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Teissier P, Bouhali H, Degeorge B, Toffoli A, Teissier J. Arthroscopic Latarjet procedure and suture-button fixation: can we predict nonunion early? J Shoulder Elbow Surg 2023; 32:610-617. [PMID: 36206979 DOI: 10.1016/j.jse.2022.08.019] [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: 03/17/2022] [Revised: 08/20/2022] [Accepted: 08/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The arthroscopic Latarjet procedure is a technically challenging technique that provides well-known results. The first series reported fixation with screws. An alternative fixation technique has been proposed, using a button, to improve the reproducibility and to decrease the complications due to screws. The first reports using this fixation technique have yielded comparable rates of fusion. The objective of this study was to assess the fusion rate and bone modifications with this type of fixation. METHODS Two hundred sixteen patients were included in this prospective study. An arthroscopic Latarjet procedure, fixed with 1 button according to the Smith & Nephew technique, was performed by a single surgeon for the treatment of anterior instability. The radiographic protocol consisted of computed tomography scans at 3, 12, and 24 weeks postoperatively. We measured the coronal and sagittal positions of the bone block, distance between the bone block and the glenoid, diameter of the glenoid tunnel, fusion rate, and time to fusion. RESULTS The position was deemed flush in 92.6% of cases in the coronal plane and under the equator in 87.5% of cases in the sagittal plane. At last follow-up, we observed 9 cases of nonunion (4%), as well as 18 cases of delayed fusion. The fusion rate was 92% at 3 months and 96% at 6 months. For bone blocks that ultimately healed, the diameter of the glenoid tunnel was <2 mm in 62% of cases at 3 weeks and <1 mm in 90% of cases at 3 months. Conversely, the diameter of this tunnel significantly increased and was >3 mm in all cases of delayed union or nonunion. CONCLUSION The described technique achieved a reliable position of the bone block and a very good fusion rate with a new type of fixation. The time to obtain fusion can be lengthy, occurring between the third and sixth months. The diameter of the glenoid tunnel was the best predictive factor for fusion. Widening of the glenoid tunnel diameter >3 mm during the first 3 weeks was the most predictive factor for delayed union or nonunion of the bone block. This finding is probably explained by a sliding effect of the sutures through this tunnel, comparable to the bungee effect in anterior cruciate ligament repair in the knee.
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Affiliation(s)
- Philippe Teissier
- Orthosud Shoulder Sport Unit, Clinique Saint-Jean Sud de France, Montpellier, France.
| | - Haroun Bouhali
- Orthosud Shoulder Sport Unit, Clinique Saint-Jean Sud de France, Montpellier, France
| | - Benjamin Degeorge
- Orthosud Shoulder Sport Unit, Clinique Saint-Jean Sud de France, Montpellier, France
| | - Adriano Toffoli
- Orthosud Shoulder Sport Unit, Clinique Saint-Jean Sud de France, Montpellier, France
| | - Jacques Teissier
- Orthosud Shoulder Sport Unit, Clinique Saint-Jean Sud de France, Montpellier, France
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MALAVOLTA EDUARDOANGELI, SOUZA JORGEANTONIOBASTOSDE, ASSUNÇÃO JORGEHENRIQUE, GRACITELLI MAUROEMILIOCONFORTO, SILVA FERNANDOBRANDÃODEANDRADEE, FERREIRA ARNALDOAMADO. TREATMENT OF RECURRENT ANTERIOR SHOULDER DISLOCATION USING THE LATARJET TECHNIQUE. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e261896. [PMID: 36844123 PMCID: PMC9949290 DOI: 10.1590/1413-785220233101e261896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/05/2022] [Indexed: 02/22/2023]
Abstract
Objective To describe the functional results, recurrence rate, postoperative radiographic appearance, and complications of patients undergoing the Latarjet procedure over 24 months. Methods Retrospective case series, including adult patients with recurrent traumatic anterior glenohumeral dislocation undergoing the Latarjet procedure. We clinically evaluated patients preoperatively by the Rowe score and at six, 12, and 24 months after the procedure. The positioning, consolidation, and resorption of the graft were analyzed by plain radiography. The recurrence rates and other complications were also described. Results We analyzed 40 patients (41 shoulders). The Rowe score median increased from 25 before surgery to 95 at 24 months after surgery (p < 0.001). We observed graft resorption in three cases (7.3%) and consolidation in 39 (95.1%). Most grafts presented adequate placement. We observed two recurrences (4.8%), one case of dislocation and one of subluxation. Seven patients (17.1%) had a positive apprehension test. The study had no cases of infection, neuropraxia, or graft breakage. Conclusion Latarjet surgery is a safe and effective procedure in the treatment of recurrent anterior dislocation of the shoulder. This surgery enables a statistically significant improvement according to the Rowe score, with a low number of recurrences. Level of Evidence IV, Case Series.
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Affiliation(s)
- EDUARDO ANGELI MALAVOLTA
- Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.,Hospital do Coração. São Paulo, SP, Brazil
| | | | | | | | | | - ARNALDO AMADO FERREIRA
- Hospital das Clínicas, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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Kotzamitelos D, Kalogrianitis S. Modification of the Traditional Open Latarjet Technique with the Use of Sutures and Cortical Buttons Instead of Screws. Indian J Orthop 2021; 55:763-768. [PMID: 33995885 PMCID: PMC8081782 DOI: 10.1007/s43465-021-00359-9] [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: 07/16/2020] [Accepted: 01/13/2021] [Indexed: 02/04/2023]
Abstract
In this article we describe a modification of the open Latarjet technique, using sutures and cortical buttons, for the fixation of the coracoid. The transfer of the coracoid to the anterior glenoid is a popular technique used for complex shoulder instability. The technique is proven to be effective with consistently good results but complications have been reported related to the screws used for the fixation of the coracoid. Recent studies confirm that the suture-button technique for the fixation of the coracoid is biomechanically comparable to the screw fixation. The proposed technique combines the advantages of the open approach and avoids the use of metal screws, potentially minimizing hardware-related complications.
