An Arthroscopic Bone Block Procedure Is Effective in Restoring Stability, Allowing Return to Sports in Cases of Glenohumeral Instability with Glenoid Bone Deficiency

Background: There is a lack of evidence in the literature comparing outcomes between the classic and the congruent arc Latarjet procedures in athletes. Purpose: To compare return to sports, functional outcomes, and complications between the classic and the congruent arc Latarjet procedures in athletes with recurrent glenohumeral instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2009 and June 2017, 145 athletes with recurrent anterior glenohumeral instability underwent surgery with the Latarjet as a primary procedure in our institution. The classic procedure was used in 66 patients, and the congruent arc method was used in 79 patients. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale (VAS) for pain in sports activity, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. Results: In the total population, the mean follow-up was 41.3 months (range, 24-90 months) and the mean age was 25.3 years (range, 18-45 years). In total, 90% of patients were able to return to sports; of these, 91% returned at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistical improvement after operation ( P < .001). The Rowe score increased from a preoperative mean of 42.8 points to a postoperative mean of 95.2 points ( P < .01). Subjective pain during sports improved from 3.2 points preoperatively to 0.7 points at last follow-up ( P < .01). The ASOSS score improved significantly from a preoperative mean of 46.4 points to a postoperative mean of 88.4 points ( P < .01). No significant differences in shoulder ROM and functional scores were found between patients who received the classic vs congruent arc procedures. There were 5 recurrences (3.5%): 3 dislocations (2%) and 2 subluxations (1%). No significant difference in the recurrence rate was noted between groups. The bone block healed in 134 cases (92%). Conclusion: In athletes with recurrent anterior glenohumeral instability, the Latarjet procedure produced excellent functional outcomes. Most athletes returned to sports at their preinjury level, and the rate of recurrence was very low, regardless of whether the patients received surgery with the classic or congruent arc technique.

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Open or arthroscopic Latarjet? Prospective analysis of the clinical results

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00004 ◽

2021 ◽

Vol 9 (2_suppl) ◽

pp. 2325967121S0000

Author(s):

Mathieu Girard ◽

Yoann Dalmas ◽

Vadim Azoulay ◽

Marie Martel ◽

Simon Rattier ◽

...

Keyword(s):

Surgical Techniques ◽

Clinical Results ◽

Bone Block ◽

Return To Sports ◽

Short Term ◽

Significant Difference ◽

Bone Block Procedure ◽

Group A ◽

Net Promoter

Objectives: The arthroscopic bone block procedure in the treatment of anterior shoulder instabilities is now a validated technique. Nevertheless, few studies have compared the clinical results of this technique to the conventional Latarjet procedure. Therefore the objective of this study was to compare the short-term clinical results of the 2 surgical techniques. Methods: We conducted a monocentric prospective comparative study, including patients who had undergone a bone block procedure for anterior instability with a minimum follow-up of 12 months. Patients with a surgical history concerning the affected shoulder were excluded. Evaluation was based on the measurement of mobility, the Walch-Duplay score, the Rowe score, the Subjective Shoulder Value (SSV), return to sports, the Net Promoter satisfaction Score, and recurrence (subluxation/luxation). Scarring was assessed by the POSAS score. Results: It was possible to follow 45 patients: arthroscopy (A) n=22, open (O) n=25. With an average follow-up of 20 months (12-30), no recurrence of instability was recorded. No significant difference was noted between groups A and O in terms of the Walch-Duplay score (85±19 vs 91±11 points; p=0.3), the Rowe score (93±14 vs 95±9 points; p=0.9), the SSV (72% vs 88%; p=0.2) and the Net Promoter Score (9.3 vs 9.7; p=0.5). At 3 months, return to sports was 11% for group A vs 48% for group O (p=0.01). This difference was no longer significant at 6 months. Loss of external rotation in group A was significantly greater at 1.5 months -58°±18° vs -41°±17° (p=0.01) and 3 months -35°±20° vs -19°±18° (p=0.01). There was no difference in the POSAS score between the 2 groups. (p= 0.9). Conclusion: With a longer recovery time for joint amplitudes and a delayed return to sports, the arthroscopic double-button fixation procedure does not seem to provide any short-term clinical benefit. Longer follow-up is required to confirm these results.

