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Zhang C, Yang S, Pang L, Li T, Li Y, Wang H, Huang Y, Tang X. Salvage Latarjet may provide worse outcomes in terms of recurrent instability and returning to sports compared to primary Latarjet: a systematic review of comparative studies. BMC Musculoskelet Disord 2024; 25:500. [PMID: 38937741 PMCID: PMC11212418 DOI: 10.1186/s12891-024-07593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The Latarjet procedure (LP) is performed as a primary stabilization procedure (primary LP) and a salvage procedure when an earlier shoulder stabilization procedure has failed (salvage LP). However, whether primary LP or salvage LP provides better outcomes for anterior shoulder instability remains unknown. METHODS Two independent reviewers performed the literature search based on the PRISMA guidelines. A comprehensive search of PubMed, Embase, web of science and Cochrane Library was performed from their inception date to December 4, 2023. Inclusion criteria mainly included the comparison of postoperative outcomes between primary and salvage LP, English language, and full text availability. Two reviewers independently examined the literature, collected data, and evaluated the methodological robustness of the included studies. The Methodological Index for Nonrandomized Studies was used to evaluate the quality of nonrandomized studies. Recurrent instability, complications, reoperations, return to sports, patient-reported outcomes, and range of motion were assessed. Statistical evaluations were conducted using Manager V.5.4.1 (The Cochrane Collaboration, Software Update, Oxford, UK). RESULTS Twelve studies were included in the systematic review, with 940 shoulders undergoing primary LP and 631 shoulders undergoing salvage LP. Statistically significant differences in favor of primary LP were found in 2 of the 11 and 2 of 4 included studies in terms of recurrent instability and returning to the same sports (RTS) at preinjury level, respectively. In terms of the visual analog scale, subjective shoulder value and the Western Ontario Shoulder Instability Index, 2 of the 4, 1 of the 3 and 1 of the 3 included studies reported statistically significant differences in favor of primary LP. Differences were not noticed regarding complications, reoperations, the time to RTS, the Rowe score, the Athletic Shoulder Outcome Scoring System, and forward flexion. CONCLUSION Current evidence suggests that compared with primary LP, salvage LP may provide inferior postoperative outcomes in terms of recurrent instability and the rate of RTS at preinjury level. Primary and salvage LP may yield comparable efficacy in terms of complications, reoperations, the rate of RTS, the time to RTS, pain, shoulder function, and range of motion. PROSPERO ID CRD42023492027.
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Affiliation(s)
- Chunsen Zhang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Songyun Yang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Santai County People's Hospital, Mianyang, 621199, China
| | - Long Pang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Tao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yinghao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Haoyuan Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yizhou Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Aboalata M, Plath J, Eltair H, Vogt S, Imhoff AB. Long-term results of arthroscopic capsulolabral revision repair for failed anterior shoulder instability repair using suture anchors at a minimum of 10 years follow-up. Arch Orthop Trauma Surg 2024; 144:2683-2689. [PMID: 38693287 DOI: 10.1007/s00402-024-05304-7] [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: 05/13/2022] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Arthroscopic revision anterior shoulder instability repair has been proposed, and early clinical results have been promising. However, long-term results after this procedure and the probable risk factors for failure have not been sufficiently discussed in the literature. MATERIALS AND METHODS Thirty-eight patients who were diagnosed with recurrent anteroinferior shoulder instability after failed Bankart repair, treated with ACRR between September 1998 and November 2003 and able to be contacted were included. Of these patients, 2 were excluded from the study due to the use of SureTak anchors for fixation, and 5 other patients refused to participate in the study due to lack of interest (3 patients) or lack of time (2 patients). The remaining shoulders were clinically examined at a minimum of ten years after surgery via the ASES, Constant, AAOS, Rowe, Dawson and VAS scores for pain and stability. Degenerative arthropathy was assessed with the modified Samilson-Prieto score. RESULTS All 31 remaining shoulders were evaluated at a mean time of 11.86 years (142.4 months) after surgery. Six patients (19.35%) reported redisolcation after the revision procedure, 4 of whom were affected by a new significant shoulder trauma. The ROWE and Constant scores improved significantly. Moderate to severe dislocation arthropathy was observed in 19.4% of patients. Five patients (16.2%) were not satisfied with the procedure. CONCLUSION Long-term follow-up after ACRR shows predictable results, with a high degree of patient satisfaction, good to excellent patient-reported outcome scores and minimal radiological degenerative changes. However, with an average recurrence rate of 19.3% after 11.86 years, the redislocation rate appears high. With careful patient selection, recurrence rates can be significantly reduced.
