions. CONCLUSIONS The coracoid and distal clavicle grafts reliably restored up to 30% GBL in nearly all patients. The coracoid was the only graft that could reliably restore up to 40% GBL. CLINICAL RELEVANCE With "subcritical" GBL (>13.5%), all autologous bone grafts can be used to adequately restore the bony defect. However, with "critical" GBL (≥20%), only the coracoid and distal clavicle can reliably restore the bony defect.
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Affiliation(s)
- Santiago Rodriguez
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Rafael Kakazu
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Maxwell T Trudeau
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
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Hurley ET, Davey MS, Montgomery C, Moore DM, Mojica ES, Gaafar M, Pauzenberger L, Jazrawi LM, Mullett H. Analysis of Athletes Who Did Not Return to Play After Open Latarjet. Orthop J Sports Med 2022; 10:23259671211071082. [PMID: 35187183 PMCID: PMC8851950 DOI: 10.1177/23259671211071082] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/08/2021] [Indexed: 02/03/2023] Open
Abstract
Background: The Latarjet procedure is indicated in patients with risk factors for postoperative recurrence, including collision and competitive athletes. However, the factors that prevent athletes from being able return to play (RTP) after the open Latarjet procedure are still unclear and have not been fully elucidated in the literature. Purpose: To evaluate patient-reported outcomes and psychological and psychosocial factors associated with athletes who did not RTP after the open Latarjet procedure compared with patients who did RTP. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a retrospective review of athletes who underwent the open Latarjet procedure and subsequently did not RTP after a minimum of 12 months. These patients were pair matched in a 2:1 ratio for age, sex, sport, and level of preoperative play with a control group who returned to play. Patients were evaluated for their psychological readiness to return to sport using the Shoulder Instability–Return to Sport after Injury (SIRSI); other measures included the visual analog scale (VAS) for pain and Subjective Shoulder Value (SSV). Multivariate regression models were used to evaluate factors affecting RTP. Results: Included were 35 patients in the no-RTP group and 70 patients in the RTP group. In the no-RTP group, 7 patients (20%) passed the SIRSI benchmark of 56, with a mean overall score of 41.5 ± 21.9; in the RTP group, 57 patients (81.4%) passed the SIRSI benchmark, with a mean overall score of 74.5 ± 19.8 (P < .0001 for both). Patients in the RTP group had better SSV (88.0 vs 75.7; P <.0001) and VAS pain (1.7 vs 2.9; P = .0046) scores. Of the athletes who did not return, 18 felt persistent pain/apprehension and 17 felt that it was a natural end to their career or that their lifestyle had changed. Multiple logistic regression revealed that thoughts of having to go through surgery and rehabilitation again was significantly associated with lower RTP (P < .05). Conclusion: Patients who did not RTP after open Latarjet exhibited poor psychological readiness to RTP and worse pain VAS and SSV scores compared with patients who did RTP.
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Affiliation(s)
- Eoghan T. Hurley
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- National University of Ireland, Galway, Ireland
- NYU Langone Health, New York, New York, USA
| | - Martin S. Davey
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- National University of Ireland, Galway, Ireland
| | | | - David M. Moore
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Nourissat G, Housset V, Lehanneur M, Bastard C. Editorial Commentary: A Functional Capsule, Not the Type of Bone Graft, Determines Outcome After Shoulder Stabilization in Cases of Anterior Glenoid Bone Deficiency. Arthroscopy 2021; 37:2409-2411. [PMID: 34353552 DOI: 10.1016/j.arthro.2021.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 02/02/2023]
Abstract
Many clinical results of surgical treatment of recurrent anterior shoulder instability confirm the importance of anterior bone grafting of the glenoid defect. Some studies even propose to perform a graft, even when there is no bony defect. Short- and middle-term studies report comparable results between bone grafting and Latarjet procedure. But one of the main questions that still remains is the quality and efficiency of the capsule. If Latarjet is the gold standard in anterior shoulder stabilization with very good results at very long follow-up, it is probably because the capsule is replaced by the conjoint tendon. Because Latarjet is a difficult surgery and has some complexes and/or challenging complications and because it is a nonanatomic procedure, there is a true place for anterior bone grafting. This anterior grafting under arthroscopy provides excellent results, but it is mandatory to be sure that the shoulder capsule is working. Clinical, functional, and imaging studies of this capsule need to be performed for a better understanding of the unstable shoulder function and treatment.