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High Rate of Return to Sports and Low Recurrences With the Latarjet Procedure in High-Risk Competitive Athletes With Glenohumeral Instability and a Glenoid Bone Loss <20%

Arthroscopy, Sports Medicine, and Rehabilitation ◽

10.1016/j.asmr.2020.06.004 ◽

2020 ◽

Vol 2 (6) ◽

pp. e735-e742

Author(s):

Luciano Andrés Rossi ◽

Tomas Gorodischer ◽

Rodrigo Brandariz ◽

Ignacio Tanoira ◽

Ignacio Pasqualini ◽

...

Keyword(s):

High Risk ◽

Bone Loss ◽

High Rate ◽

Glenoid Bone Loss ◽

Rate Of Return ◽

Return To Sports ◽

Latarjet Procedure ◽

Glenohumeral Instability ◽

Competitive Athletes

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Arthroscopic Capsulolabral Reconstruction of the Type VIII Superior Labrum Anterior Posterior Lesion

The American Journal of Sports Medicine ◽

10.1177/0363546507302546 ◽

2007 ◽

Vol 35 (9) ◽

pp. 1477-1483 ◽

Cited By ~ 20

Author(s):

Shane Seroyer ◽

Samir G. Tejwani ◽

James P. Bradley

Keyword(s):

Range Of Motion ◽

Strength Function ◽

Weight Lifting ◽

Return To Sports ◽

Glenohumeral Instability ◽

Type Viii ◽

Superior Labrum ◽

Posterior Lesion ◽

Capsulolabral Reconstruction ◽

Anterior Posterior

Background A type VIII superior labrum anterior posterior lesion represents pathologic posteroinferior extension of a type II superior labrum anterior posterior lesion with injury to the insertion of the posterior band of the inferior glenohumeral ligament. No reports in the literature describe arthroscopic treatment of a type VIII superior labrum anterior posterior lesion and its associated glenohumeral instability. Hypothesis Arthroscopic capsulolabral reconstruction is effective in alleviating pain and restoring stability and function in athletes with glenohumeral instability due to the type VIII superior labrum anterior posterior lesion. Study Design Case series; Level of evidence, 4. Methods From 2003 to 2006, 23 shoulders in 23 athletes were diagnosed with a type VIII superior labrum anterior posterior lesion by physical examination, magnetic resonance arthrography, and arthroscopy. All were treated with an arthroscopic capsulolabral reconstruction. Ten patients were involved in rehabilitation less than 9 months after surgery and were not included in this study. Thirteen remaining shoulders in 13 athletes with a mean age of 27.8 ± 10.9 years were analyzed at a mean follow-up of 24 months. Shoulders were evaluated preoperatively and postoperatively using the American Shoulder and Elbow Surgeons scoring system and standard subjective scales for stability, strength, function, and range of motion. Results Athletes most commonly participated in sport at the recreational level (n = 8), followed by collegiate (n = 3) and high school (n = 2). The most common activity was weight lifting (n = 4). Eight athletes (62%) participated in contact sports, most commonly football and wrestling. Two patients (15%) had a partial-thickness articular-sided supraspinatus tendon tear that was debrided at the time of surgery. Mean American Shoulder and Elbow Surgeons score improved from 51.4 to 90.0 (P < .001). There were significant improvements in stability, pain, function, and range of motion based on standardized subjective scales (P < .001). No shoulder required revision surgery for recurrent instability. All patients were able to return to sports, with 9 (69%) able to return to their highest level before surgery. Conclusion Arthroscopic capsulolabral reconstruction is an effective and reliable treatment for glenohumeral instability due to a type VIII superior labrum anterior posterior lesion in the contact, noncontact, and throwing athlete. Successful postoperative return to sport is a reasonable expectation.