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Affiliation(s)
- Mohamed Aboalata
- Department of orthopaedic Surgery, Mansoura University, Mansoura, Egypt.
- Department of Orthopaedic Surgery, Rhön klinik Campus Bad Neustadt, Bad Neustadt an der Saale, Germany.
| | - Johannes Plath
- Department of Trauma Surgery, Hand and Plastic Surgery, University of Augsburg, Augsburg, Germany
| | - Hani Eltair
- Department of Orthhopedic surgery, Students' hospital Mansoura University, Mansoura, Egypt
- Department of Orthopedic surgery, Bad Windsheim hospital, Bad Windsheim, Germany
| | - Stephan Vogt
- Department of sport orthopaedic, Hessing clinic, Augsburg, Germany
| | - Andreas B Imhoff
- Department of orthopaedic sports medicine, Klinikum Rechts der Isar, TUM, Munich, Germany
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Jackson GR, Tuthill T, Asif S, DeWald D, Wessels M, McCormick JR, Mameri ES, Knapik DM, Familiari F, Hevesi M, Batra AK, Chahla J, Verma NN. Clinical outcomes, return to sport, and complications after isolated primary Latarjet versus Latarjet as a revision procedure: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2024; 110:103810. [PMID: 38159640 DOI: 10.1016/j.otsr.2023.103810] [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: 07/10/2023] [Revised: 10/23/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The purpose of this review was to compare clinical outcomes, return to sport (RTS), and complications in comparative studies examining patients undergoing primary Latarjet procedure versus Latarjet in the revision setting following soft tissue stabilization. METHODS A literature search was conducted using PubMed and Scopus databases using Preferred Reporting Items for Systematic Meta-Analyses guidelines. Inclusion criteria consisted of level I to III human clinical studies reporting clinical outcomes (Visual Analogue Pain Scale [VAS]), RTS metrics, and complications in patients following primary versus revision Latarjet procedures. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS A total of seven studies, consisting of 1170 patients (n=1179 shoulders) with a mean age of 26.4 years, consisting of 91.9% males (n=1083/1179 shoulders), were identified. Mean final follow-up was 46.4 (mean range, 7.3-72.2) months. A total of 748 primary and 431 revision Latarjet procedures were analyzed. Complications were reported in 9.6% (range, 0%-24.2%) of patients undergoing primary and 20.2% (range, 0%-40.7%) in patients undergoing revision procedures (p=0.22). There was no significant difference in the RTS rate between patients undergoing primary (87.3%; range, 83.8%-92.1%) versus Latarjet as a revision procedure (78.9%; range, 60%-100%) (p=0.08). Moreover, no significant difference in postoperative VAS was observed in patients undergoing primary versus Latarjet as a revision procedure (p=0.21). Recurrent shoulder subluxation was significantly greater in patients undergoing revision (12.0%; n=31/259 shoulders; range, 0%-20.7%) compared to primary procedures (3.3%; n=27/511 shoulders; range, 0%-9%) (p<0.001). DISCUSSION Patients undergoing primary and revision Latarjet demonstrated overall similar rates of complications and return to sport. Of clinical importance, Latarjet as a revision procedure possessed a risk of recurrent subluxation 3.6 times higher than primary Latarjet. While effective, patients should be counseled regarding the differing prognosis between Latarjet as a primary or revision procedure. LEVEL OF EVIDENCE III; Systematic review and meta-analysis.