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Short-term complications of the Latarjet procedure: a systematic review. J Shoulder Elbow Surg 2021; 30:1693-1699. [PMID: 33607332 DOI: 10.1016/j.jse.2021.01.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the short-term complication rate following the open and arthroscopic Latarjet procedures and to meta-analyze the studies comparing the 2 approaches. METHODS PubMed was searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to find clinical and biomechanical studies comparing complication rates in open and arthroscopic Latarjet procedures. A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the PRISMA guidelines. Clinical studies reporting on the complications following the open or arthroscopic Latarjet were included. Meta-analysis was performed for comparative studies using Review Manager, version 5.3. A P value of <.05 was considered statistically significant. RESULTS Overall, 89 studies (Level of Evidence [LOE] I: 2, LOE II: 2, LOE III: 24, LOE IV: 61) met inclusion criteria, with 7175 shoulders. Following the open Latarjet procedure, the overall complication rate was 6.1%, with a 1.9% occurrence of graft-related complications, 1.1% hardware, 1.1% wound, 0.9% nerve, and 1.2% other complications. Following the arthroscopic Latarjet procedure, the overall complication rate was 6.8%, with a 3.2% occurrence of graft-related complications, 1.9% hardware, 0.5% wound, 0.7% nerve, and 0.5% other complications. Complications were reported in 7 studies comparing 379 patients treated with the open Latarjet and 531 treated with the arthroscopic Latarjet, with no statistically significant difference between the two (P = .81). CONCLUSION Our study established that the overall complication rate following the Latarjet procedure was 6%-7%, with the most common complication being graft-related. Furthermore, based on the current evidence, there is no significant difference in the complication rate between the open and arthroscopic Latarjet procedures.
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16
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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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Abstract
The rate of recurrence of anterior unidirectional instability is lower after coracoid bone-block than with other techniques, even if failures still occur with this difficult procedure. Failure may consist in recurrent instability (dislocation, subluxation, unstable painful shoulder) or despite absence of obvious clinical signs, in radiologic failure (non-union, fracture), biologic failure (osteolysis) or infection, all of which may require revision surgery or lead to late instability or subclinical chronic apprehension. Clinical, X-ray and CT assessment identifies the type of failure and may lead to a second surgery being discussed with the patient according to functional demand. Technical error is often implicated and is generally due to deficient coracoid preparation, insufficient conjoint and coracoid tendon release or problems of positioning and fixing the bone-block on the glenoid. There are 2 types of revision surgery. Iliac bone-block involves the same demands as coracoid bone-block; it stabilises the shoulder and provides very good functional results. Although less effective, anterior capsule repair can also stabilise the shoulder when associated to posterior Hill-Sachs lesion remplissage by infraspinatus tenodesis. Osteoarthritis of the shoulder may set in after any surgical revision and impair the result.
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Affiliation(s)
- Pierre Métais
- Service de chirurgie du membre supérieur, Elsan, hôpital privé la Châtaigneraie, 59, rue de la Châtaigneraie, 63110 Beaumont, France.
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18
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Bohu Y, Abadie P, van Rooij F, Nover L, Berhouet J, Hardy A. Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores. Knee Surg Sports Traumatol Arthrosc 2021; 29:2606-2615. [PMID: 33743029 PMCID: PMC8298242 DOI: 10.1007/s00167-021-06475-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Systematic reviews report return to play (RTP) within 5.8 months (range, 3-8) following the Latarjet procedure, but the factors that influence RTP remain unknown. The present study aimed to report the rate and time of return to play (RTP) during the first 8 months following the Latarjet procedure, and to determine the influence of sport type or patient characteristics. METHODS The authors retrospectively collected the records of patients that underwent Latarjet procedures for anterior shoulder instability between 2015 and 2017. Patients were excluded if they had any concomitant rotator cuff tendon lesions, or previous ipsilateral shoulder surgery. The authors retrieved patient demographics, time from injury to surgery, type of sport practiced (overhead/non-overhead, contact/non-contact), as well as pre- and postoperative Western Ontario Shoulder Instability index (WOSI), Shoulder Instability-Return to Sport After Injury index (SIRSI), and Rowe score. RESULTS A total of 217 patients (217 shoulders) were eligible for inclusion, comprising 184 males and 33 females, aged 26.8 ± 7.3 years at index surgery. The main sport practiced prior to surgery involved overhead (n = 173, 80%) and/or contact (n = 152, 70%) activities. By 8 month follow-up, 158 patients (73%) resumed their main sport, at a mean of 5.1 ± 1.5 months. Multivariable analysis revealed that RTP was more likely in patients with higher preoperative Rowe score (OR, 1.02; p = 0.024) and SIRSI score (OR, 1.02; p = 0.008). CONCLUSIONS By 8 months following the Latarjet procedure, 73% of patients had resumed their main sport. The likelihood of RTP was significantly associated with preoperative Rowe and SIRSI scores, but not with sport type. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yoann Bohu
- Clinique du Sport Paris V, Ramsay Santé, Paris, France.
