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Hurley ET, Doyle TR, Lorentz SG, Dickens JF. Editorial Commentary: Latarjet for Anterior Shoulder Instability Literature Shows Limited Reporting of Outcomes in Female Patients: Female Patients Show Similar Outcomes but Greater Rate of Emergency Department Visits and Possible Greater of Complications. Arthroscopy 2024:S0749-8063(24)00322-0. [PMID: 38703921 DOI: 10.1016/j.arthro.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
It has been reported that use of the Latarjet procedure for anterior shoulder instability increased 250% from 2008 to 2019. With this increase in use, it is imperative to minimize complications. At present, most literature focuses on male patients, with scant evidence regarding female patients. Outcomes are similar when female with male patients are compared, but female patients have greater postoperative visits to the emergency department than male patients, which requires specific attention during the postoperative period. In addition, the literature reporting complications in female versus male patients after Latarjet is conflicting; some studies show similar rates of complications, whereas other studies show greater rates of adverse events in female patients. Previous consensus statements recommended (1) careful dissection; (2) identification of the musculocutaneous and axillary nerves; (3) prevention of overlateralization of the graft; (4) the use of tranexamic acid to reduce blood loss; (5) accurate screw placement; and (6) careful preparation of the glenoid neck and coracoid to reduce rates of nonunion or delayed union.
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Berk AN, Ifarraguerri AM, Rao AJ, Dib AG, Hysong AA, Meade JD, Trofa DP, Fleischli JE, Schiffern SC, Hamid N, Saltzman BM. Outcomes of the Latarjet procedure in female patients: A case series and matched-pair analysis. Shoulder Elbow 2024; 16:76-84. [PMID: 38435033 PMCID: PMC10902412 DOI: 10.1177/17585732231217170] [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: 05/20/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 03/05/2024]
Abstract
Background The objective of this study was to retrospectively report on the outcomes of female patients undergoing the Latarjet procedure. Methods Female patients undergoing the Latarjet procedure with minimum 1 year follow-up were identified and contacted to obtain Numeric Pain Rating Scale (NPRS), Subjective Shoulder Value (SSV), and return to sport (RTS) data. Eligible females were then matched 1:1 with a male counterpart based on laterality and age (± 3 years), and outcomes compared. Results A total of 20 female patients with a mean follow-up of 73.8 months reported postoperative NPRS and SSV scores of 2.2 ± 2.3 and 69.3 ± 22.0, respectively. Of the nine athletes, 3 (33%) reported a successful RTS at a mean of 9 months. Four patients (20.0%) required reoperation at a mean of 27.1 months. The matched analysis demonstrated similar NPRS scores between male and female patients and a trend towards lower SSV scores and rates of RTS. Conclusion At mid-term follow-up female patients reported pain levels similar to female-specific literature reports, but overall low subjective shoulder function and RTS. Compared to propensity-matched males, females reported similar levels of pain, lower shoulder function, and lower rates of RTS, however, differences did not reach statistical significance. Level of Evidence IV, retrospective case series.
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Affiliation(s)
- Alexander N Berk
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Anna M Ifarraguerri
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Allison J Rao
- Department of Orthopedic Surgery, University of Minnesota Physicians, University of Minnesota, Minneapolis, MNN, USA
| | - Aseel G Dib
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Alexander A Hysong
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Joshua D Meade
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - James E Fleischli
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Shadley C Schiffern
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Nady Hamid
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Bryan M Saltzman
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
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Limam K, Barret H, Girard M, Letartre R, Mansat P, Bonnevialle N. Latarjet in women for anterior shoulder instability: a case series analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:633-639. [PMID: 37668751 DOI: 10.1007/s00590-023-03703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE The Latarjet procedure is traditionally used to treat chronic anterior shoulder instability associated with glenoid bone loss. However, few series have analyzed outcomes in a female-only population. The objective of this study was to evaluate the clinical and radiological outcomes of a Latarjet bone block in this specific population. METHODS This single-center retrospective study included 15 women (mean age 35 ± 11.3; 19-60) reviewed with a minimum follow-up of 2 years. The procedure was performed using the open bone block screw technique (n = 7) or by arthroscopy with cortical button (n = 8). Clinical evaluation was based on active range of motion measurements, Rowe and Walch-Duplay scores, and subjective shoulder value (SSV). Radiographic analysis explored bone block healing at the last follow-up. RESULTS At a mean follow-up of 48 months (32-86), no recurrence was reported. The mean Rowe score was 91 points (70-100), Walch-Duplay 90 points (60-100), and SSV 87% (70-100). The active mobilities reached 169° (± 9°) in elevation, 57° (± 15°) in external rotation at side, and 89° (± 6°) in abduction. The return-to-sport rate was 91%. Five patients experienced persistent anterior pain, with screws requiring hardware removal in 2 (p = 0.02). Radiological assessment detected one case of nonunion (7%). CONCLUSION Women treated with the Latarjet procedure experienced satisfactory midterm clinical outcomes. The arthroscopic technique using cortical button fixation seems to avoid residual anterior pain requiring hardware removal.