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Affiliation(s)
- Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA.
| | - Trevor Tuthill
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Shaan Asif
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Daniel DeWald
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Morgan Wessels
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Johnathon R McCormick
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA; Instituto Brasil de Tecnologia da Saúde, 407 Visconde de Piraja St., 22410 Rio de Janeiro, RJ, Brazil; Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), 740 Botucatu St., 04023 São Paulo, SP, Brazil
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, 14532 South Outer Forty Drive, 63017 Chesterfield, MO, USA
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, V.le Europa (loc. Germaneto), 88100 Catanzaro, Italy
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, 55905 Rochester, MN, USA
| | - Anjay K Batra
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611W Harrison St., 60612 Chicago, IL, USA
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Calvo E, Dzidzishvili L, Valencia M, Calvo C. Outcomes of Arthroscopic Latarjet as a Revision Surgery After Failed Arthroscopic Bankart Repair. Am J Sports Med 2024; 52:190-200. [PMID: 38164667 DOI: 10.1177/03635465231209986] [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: 01/03/2024]
Abstract
BACKGROUND The role of arthroscopic Latarjet as a revision surgery after failed arthroscopic Bankart repair has yet to be established. PURPOSE To compare clinical outcomes, recurrences, and complication rates of arthroscopic Latarjet as a revision procedure after failed arthroscopic Bankart repair versus arthroscopic Latarjet as a primary procedure. DESIGN Cohort study; Level of evidence, 3. METHODS This is a retrospective study of prospectively collected data of patients who were diagnosed with anterior shoulder instability and underwent arthroscopic Latarjet stabilization between 2009 and 2018. Patients were separated into 2 groups depending on whether Latarjet was performed after a previous instability surgery (revision) or as a primary surgery (primary). Rowe score, Western Ontario Shoulder Instability Index (WOSI), Constant-Murley Shoulder Outcome (CMSO) score, and Single Assessment Numeric Evaluation (SANE) were assessed pre- and postoperatively with a minimum 24 months of follow-up. In addition, pre- and postoperative levels of sports activity, dislocations, subluxations, and complications were assessed. RESULTS A total of 97 patients (n = 62 revision; n = 35 primary), with a mean age of 31.0 ± 8.8 and 29.4 ± 7.6 years old in the revision and primary Latajet group, respectively, met the inclusion criteria. The mean follow-up in the revision group was 32 months (24-53) and 35.5 months (27.7-42.2) in the primary Latarjet group. No significant differences between groups were observed in Rowe score (revision = 91.4, primary = 94.1; P = .223), CMSO score (revision = 90.7, primary = 94; P = .105), and SANE (revision = 85.8, primary = 87.3; P = .683) postoperatively. However, the postoperative difference in the WOSI score between the revision and primary Latarjet groups was nearly significant (510 ± 334 vs 403 ± 343, respectively; P = .05). Four (6.4%) postoperative dislocations were reported in the revision and 1 (2.8%) in the primary Latarjet group (P = .14). Patients in the revision group had a lower return to the previous level of sports participation (P = .008) and decreased external rotation with the arm by the side compared with the primary Latarjet group (P = .000). CONCLUSION Arthroscopic Latarjet as a revision surgery is a reasonable surgical option in failed Bankart repair cases. The decision to perform arthroscopic Latarjet stabilization as a revision surgery should not be influenced by the potential risk of future complications as it provides comparable clinical outcomes to the primary Latarjet procedure with a low postoperative recurrence rate. However, a decreased level of postoperative sports participation and external rotation with the arm by the side can be expected.
