scholarly journals Both Open and Arthroscopic Latarjet Result in Excellent Outcomes and Low Recurrence Rates for Anterior Shoulder Instability

2021 ◽  
Author(s):  
Eoghan T. Hurley ◽  
Erel Ben Ari ◽  
Nathan A. Lorentz ◽  
Edward S. Mojica ◽  
Christopher A. Colasanti ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Recurrence Rates ◽  
Arthroscopic Latarjet

scholarly journals Revision Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Failed Primary Arthroscopic Stabilization With Subcritical Bone Loss

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110018
Author(s):  
Emilio Calvo ◽  
Gonzalo Luengo ◽  
Diana Morcillo ◽  
Antonio M. Foruria ◽  
María Valencia
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Activity Level ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Bankart Repair ◽  
Functional Scores ◽  
Arthroscopic Latarjet

Background: Limited evidence is available regarding the recommended technique of revision surgery for recurrent shoulder instability. Only 1 previous study has compared the results of soft tissue repair and the Latarjet technique in patients with persistent shoulder instability after primary surgical stabilization. Purpose/Hypothesis: To evaluate the results of revision surgery in patients with previous surgical stabilization failure and subcritical glenoid bone defects, comparing repeated Bankart repair versus arthroscopic Latarjet technique. The hypothesis was that Latarjet would be superior to soft tissue procedures in terms of objective and subjective functional scores, recurrence rates, and range of movement. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 45 patients (mean age, 29.1 ± 8.9 years) with subcritical bone loss (<15% of articular surface) who had undergone revision anterior shoulder instability repair after failed Bankart repair. Of these, 17 patients had arthroscopic Bankart repair and 28 had arthroscopic Latarjet surgery. Patients were evaluated at a minimum of 2 years postoperatively with the Rowe score, Western Ontario Shoulder Instability Index, and Subjective Shoulder Value. Subluxation or dislocation episodes were considered failures. Results: No statistically significant differences were found between groups in age, sex, sporting activity, preoperative Rowe score, or the presence of hyperlaxity or bony lesions. At revision arthroscopy, 20 shoulders showed a persistent Bankart lesion, 13 a medially healed labrum, and 6 a bony Bankart. In 6 patients, no abnormalities were present that could explain postoperative recurrence. In the Bankart repair group, 7 patients underwent isolated Bankart procedures; in the remaining 10 cases, a capsular shift was added. No significant differences were found between the Bankart and Latarjet groups in outcome scores, recurrence rate (11.8% vs 17.9%, respectively), or postoperative athletic activity level. The mean loss of passive external rotation at 0° and 90° of abduction was similar between groups. Conclusion: Arthroscopic Latarjet did not lead to superior results compared with repeated Bankart repair in patients with subcritical glenoid bone loss and recurrent anterior shoulder instability after Bankart repair.

scholarly journals ARTHROSCOPIC LATARJET TECHNIQUE COMBINED WITH ENDOBUTTONS: FUNCTIONAL OUTCOMES IN 26 CASES

2018 ◽  
Vol 26 (5) ◽  
pp. 328-331 ◽  
Author(s):  
Alexandre Tadeu do Nascimento ◽  
Gustavo Kogake Claudio ◽  
Pedro Bellei Rocha ◽  
Juan Pablo Zumárraga ◽  
Olavo Pires de Camargo
Keyword(s):  
Shoulder Instability ◽  
Functional Outcomes ◽  
Short Form ◽  
Case Series ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Glenohumeral Instability ◽  
Duration Of Symptoms ◽  
Arthroscopic Latarjet ◽  
Arthroscopic Latarjet Procedure

ABSTRACT Objective: The cause of anterior shoulder instability is not fully understood and surgical management remains controversial. The objective of this study was to evaluate the results of patients undergoing arthroscopic Latarjet procedure with endobuttons. Methods: A retrospective study of 26 patients undergoing arthroscopic Latarjet procedure with endobuttons to treat anterior shoulder instability. Patients with previous glenohumeral instability, failure of Bankart procedure or Instability Severity Index Score (ISIS) greater than or equal to 6, were included. Patients were assessed by: DASH, UCLA, Rowe, Visual Analog Scale (VAS) of pain and Short-Form 36 (SF36) scores. Correct position and consolidation of the graft were evaluated. Results: Mean age was 31.5 years (16 to 46). Preoperative duration of symptoms was 1.7 years (1 month to 10 years). Mean follow-up was 14.3 (6 to 24) months. Mean postoperative scores were: 10 points in DASH; 1.6 in VAS, where 23 (88%) patients experienced mild pain and 3 (12%) moderate pain; 89 in Rowe; 32 in UCLA and 78 in SF-36. Positioning of the graft was correct in 25 (96%) cases, and was consolidated in 23 (88%). We had two cases of graft fracture (7%) and postoperative migration (7%). Conclusion: Surgical treatment using arthroscopic Latarjet with endobuttons is safe and effective, producing good functional outcomes in patients. Level of Evidence IV, Case Series.