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Coracoid Transfer: The Modified Latarjet Procedure for the Treatment of Recurrent Anterior Inferior Glenohumeral Instability in Patients with Bone Deficiency

Surgical Techniques of the Shoulder, Elbow, and Knee in Sports Medicine ◽

10.1016/b978-1-4160-3447-6.50017-x ◽

2008 ◽

pp. 143-155

Author(s):

David P. Huberty ◽

Stephen S. Burkhart

Keyword(s):

Latarjet Procedure ◽

Glenohumeral Instability ◽

Coracoid Transfer ◽

Bone Deficiency

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Anterior Glenohumeral Instability Associated with Glenoid or Humeral Bone Deficiency

Operative Techniques: Shoulder and Elbow Surgery ◽

10.1016/b978-1-4160-3278-6.50021-9 ◽

2011 ◽

pp. 249-260

Author(s):

Kristofer J. Jones ◽

Christopher C. Dodson ◽

Russell F. Warren

Keyword(s):

Glenohumeral Instability ◽

Bone Deficiency ◽

Anterior Glenohumeral Instability

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Effect of Posterior Glenoid Bone Loss and Retroversion on Arthroscopic Posterior Glenohumeral Stabilization

The American Journal of Sports Medicine ◽

10.1177/0363546520946101 ◽

2020 ◽

Vol 48 (11) ◽

pp. 2621-2627

Author(s):

Jared A. Wolfe ◽

Michael Elsenbeck ◽

Kyle Nappo ◽

Daniel Christensen ◽

Robert Waltz ◽

...

Keyword(s):

Bone Loss ◽

Circle Method ◽

Glenoid Bone Loss ◽

Labral Repair ◽

Glenohumeral Instability ◽

Level Of Evidence ◽

Bone Deficiency ◽

Posterior Shoulder ◽

Deficiency Group ◽

Glenoid Retroversion

Background: Posterior glenohumeral instability is an increasingly recognized cause of shoulder instability, but little is known about the incidence or effect of posterior glenoid bone loss. Purpose: To determine the incidence, characteristics, and failure rate of posterior glenoid deficiency in shoulders undergoing isolated arthroscopic posterior shoulder stabilization. Study Design: Cohort study; Level of evidence, 3. Methods: All patients undergoing isolated posterior labral repair and glenoid-based capsulorrhaphy with suture anchors between 2008 and 2016 at a single institution were identified. Posterior bone deficiency was calculated per the best-fit circle method along the inferior two-thirds of the glenoid by 2 independent observers. Patients were divided into 2 groups: minimal (0%-13.5%) and moderate (>13.5%) posterior bone loss. The primary outcome was reoperation for any reason. The secondary outcomes were military separation and placement on permanent restricted duty attributed to the operative shoulder. Results: A total of 66 shoulders met the inclusion criteria, with 10 going on to reoperation after a median follow-up of 16 months (range, 14-144 months). Of the total shoulders, 86% (57/66) had ≤13.5% bone loss and 14% (9/66) had >13.5%. Patients with moderate posterior glenoid bone loss had significantly greater retroversion (−11.5° vs −4.3°; P = .01). Clinical failure requiring reoperation was seen in 10.5% of patients in the minimal bone deficiency group and 44.4% in the moderate group ( P = .024). There was no difference between groups in rate of military separation or restricted duty. Patients with moderate posterior glenoid bone deficiency were more likely to be experiencing instability instead of pain on initial presentation ( P < .001), were more likely to have a positive Jerk test result ( P = .05), and had increased glenoid retroversion ( P = .01). Conclusion: In shoulders with moderate glenoid bone deficiency (>13.5%) and increased glenoid retroversion, posterior capsulolabral repair alone may result in higher reoperation rates than in shoulders without bone deficiency.

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