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Affiliation(s)
- Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lika Dzidzishvili
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Claudio Calvo
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Alkhelaifi K, Alzobi OZ, Mahmoud SA, Zikria BA. Recurrent Instability after the Latarjet Procedure. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202312000-00001. [PMID: 38011051 PMCID: PMC10664849 DOI: 10.5435/jaaosglobal-d-23-00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023]
Abstract
The Latarjet procedure is a favored approach for managing chronic and recurrent dislocation, especially in the presence of bone loss. Although generally yielding excellent results, the procedure carries a 15 to 30% complication rate. Although recurrent instability is a major concern, various complications such as infection, nerve injuries, and hardware impingement can also necessitate revision after a Latarjet procedure. Strategies for addressing this issue include glenoid bone grafting, using autogenous bone grafts from the iliac crest or distal clavicle, and allografts, with fresh lateral distal tibial allografts offering advantages because of their osteochondral nature. In addition, soft-tissue procedures offer another solution for recurrent instability, suitable for patients lacking substantial bone loss or those experiencing multidirectional instability. This review aims to provide a comprehensive overview of the causes and management strategies for recurrent instability following a failed Latarjet procedure.
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Affiliation(s)
- Khalid Alkhelaifi
- From the Orthopaedic Surgeon, Aspetar-Qatar Orthopaedic and Sports Medicine Hospital, Qatar (Dr. Alkhelaifi and Dr. Zikria), and the Department of Orthopeadic (Dr. Alzobi and Dr. Mahmoud), Hamad General Hospital, Qatar
| | - Osama Z. Alzobi
- From the Orthopaedic Surgeon, Aspetar-Qatar Orthopaedic and Sports Medicine Hospital, Qatar (Dr. Alkhelaifi and Dr. Zikria), and the Department of Orthopeadic (Dr. Alzobi and Dr. Mahmoud), Hamad General Hospital, Qatar
| | - Shady A. Mahmoud
- From the Orthopaedic Surgeon, Aspetar-Qatar Orthopaedic and Sports Medicine Hospital, Qatar (Dr. Alkhelaifi and Dr. Zikria), and the Department of Orthopeadic (Dr. Alzobi and Dr. Mahmoud), Hamad General Hospital, Qatar
| | - Bashir A. Zikria
- From the Orthopaedic Surgeon, Aspetar-Qatar Orthopaedic and Sports Medicine Hospital, Qatar (Dr. Alkhelaifi and Dr. Zikria), and the Department of Orthopeadic (Dr. Alzobi and Dr. Mahmoud), Hamad General Hospital, Qatar
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Song Q, Zhang S, Bai J, Cheng X, Luo H, Shao Z, Cui G. Previously failed Bankart repair and the duration from first dislocation to surgery were the risk factors associated with the level of return to sports after coracoid transfer. Knee Surg Sports Traumatol Arthrosc 2023; 31:4052-4059. [PMID: 37212830 DOI: 10.1007/s00167-023-07453-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE This study aims to determine the rate of different levels of return to sports (RTS) in athletes undergoing the modified arthroscopic Bristow procedure and the factors associated with the level of RTS. METHODS The study was performed retrospectively on patients with traumatic anterior shoulder instability who underwent the modified arthroscopic Bristow procedure with a minimum follow-up of 2 years. The RTS rate, the level of return and the timing of return were assessed. Additionally, factors such as preoperative basic information, clinical outcomes, graft position, graft healing and graft absorption were analysed to investigate their correlation with the level of RTS. Multivariate regression models were used to evaluate the factors affecting the level of RTS. RESULTS In total, this study included 182 shoulders of 177 athletes undergoing the modified arthroscopic Bristow procedure. Of these patients, 142 (78.0%) shoulders of 137 athletes were enrolled, with a mean of 3.3-year follow-up. At the final follow-up, 134 (94.4%) shoulders were able to RTS, 123 (86.6%) shoulders were able to RTS to the pre-injury level, 52 (36.6%) shoulders could be completely "forgotten" without