scholarly journals Management of Traumatic Coracoid Fracture and Anterior Shoulder Instability With a Modified Arthroscopic Latarjet Technique

2020 ◽  
Vol 9 (9) ◽  
pp. e1341-e1348
Author(s):  
Shariff K. Bishai ◽  
Jonathon A. Hinz ◽  
L. Colby Ward ◽  
Melissa M. Martinez
Keyword(s):  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Latarjet

A lower Instability Severity Index score threshold may better predict recurrent anterior shoulder instability after arthroscopic Bankart repair: a systematic review

2021 ◽  
pp. jisakos-2020-000584
Author(s):  
Samuel I Rosenberg ◽  
Simon J Padanilam ◽  
Brandon Alec Pagni ◽  
Vehniah K Tjong ◽  
Ujash Sheth
Keyword(s):  
Shoulder Instability ◽  
Severity Index ◽  
Postoperative Recurrence ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Recurrence Rates ◽  
Recurrent Instability ◽  
Arthroscopic Bankart Repair ◽  
Score Threshold ◽  
Recurrent Anterior Shoulder Instability

ImportanceThe Instability Severity Index (ISI) score was developed to evaluate a patient’s risk of recurrent shoulder instability following arthroscopic Bankart repair. While patients with an ISI score of >6 were originally recommended to undergo an open procedure (ie, Latarjet) to minimise the risk of recurrence, recent literature has called into question the utility of the ISI score.ObjectiveThe purpose of this systematic review was to evaluate the efficacy of the ISI score as a tool to predict postoperative recurrence among patients undergoing arthroscopic Bankart procedures.Evidence reviewArticles were included if study participants underwent arthroscopic Bankart repair for anterior shoulder instability and reported postoperative recurrence by ISI score at a minimum of 2 years of follow-up. Methodological study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Pearson’s χ2 test was used to compare recurrence rates among patients above and below an ISI score of 4. Sensitivity, specificity, mean ISI scores and predictive value of individual factors of the ISI score were qualitatively reviewed.FindingsFour studies concluded the ISI score was effective in predicting postoperative recurrence following arthroscopic Bankart repair; however, these studies found threshold values lower than the previously proposed score of >6 may be more predictive of recurrent instability. A pooled analysis of these studies found patients with an ISI score <4 to experience significantly lower recurrence rates when compared with patients with a score ≥4 (6.3% vs 26.0%, p<0.0001). The mean ISI score among patients who experienced recurrent instability was also significantly higher than those who did not.Conclusions and relevanceThe ISI score as constructed by Balg and Boileau may have clinical utility to help predict recurrent anterior shoulder instability following arthroscopic Bankart repair. However, this review found the threshold values published in their seminal article to be insufficient predictors of recurrent instability. Instead, a lower score threshold may provide as a better predictor of failure. The paucity of level I and II investigations limits the strength of these conclusions, suggesting a need for further large, prospective studies evaluating the predictive ability of the ISI score.Level of evidenceIV.

Return to Sport After Surgical Treatment for Anterior Shoulder Instability: A Systematic Review

2018 ◽  
Vol 47 (6) ◽  
pp. 1507-1515 ◽  
Author(s):  
Hussein Abdul-Rassoul ◽  
Joseph W. Galvin ◽  
Emily J. Curry ◽  
Jason Simon ◽  
Xinning Li
Keyword(s):  
Systematic Review ◽  
Shoulder Instability ◽  
Return To Sport ◽  
Activity Level ◽  
Rate Of Return ◽  
Anterior Shoulder Instability ◽  
Activity Levels ◽  
Shoulder Stabilization ◽  
Successful Recovery ◽  
Arthroscopic Latarjet