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Affiliation(s)
- Kenza Limam
- Service de Chirurgie Orthopédique et du Sport, Hôpital Pierre Paul Riquet, CHU de Toulouse, Place du Dr Baylac, 31059, Toulouse, France
- Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Hugo Barret
- Service de Chirurgie Orthopédique et du Sport, Hôpital Pierre Paul Riquet, CHU de Toulouse, Place du Dr Baylac, 31059, Toulouse, France
- Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Mathieu Girard
- Service de Chirurgie Orthopédique et du Sport, Hôpital Pierre Paul Riquet, CHU de Toulouse, Place du Dr Baylac, 31059, Toulouse, France
- Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France
| | | | - Pierre Mansat
- Service de Chirurgie Orthopédique et du Sport, Hôpital Pierre Paul Riquet, CHU de Toulouse, Place du Dr Baylac, 31059, Toulouse, France
- Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Nicolas Bonnevialle
- Service de Chirurgie Orthopédique et du Sport, Hôpital Pierre Paul Riquet, CHU de Toulouse, Place du Dr Baylac, 31059, Toulouse, France.
- Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France.
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Agarwalla A, Gowd AK, Liu JN, Garcia GH, Perry AK, Polce EM, Cole BJ, Romeo AA, Verma NN. High Rate of Return to Work by 3 Months Following Latarjet for Anterior Shoulder Instability. Arthroscopy 2022; 38:684-691. [PMID: 34252559 DOI: 10.1016/j.arthro.2021.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/12/2021] [Accepted: 06/29/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the rate and duration of return to work in patients undergoing Latarjet for failed soft-tissue stabilization or glenoid bone loss. METHODS Consecutive patients undergoing Latarjet from 2005 to 2015 at our institution were retrospectively reviewed at a minimum of 2 years postoperatively. Patients completed a standardized and validated work questionnaire, Western Ontario Shoulder Instability Index Survey, and a satisfaction survey. RESULTS Of 89 eligible patients who had Latarjet, 67 patients (75.3%) responded to the questionnaire, of whom 51 patients (76.1%) were employed within 3 years before surgery (mean age: 29.9 ± 11.8 years; mean follow-up: 54.6 ± 11.9 months) and had an average glenoid bone loss of 14.5 ± 6.1%. Fifty patients (98.0%) returned to work by 2.7 ± 3.0 months postoperatively; 45 patients (88.2%) patients returned to the same level of occupational intensity. Those who held sedentary, light, moderate, or heavy intensity occupations returned to their previous occupation at a rate of 100.0%, 93.3%, 90.0%, and 66.7% (P = .2) at a duration of 1.2 ± 1.6 months, 1.8 ± 1.9 months, 3.1 ± 3.5 months, and 6.5 ± 4.1 months (P = .001), respectively. The average postoperative Western Ontario Shoulder Instability Index score was 70.9 ± 34.2. Fifty patients (98.0%) noted at least "a little improvement" in their quality of life following surgery, with 35 patients (68.6%) noting great improvement. Furthermore, 49 patients (96.1%) reported being satisfied with their procedure, with 25 patients (49.0%) reporting being very satisfied. Four patients (7.8%) returned to the operating room, with 1 patient (2.0%) requiring arthroscopic shoulder stabilization. CONCLUSIONS Approximately 98% of patients who underwent Latarjet returned to work by 2.7 ± 3.0 months postoperatively. Patients with greater-intensity occupations had a longer duration of absence before returning to their preoperative level of occupational intensity. Information regarding return to work is imperative in preoperative patient consultation to manage expectations. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, U.S.A
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, California, U.S.A
| | | | - Allison K Perry
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Evan M Polce
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Musculoskeletal Institute, DuPage Medical Group, Westmont, Illinois, U.S.A
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
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