| | - Pierre Abadie
- Clinique du Sport de Bordeaux-Merignac, Mérignac, France
| | | | - Luca Nover
- ReSurg SA, 22 Rue Saint Jean, 1260 Nyon, Switzerland
| | | | | | - Alexandre Hardy
- Clinique du Sport Paris V, Ramsay Santé, Paris, France ,Ambroise Paré Hospital, Boulogne-Billancourt, France
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Siegert P, Plachel F, Akgün D, Baur ADJ, Schulz E, Auffarth A, Tauber M, Moroder P. Comparison of Structural Subscapularis Integrity After Latarjet Procedure Versus Iliac Crest Bone Graft Transfer. Orthop J Sports Med 2020; 8:2325967120958007. [PMID: 33110928 PMCID: PMC7564622 DOI: 10.1177/2325967120958007] [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: 07/08/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Although clinical outcome scores are comparable after coracoid transfer
procedure (Latarjet) and iliac crest bone graft transfer (ICBGT) for
anterior shoulder instability with glenoid bone loss, a significant decrease
in internal rotation capacity has been reported for the Latarjet
procedure. Hypothesis: The subscapularis (SSC) musculotendinous integrity will be less compromised
by ICBGT than by the Latarjet procedure. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively analyzed pre- and postoperative computed tomography (CT)
scans at short-term follow-up of 52 patients (26 Latarjet, 26 ICBGT)
previously assessed in a prospective randomized controlled trial.
Measurements included the preoperative glenoid defect area and graft area
protruding the glenoid rim at follow-up and tendon thickness assessed
through SSC and infraspinatus (ISP) ratios. Fatty muscle infiltration was
graded according to Goutallier, quantified with muscle attenuation in
Hounsfield units, and additionally calculated as percentages. We measured 3
angles to describe rerouting of the SSC musculotendinous unit around the
bone grafts. Results: SSC fatty muscle infiltration was 2.0% ± 2.2% in the Latarjet group versus
2.4% ± 2.2% in ICBGT (P = .546) preoperatively and showed
significantly higher values in the Latarjet group at follow-up (5.3% ± 4.5%
vs 2.3% ± 1.7%; P = .001). In total, 4 patients (15.4%) in
the Latarjet group showed a progression from grade 0 to grade 1 at
follow-up, whereas no changes in the ICBGT group were noted. The measured
rerouting angle of the SSC muscle was significantly increased in the
Latarjet group (11.8° ± 2.1°) compared with ICBGT (7.5° ± 1.3°;
P < .001) at follow-up, with a significant positive
correlation between this angle and fatty muscle infiltration
(R = 0.447; P = .008). Ratios of
SSC/ISP tendon thickness were 1.03 ± 0.3 in the Latarjet group versus 0.97 ±
0.3 (P = .383) in ICBGT preoperatively and showed
significantly lower ratios in the Latarjet group (0.7 ± 0.3 vs 1.0 ± 0.2;
P < .001) at follow-up. Conclusion: Although clinical outcome scores after anterior shoulder stabilization with a
Latarjet procedure and ICBGT are comparable, this study shows that the
described decline in internal rotation capacity after Latarjet procedure has
a radiographic structural correlate in terms of marked thinning and
rerouting of the SSC tendon as well as slight fatty degeneration of the
muscle.
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Affiliation(s)
- Paul Siegert
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Department for Shoulder and Elbow Surgery, Berlin, Germany
| | - Fabian Plachel
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Doruk Akgün
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Department for Shoulder and Elbow Surgery, Berlin, Germany
| | - Alexander D J Baur
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Eva Schulz
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Alexander Auffarth
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Mark Tauber
- Department for Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
| | - Philipp Moroder
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Department for Shoulder and Elbow Surgery, Berlin, Germany
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