Background: For athletes, a return to preinjury activity levels with minimal time away is a metric indicative of successful recovery. The knowledge of this metric would be helpful for the sports medicine specialist to advise patients on appropriate expectations after surgery. Purpose: To evaluate the rate and amount of time needed for athletes to return to sport (RTS) after different surgical treatments for anterior shoulder instability. Study Design: Systematic review and meta-analysis. Methods: The MEDLINE, EMBASE, and Cochrane databases were searched for articles relevant to athletes’ RTS after surgical anterior shoulder stabilization with variants of the Latarjet and Bankart procedures. Article selection was based on relevant inclusion and exclusion criteria. After the articles were reviewed, the data pertinent to rates of and time to RTS were extracted, compiled, and analyzed. Results: Sixteen articles met the inclusion criteria. Based on these articles, the rate of RTS was 97.5% after arthroscopic Bankart, 86.1% after open Bankart, 83.6% after open Latarjet, 94.0% after arthroscopic Latarjet, and 95.5% after arthroscopic Bankart with remplissage. Among the athletes who did RTS, arthroscopic Bankart had the highest rate of return to preinjury levels (91.5%), while arthroscopic Latarjet had the lowest rate (69.0%). The time to RTS was 5.9 months after arthroscopic Bankart, 8.2 months after open Bankart, 5.07 months after open Latarjet, 5.86 months after arthroscopic Latarjet, and 7 months after arthroscopic Bankart with remplissage. Conclusion: Of the pooled data, patients who underwent arthroscopic Bankart showed the highest rate of RTS, while patients who underwent open Latarjet showed the shortest time to RTS. Return to preinjury level was highest in the arthroscopic Bankart group and lowest in the arthroscopic Latarjet group. Physicians can utilize these data to set expectations for their patient-athletes regarding RTS after anterior shoulder stabilization procedures. Clinical Relevance: When treating an athlete, many factors must be taken into account to weigh treatment options. Two important factors to consider with the patient-athlete are the rate of return to the previous activity level and the timeline for this to occur. This study provides a guide for physicians and a time frame for athletes with respect to the mean percentage and time for return to sport after different surgical procedures for anterior shoulder instability.

The Arthroscopic Latarjet Procedure for the Treatment of Anterior Shoulder Instability

2007 ◽  
Vol 23 (11) ◽  
pp. 1242.e1-1242.e5 ◽  
Author(s):  
Laurent Lafosse ◽  
Etienne Lejeune ◽  
Antoine Bouchard ◽  
Carlos Kakuda ◽  
Reuben Gobezie ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Arthroscopic Latarjet ◽  
Arthroscopic Latarjet Procedure

Management of Recurrent Anterior Shoulder Instability With Bipolar Bone Loss: A Systematic Review to Assess Critical Bone Loss Amounts

2018 ◽  
Vol 47 (10) ◽  
pp. 2484-2493 ◽  
Author(s):  
Anirudh K. Gowd ◽  
Joseph N. Liu ◽  
Brandon C. Cabarcas ◽  
Grant H. Garcia ◽  
Gregory L. Cvetanovich ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Loss ◽  
Shoulder Instability ◽  
Operative Management ◽  
Glenoid Bone Loss ◽  
Cochrane Library ◽  
Anterior Shoulder Instability ◽  
Bone Block ◽  
Recurrence Rates ◽  
The Mean

Background: There is increasing evidence to suggest that the amount of glenoid bone loss to indicate bone block procedures may be lower than previously thought, particularly in the presence of a Hill-Sachs defect. Purpose: To better establish treatment recommendations for anterior shoulder instability among patients with bipolar bone lesions. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review of the literature was performed with PubMed, EMBASE, Cochrane Library, and Scopus databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies evaluating outcomes of operative management in anterior shoulder instability that also reported glenoid bone loss in the presence of Hill-Sachs defects were included. Recurrence rates, glenoid bone loss, and humeral bone loss were pooled and analyzed with forest plots stratified by surgical procedure. Methods of quantification were analyzed for each article qualitatively. Results: Thirteen articles were included in the final analysis, with a total of 778 patients. The mean ± SD age was 24.9 ± 8.6 years. The mean follow-up was 30.1 months (range, 11-240 months). Only 13 of 408 (3.2%) reviewed bipolar bone loss articles quantified humeral and/or glenoid bone loss. Latarjet procedures had the greatest glenoid bone loss (21.7%; 95% CI, 14.8%-28.6%), followed by Bankart repairs (13.1%; 95% CI, 9.0%-17.2%), and remplissage (11.7%; 95% CI, 5.5%-18.0%). Humeral bone loss was primarily reported as percentage bone loss (22.2%; 95% CI, 13.1%-31.3% in Bankart repairs and 31.7%; 95% CI, 21.6%-41.1% in Latarjet) or as volumetric defects (439.1 mm3; 95% CI, 336.3-541.9 mm3 in Bankart repairs and 366.0 mm3; 95% CI, 258.4-475.4 mm3 in remplissage). Recurrence rates were as follows: Bankart repairs, 19.5% (95% CI, 14.5%-25.8%); remplissage, 4.4% (95% CI, 1.3%-14.0%); and Latarjet, 8.7% (95% CI, 5.0%-14.7%). Bankart repairs were associated with significantly greater recurrence of instability in included articles ( P = .013). Conclusion: There exists a need for universal and consistent preoperative measurement of humeral-sided bone loss. The presence of concomitant Hill-Sachs defects with glenoid pathology should warrant more aggressive operative management through use of bone block procedures. Previously established values of critical glenoid bone loss are not equally relevant in the presence of bipolar bone loss.