any psychological barrier during exercise. The multivariate logistic regression analysis identified the variable associated with RTS at the pre-injury level as previously failed arthroscopic Bankart repair (p < 0.001). As for the "forgetting" operated shoulder, the duration from first dislocation to surgery was a significant independent predictor (p = 0.034). CONCLUSION Although a large majority of athletes were able to RTS at the pre-injury level after the modified arthroscopic Bristow procedure, about two-thirds of the athletes felt difference in shoulders on both sides and could not completely "forget" the operated shoulder during exercise. Previously failed Bankart repair and the duration from first dislocation to surgery were the risk factors associated with the level of RTS after the modified arthroscopic Bristow procedure. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Qingfa Song
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Shuhan Zhang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jucheng Bai
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Xu Cheng
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Hao Luo
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Zhenxing Shao
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Guoqing Cui
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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Lho T, Lee J, Oh KS, Chung SW. Latarjet procedure for failed Bankart repair provides better stability and return to sports, but worse postoperative pain and external rotation limitations with more complications, compared to revision Bankart repair: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07410-2. [PMID: 37038019 DOI: 10.1007/s00167-023-07410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE This study aimed to compare the clinical results of revision Bankart repair versus the Latarjet procedure for failed Bankart repair. METHODS A literature search was performed in databases, such as Pubmed, Embase, and Scopus Library. The studies were appraised using the Methodological Index for Non-randomized Studies tool. Studies for failed Bankart repair with revision Bankart repair or Latarjet procedure were included. The pain VAS, ROWE score, rate of return to sports and preinjury level of sports, recurrent instability, range of motion, and complications were compared. Additionally, the pain VAS, ROWE score, forward flexion, and external rotation at side were subjected to a meta-analysis. RESULTS Twenty-four articles were included in the systematic review. The functional outcomes in terms of the ROWE score, recurrent instability, return to sports, and the preinjury level of sports was better in the Latarjet procedure group than those in the revision Bankart repair group (ROWE score, 91 vs. 86.7; recurrent instability rate, 3.5% vs. 14.4%; return to sports rate, 100% vs. 87.9%; return to preinjury level of sports rate, 89.9% vs. 74.9%; all P < 0.001). However, the results of postoperative pain and the postoperative limitation of external rotation at side were worse in the Latarjet procedure group than those in the revision Bankart repair group (pain VAS, 1.4 vs. 0.8; postoperative external rotation at side, 38° vs. 60°; all P < 0.001). In addition, the majority of the complications occurred in the Latarjet procedure group. In the meta-analysis, the postoperative ROWE score was significantly higher in the Latarjet procedure group than that in the revision Bankart group (revision Bankart repair: 95% CI 88.9-80.9, I2 = 65.70; Latarjet procedure: 95% CI 95.8-88.1, I2 = 93.37; P = 0.014). However, the pain VAS, forward flexion, and external rotation at side did not reach the significant level in the meta-analysis. CONCLUSION Compared with revision Bankart repair, the Latarjet procedure for failed Bankart repair showed better ROWE scores, stability, and return to sports or preinjury level of sports; however, the postoperative pain and the limitation of external rotation at side were worse with more complications. IRB NO KUMC 2022-01-024. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Taewoo Lho
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - JiHwan Lee
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea.
