Graft osteolysis and recurrent instability after the Latarjet procedure performed with bioabsorbable screw fixation

HYPOTHESIS AND BACKGROUND

The Latarjet procedure is a reliable treatment of recurrent anterior shoulder instability. The coracoid process is usually fixed with metallic screws; however, these can lead to irritation and the necessity for hardware removal and also can produce artifacts on imaging studies. The use of resorbable screws could avoid these complications. The purpose of this study was to assess the clinical results of the Latarjet procedure performed with bioabsorbable screws in addition to healing of the graft and resorption of the screws.

METHODS

In 2009, we performed a prospective study (case series,

LEVEL OF EVIDENCE

IV) of 11 patients (12 shoulders) who underwent a Latarjet procedure fixed with resorbable screws. Each patient was observed clinically and had a computed tomography scan at 3 months and 2 years of follow-up.

RESULTS

Every graft healed at 3-month follow-up. At 2-year follow-up, 4 patients had at least one instability episode, and one underwent a revision surgery. Three of these 4 patients were unhappy or disappointed. The Walch-Duplay score was excellent or good for 7 shoulders and medium or poor for 5. Screw resorption appeared complete in every case. No drill hole enlargement was observed. Every drill hole was partially filled with bone. Of 12 shoulders, 8 (66.67%) were associated with a severe osteolysis and an almost complete disappearance of the graft.

CONCLUSION

Coracoid graft osteolysis, previously reported after the Latarjet procedure, appears to be exacerbated with a risk of complete disappearance of the graft when the procedure is performed with the bioabsorbable screws used in this study.

The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes

Recurrent anterior shoulder instability is common in contact athletes and the high-energy injuries seen in this group make them more prone to bone loss. Athletes with recurrent instability and associated bone loss have high failure rates when treated with a soft tissue reconstruction procedure. Therefore it is preferred to manage recurrent instability in contact athletes with the Latarjet-Patte procedure. In this article, the authors describe their technique. They have found this procedure to be safe and effective, with very low recurrence and early return to sport. A meticulous surgical technique is important to avoid intraoperative and postoperative complications.

The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes

The Latarjet-Patte procedure satisfies all of the requirements for treating recurrent anterior instability in contact athletes and is therefore their preferred management in this patient group.

In vivo assessment of weight-bearing knee flexion reveals compartment-specific alterations in meniscal slope

PURPOSE

The purpose of this study was to determine the effects of flexion angle on meniscal slope during partial weight-bearing knee flexion.

METHODS

Forty-eight sagittal sequences were performed on 12 patients (6 male patients, 6 female patients; 25.7 ± 10.5 years) during partial weight bearing in an open magnetic resonance imaging (MRI) scanner at full extension, 60°, 90°, and maximum knee flexion. A previously published method was used to measure the meniscal slope for each compartment using manual digitalization. A general linear model was used to test for effects of compartment and flexion angle on meniscal slope.

RESULTS

The mean maximum flexion angle achieved was 125° ± 10.5°. A significant main effect of compartment (P < .01) and flexion angle (P < .01) on meniscal slope was observed. A significant interaction between compartment and angle was also detected (P < .01). Specifically, the lateral meniscal slope was significantly more horizontal than the medial meniscus slope at full extension (P = .017) but significantly more posterior at all other angles. In addition, the lateral meniscus displayed a greater change in posterior slope across the range of motion compared with the medial meniscus. Significant correlations were found in medial meniscal slope at full extension and at maximum knee flexion (P = .031).

CONCLUSIONS

The results showed that meniscal slope in healthy knees increased significantly with knee flexion for both menisci, with significantly greater changes in the lateral meniscus. Furthermore, a lack of correlation was observed between the meniscal slope in extension and the meniscal slope at increasing flexion angles, questioning the efficacy of measuring the meniscal slope only in extension as commonly described. Overall, this study has provided valuable insight into how meniscal slope changes with knee motion.

Open inguinal hernia repair by plug and patch: the value of fibrin sealant fixation

BACKGROUND

Prosthetic meshes give excellent results in groin hernia repair. However, although recurrence rates are very low, chronic pain remains frequent and mesh fixation may play a role in the occurrence of this complication. The use of fibrin sealant to secure the mesh may represent a useful alternative for the prevention of chronic pain. The aim of this study is to confirm that the mesh may be secured by spraying fibrin sealant and to assess the reduction in the incidence of chronic pain.

METHODS

Seventy hernias were operated on in 57 patients and were evaluated on a prospective basis. The procedure involved placement of a plug and patch mesh which was secured with fibrin sealant alone. These patients were compared to a matched retrospective series of 57 patients who underwent the same procedure, except that conventional non-absorbable suture was used to secure the mesh.

RESULTS

The two groups were equivalent for inclusion criteria and preoperative data. The complication rate was similar in the two groups. The operative time was shorter in the fibrin sealant group: 7 min for unilateral hernia (p=0.0017) and 16 min for bilateral hernia (p=0.0008). The length of hospital stay was also shorter in the fibrin sealant group (1.8 days vs. 2.5 days: p < 0.0001). There was no recurrence in the fibrin sealant group after a minimum follow-up of 12 months and no recurrence in the suture group after a minimum follow-up of 25 months. Finally, a significant reduction in chronic pain was observed in the fibrin sealant group (3.5% vs. 22.8%: p=0.042).

CONCLUSION

This study confirms the effectiveness of fibrin glue in securing prosthetic meshes and reducing chronic inguinal pain.