Open Versus Arthroscopic Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review and Meta-analysis

2018 ◽  
Vol 47 (5) ◽  
pp. 1248-1253 ◽  
Author(s):  
Eoghan T. Hurley ◽  
Daren Lim Fat ◽  
Shane K. Farrington ◽  
Hannan Mullett
Keyword(s):  
Systematic Review ◽  
Learning Curve ◽  
Shoulder Instability ◽  
Meta Analysis ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Recurrent Instability ◽  
Arthroscopic Procedure ◽  
Arthroscopic Latarjet ◽  
Arthroscopic Latarjet Procedure

Background: Anterior shoulder instability with significant glenoid bone loss is a challenging condition. The open Latarjet procedure is the established standard treatment method in this setting, but there is an increasing use of the arthroscopic technique. Purpose: To systematically review the current evidence in the literature to ascertain if the open or arthroscopic Latarjet procedure resulted in improved patient outcomes. Study Design: Systematic review and meta-analysis. Methods: A literature search of MEDLINE, EMBASE, and the Cochrane Library was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Cohort studies comparing the open and arthroscopic Latarjet procedures for anterior shoulder instability were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager (version 5.3). A P value of <.05 was considered statistically significant. Results: Six clinical trials with 896 patients were included. The open and arthroscopic Latarjet procedures resulted in a similar number of total recurrent instability (2.0% vs 2.4%; P = .75), revision procedures (2.4% vs 5.4%; P = .06), and total complications (13.8% vs 11.9%; P = .50), but the open procedure had a lower rate of persistent apprehension (10.2% vs 35.7%; P < .05). In addition, after the learning curve, the operative time was similar between the 2 procedures. Conclusion: Both the open and arthroscopic Latarjet procedures result in significant improvements in patient function and outcome scores, with low rates of recurrent instability and similar complication rates. While technically challenging, the arthroscopic procedure has been shown to be a safe and viable alternative. However, there is a significant learning curve associated with the arthroscopic Latarjet procedure. The significant learning curve associated with this procedure suggests the arthroscopic procedure may be advisable to perform only in high-volume centers with experienced arthroscopists.

scholarly journals Is the learning curve for arthroscopic Latarjet procedure facilitated by a specific step-by-step guiding system for the surgical technique?

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0000
Author(s):  
Maxime Belas ◽  
Nicolas Gaujac ◽  
Pierre Alban Bouche ◽  
Christophe Charousset,MD
Keyword(s):  
Learning Curve ◽  
Shoulder Instability ◽  
Operating Time ◽  
Difficulty Level ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Arthroscopic Latarjet ◽  
Arthroscopic Latarjet Procedure ◽  
Group A ◽  
Group B

Objectives: Treating anterior shoulder instability with the arthroscopic Latarjet procedure is a complex, operator-dependent technique that requires a learning curve. The objective of the study is to compare a guided technique with cortical button fixation and a non-guided technique with screw fixation. Methods: This is a retrospective study including 72 consecutive patients who underwent surgery for recurrent anterior shoulder instability by the arthroscopic Latarjet procedure, with a mean age of 26 years and minimum clinical follow-up of 6 months. The same surgeon performed all the surgeries. The procedure was performed either with an instrument set and dedicated instrumentation that guides the different surgical steps and fixed by two cortical buttons connected by loops of a continuous thread (Group A) or with a specific instrument set and fixed by two cortical screws (Group B). We compared the difficulty of the different surgical steps, each rated from 1 to 5 (1 being the simplest and 5 the most difficult), the number of procedures required to attain a level of difficulty, the operating time and the intraoperative or postoperative complications. Results: Coracoid preparation had a score of 1.3 in group A versus 2.9 in group B (p<0.001) with a difficulty level of 1 as of 19 procedures. The Subscapularis split had a score of 1.9 in group A versus 3.2 in group B (p<0.001) with a level as of 15 procedures. Horizontal positioning of the bone block scored 1.4 in group A versus 1.8 in group B (p=0.019) with a level as of 15 procedures. The mean operating time was 95 minutes in group A and 123 minutes in group B (p<0.0001). There was one coracoid fracture in group A, one case of sepsis and 2 repeat procedures for screw removal in group B, and 2 reversible neurological complications in each group. Conclusion: The Latarjet procedure performed under arthroscopy remains a difficult procedure. An instrument set and dedicated instrumentation with reciprocating rasp and saw, posterior glenoid drill guide and subscapularis retractors allow faster and more reproducible learning.

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