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van Iersel TP, van Spanning SH, Verweij LPE, Priester-Vink S, van Deurzen DFP, van den Bekerom MPJ. Bony reconstruction after failed labral repair is associated with higher recurrence rates compared to primary bony reconstruction: a systematic review and meta-analysis of 1319 shoulders in studies with a minimum of 2-year follow-up. J Shoulder Elbow Surg 2022; 31:1982-1991. [PMID: 35430365 DOI: 10.1016/j.jse.2022.02.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is uncertainty with regard to the optimal revision procedure after failed labral repair for anterior shoulder instability. An overview of outcomes of these procedures with quantitative analysis is not available in literature. The aim of this review is (1) to compare recurrence rates after revision labral repair (RLR) and revision bony reconstruction (RBR), both following failed labral repair. In addition, (2) recurrence rates after RBR following failed labral repair and primary bony reconstruction (PBR) are compared to determine if a previous failed labral repair influences the outcomes of the bony reconstruction. METHODS Randomized controlled trials and cohort studies with a minimum follow-up of 2 years and reporting recurrence rates of (1) RBR following failed labral repair and PBR and/or (2) RLR following failed labral repair and RBR following failed labral repair were identified by searching PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, and Web of Science/Clarivate Analytics. RESULTS Thirteen studies met the inclusion criteria and comprised 1319 shoulders. Meta-analyses showed that RBR has a significantly higher recurrence rate than PBR (risk ratio [RR] 0.51, P < .008) but found no significant difference in the recurrence rates for RLR and RBR (RR 1.40, P < .49). Also, no significant differences were found between PBR and RBR in return to sport (RR 1.07, P < .41), revision surgery (RR 0.8, P < .44), and complications (RR 0.84, P < .53). Lastly, no significant differences between RLR and RBR for revision surgery (RR 3.33, P < .19) were found. CONCLUSION The findings of this meta-analyses show that (1) RBR does not demonstrate a significant difference in recurrence rates compared with RLR and that (2) RBR has a significantly higher recurrence rate than PBR.
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Affiliation(s)
- Theodore P van Iersel
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.
| | - Sanne H van Spanning
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Lukas P E Verweij
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | | | - Derek F P van Deurzen
- Trauma Unit & Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Danilkowicz RM, Crook B, Kim J, Robinette JP, O’Donnell J, Grimm NL. Patient Factors Associated With Increased Risk for Complications After the Latarjet Procedure. Orthop J Sports Med 2022; 10:23259671211062573. [PMID: 35198640 PMCID: PMC8859666 DOI: 10.1177/23259671211062573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background: The open Latarjet has become the most common method of addressing significant glenoid bone loss in patients with recurrent glenohumeral instability. Purpose: To describe national trends in Latarjet procedures and risk factors for complications associated with this procedure. Study Design: Cohort study; Level of evidence, 3. Methods: Eligible patients were identified through the National Surgical Quality Improvement Program (NSQIP) data set over the years 2014 to 2018 by using the Current Procedural Terminology (CPT) code for “capsulorrhaphy anterior with coracoid process transfer” (CPT 23462). Patient and surgical outcome variables were extracted and analyzed from the NSQIP database. Logistic regression analysis and odds ratios (ORs) were performed to evaluate the relative risk of complications. Results: The authors identified 458 patients (399 men and 59 women) from the data set. The mean body mass index was 27.4 kg/m2, and mean operative time was 130.2 minutes. Statistically significant variables included smoking status and sex, which were further stratified. Smokers were 2.19 times more likely to experience at least 1 adverse outcome, including deep vein thrombosis (DVT), pulmonary embolism, reoperation, wound infection, unplanned readmission, or readmission (95% CI, 0.62-7.82). Specifically, smokers were 7.8 times more likely to have a DVT (95% CI, 0.58-105.96), 1.4 times more likely to undergo reoperation (95% CI, 0.14-5.73), and 2.4 times more likely to have an unplanned readmission (95% CI, 0.19-28.68). Women were 2.2 times more likely to experience at least 1 adverse outcome. Specifically, women were found to be 6.4 times more likely to have a DVT (95% CI, 0.76-54.87), 4.1 times more likely to have an unplanned readmission (95% CI, 0.00-106.21), and 4.7 times more likely to have a readmission (95% CI, 0.00-13.92). Conclusion: The results indicate that smokers and female patients are at a higher risk of experiencing adverse outcomes and may require additional pre- and postprocedural precautions when undergoing the Latarjet procedure. With the increase in frequency, providers should be aware of patient-related factors that may lead to adverse outcomes.