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Affiliation(s)
| | - Socrates Kalogrianitis
- Queen Elizabeth, Birmingham University Hospitals NHS Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW UK
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Gouveia K, Abidi SK, Shamshoon S, Gohal C, Madden K, Degen RM, Leroux T, Alolabi B, Khan M. Arthroscopic Bankart Repair With Remplissage in Comparison to Bone Block Augmentation for Anterior Shoulder Instability With Bipolar Bone Loss: A Systematic Review. Arthroscopy 2021; 37:706-717. [PMID: 32911004 DOI: 10.1016/j.arthro.2020.08.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this systematic review is to examine the rates of postoperative recurrence of instability, functional outcomes, and complications after treatment with bone augmentation procedures or arthroscopic Bankart repair with remplissage for recurrent anterior shoulder instability in the setting of subcritical glenoid bone loss. METHODS EMBASE, PubMed, and MEDLINE were searched from database inception until June 2019 for articles examining either bone block augmentation to the glenoid or Bankart repair with remplissage (BRR) in the setting of subcritical glenoid bone loss. Search and data extraction were performed by 2 reviewers independently and in duplicate. A separate analysis was done for comparative studies. RESULTS Overall, 145 studies were identified, including 4 comparative studies. Across all studies, postoperative recurrence rates ranged from 0% to 42.8% for bone block augmentation and 0% to 15% for Bankart repair with remplissage. In comparative studies reporting subcritical glenoid bone loss, rates were 5.7% to 11.6% in the Latarjet group and 0% to 13.3% in the Bankart repair with remplissage group. However, in all studies reporting 10% to 15% mean glenoid bone loss, there was an increased rate of recurrent instability with arthroscopic soft tissue repair (6.1% to 13.2%) in comparison with bony augmentation (0% to 8.2%). Lastly, complication rates ranged from 0% to 66.7% for the bone block group and 0% to 2.3% for arthroscopic Bankart repair with remplissage. CONCLUSION Both bone block augmentation and Bankart repair with remplissage are effective treatment options for recurrent anterior shoulder instability in patients with bipolar bone loss but subcritical glenoid bone loss. Both have comparable functional outcomes, albeit bone block procedures carry an increased risk of complications. Arthroscopic BRR may be associated with a higher failure rate for preoperative glenoid bone loss >10%. Therefore, it may represent a stabilization procedure best suited for cases of recurrent anterior instability with glenoid bone loss <10% and the presence of a significant, off-track Hill-Sachs lesion. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Kyle Gouveia
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Saif Shamshoon
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chetan Gohal
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kim Madden
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ryan M Degen
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Ontario, Canada
| | - Timothy Leroux
- Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Boehm E, Minkus M, Moroder P, Scheibel M. Arthroscopic iliac crest bone grafting in recurrent anterior shoulder instability: minimum 5-year clinical and radiologic follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29:266-274. [PMID: 32285158 PMCID: PMC7862210 DOI: 10.1007/s00167-020-05986-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 04/07/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the clinical and radiologic mid- to long-term results of arthroscopic iliac crest bone-grafting for anatomic glenoid reconstruction in patients with recurrent anterior shoulder instability. METHODS Seventeen patients were evaluated after a minimum follow-up of 5 years. Clinical [range of motion, subscapularis tests, apprehension sign, Subjective Shoulder Value (SSV), Constant Score (CS), Rowe Score (RS), Walch Duplay Score (WD), Western Ontario Shoulder Instability Index (WOSI)], and radiologic [X-ray (true a.p., Bernageau and axillary views) and computed tomography (CT)] outcome parameters were assessed. RESULTS Fourteen patients [mean age 31.1 (range 18-50) years] were available after a follow-up period of 78.7 (range 60-110) months. The SSV averaged 87 (range 65-100) %, CS 94 (range 83-100) points, RS 89 (range 30-100) points, WD 87 (range 25-100) points, and WOSI 70 (range 47-87) %. The apprehension sign was positive in two patients (14%). One patient required an arthroscopic capsular plication due to a persisting feeling of instability, while the second patient experienced recurrent dislocations after a trauma, but refused revision surgery. CT imaging showed a significant increase of the glenoid index from preoperative 0.8 ± 0.04 (range 0.7-0.8) to 1.0 ± 0.11 (range 0.8-1.2) at the final follow-up (p < 0.01). CONCLUSION Arthroscopic reconstruction of anteroinferior glenoid defects using an autologous iliac crest bone-grafting technique yields satisfying clinical and radiologic results after a mid- to long-term follow-up period. Postoperative re-dislocation was experienced in one (7.1%) of the patients due to a trauma and an anatomic reconstruction of the pear-shaped glenoid configuration was observed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Elisabeth Boehm
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marvin Minkus
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Philipp Moroder
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Department of Shoulder and Elbow Surgery, Schulthess Clinic Zurich, Zurich, Switzerland.
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