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Affiliation(s)
- Richard M. Danilkowicz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Bryan Crook
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jaewhan Kim
- Department of Physical Therapy, University of Utah College of Health, Salt Lake City, Utah, USA
- Study Design and Biostatistics Center, University of Utah College of Health, Salt Lake City, Utah, USA
| | - Jesse Patton Robinette
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey O’Donnell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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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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Xiang M, Yang J, Chen H, Hu X, Zhang Q, Li Y, Jiang C. Arthroscopic Autologous Scapular Spine Bone Graft Combined With Bankart Repair for Anterior Shoulder Instability With Subcritical (10%-15%) Glenoid Bone Loss. Arthroscopy 2021; 37:2065-2074. [PMID: 33581303 DOI: 10.1016/j.arthro.2021.01.061] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study is to prove that the autologous scapular spine bone graft is an alternative for the treatment of anterior shoulder instability and the clinical and radiological results are promising. METHOD From July 2016 to August 2018, patients who were diagnosed as having anterior shoulder instability with subcritical (10%-15%) glenoid bone loss were treated by arthroscopic repair with autologous scapular spine bone graft. The inclusion criteria were (1) anterior shoulder instability underwent arthroscopic autologous scapular spine bone graft; (2) glenoid bone loss was within 10% to 15% (measured by Sugaya's method); (3) three complete sets of computed tomography (CT) scans (preoperative, 1 week after surgery, and 1 year after surgery) available; and (4) clinical follow-up time was at least 2 years. The exclusion criteria were (1) concomitant rotator cuff tear; (2) concomitant remplissage or SLAP repair; (3) previous surgery of the affected shoulder; (4) open surgery; and (5) incomplete radiological or clinical follow-up. The preoperative and postoperative Constant-Murley score, dietary approaches to stop hypertension (DASH) score, visual analog scale (VAS) score, and range of motion (ROM) were recorded. CT scans with 3-dimensional reconstruction were obtained at the first week after operation and at 1 year after operation; the graft resorption rate was consequently calculated. RESULTS Twenty-seven patients were qualified and enrolled in the study. No severe complication was recorded during follow-up. No redislocation or subluxation was found, and the apprehension tests were all negative. At the last follow-up, the mean Constant-Murley score was 89.74 ± 3.71, the mean DASH score was 9.77 ± 5.31, the mean VAS score was 0.74 ± 0.64, which are all improved significantly compared with preoperative scores (P = .00,.00,.00, respectively). At the last follow-up, the ROM including anterior flexion, external rotation by side, and the internal rotation were well restored without significant difference compared with the contralateral shoulder (P =.48, .08, .47, respectively). At 1 year after operation, the resorption rate of the bone graft was 19.4%. CONCLUSION This study found that anterior shoulder instability with subcritical (10%-15%) glenoid bone loss treated with arthroscopic autologous scapular spine bone graft with suture anchor fixation is safe and could achieve satisfactory result at short-term follow-up. LEVEL OF EVIDENCE Therapeutic case series.
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Affiliation(s)
- Ming Xiang
- Upper Limb Department, Sichuan Provincial Orthopaedic Hospital, Chengdu
| | - Jinsong Yang
- Upper Limb Department, Sichuan Provincial Orthopaedic Hospital, Chengdu
| | - Hang Chen
- Upper Limb Department, Sichuan Provincial Orthopaedic Hospital, Chengdu
| | - Xiaochuan Hu
- Upper Limb Department, Sichuan Provincial Orthopaedic Hospital, Chengdu
| | - Qing Zhang
- Upper Limb Department, Sichuan Provincial Orthopaedic Hospital, Chengdu
| | - Yiping Li
- Upper Limb Department, Sichuan Provincial Orthopaedic Hospital, Chengdu
| | - Chunyan Jiang
- Shoulder Service, Beijing Jishuitan Hospital, School of Medicine, Peking University, Beijing, China.
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