Modified Latarjet Without Capsulolabral Repair in Rugby Players With Recurrent Anterior Glenohumeral Instability and Significant Glenoid Bone Loss

Background: The optimal management of recurrent anterior shoulder instability with significant glenoid bone loss in high-demand collision athletes remains a challenge. Purpose: To analyze the time to return to sport, clinical outcomes, and recurrences following a modified Latarjet procedure without capsulolabral repair in rugby players with recurrent anterior shoulder instability and significant glenoid bone loss. Study Design: Case series; Level of evidence, 4. Methods: Between June 2008 and June 2015, 50 competitive rugby players (practice >2 times per week and competition during weekends) with recurrent anterior shoulder instability underwent operation with the modified congruent arc Latarjet procedure without capsulolabral repair in our institution. Cases included 18 primary repairs and 32 revisions. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale for pain in sport activity (VAS), 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. The final analysis included 49 shoulders in 48 patients (31 revision cases). Results: The mean follow-up was 48 months (range, 24-108 months) and the mean age at the time of operation was 22.8 years (range, 17-35 years). Forty-five patients (93.7%) returned to playing rugby, all 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 statistically significant improvement after operation ( P < .001). The Rowe score increased from a mean of 39.5 points preoperatively to 94 points postoperatively ( P < .01). The VAS score decreased from 3.6 points preoperatively to 1.2 points postoperatively ( P < .01). The ASOSS score improved significantly from a mean of 44 points preoperatively to 89.5 points postoperatively ( P < .01). No recurrence of shoulder dislocation or subluxation was noted. The bone block healed in 43 shoulders (88%). Conclusion: In rugby players with recurrent anterior shoulder instability and significant glenoid bone loss, the modified Latarjet procedure without capsulolabral repair produced excellent functional outcomes, with most athletes returning to rugby at their preinjury level of play without recurrences.

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An Evaluation of the Clinical and Anatomic Predictors of Outcomes at a Minimum of 2 yrs Following the Latarjet Procedure for Recurrent Anterior Shoulder Instability with Glenoid Bone Loss

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967115s00151 ◽

2015 ◽

Vol 3 (7_suppl2) ◽

pp. 2325967115S0015

Author(s):

William R. Mook ◽

Maximilian Petri ◽

Joshua A. Greenspoon ◽

Marilee P. Horan ◽

Peter J. Millett

Keyword(s):

Bone Loss ◽

Shoulder Instability ◽

Glenoid Bone Loss ◽

Anterior Shoulder Instability ◽

Latarjet Procedure ◽

Predictors Of Outcomes ◽

Recurrent Anterior Shoulder Instability

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

The American Journal of Sports Medicine ◽

10.1177/0363546518791555 ◽

2018 ◽

Vol 47 (10) ◽

pp. 2484-2493 ◽

Cited By ~ 15

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.

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The Latarjet procedure in competitive athletes younger than 20 years old with a significant glenoid bone loss

Shoulder & Elbow ◽

10.1177/1758573220944166 ◽

2020 ◽

pp. 175857322094416

Author(s):

Luciano A Rossi ◽

Ignacio Tanoira ◽

María G Bruchmann ◽

Ignacio Pasqualini ◽

Maximiliano Ranalletta

Keyword(s):

Bone Loss ◽

Scoring System ◽

Functional Outcomes ◽

Glenoid Bone Loss ◽

Bone Block ◽

Return To Sports ◽

Latarjet Procedure ◽

Competitive Athletes ◽

The Mean

Purpose To analyze return to sports, functional outcomes, and complications following the Latarjet procedure in competitive athletes younger than 20 years old with a significant glenoid bone loss. Methods Between 2010 and 2017, 60 competitive athletes younger than 20 years old with a significant glenoid bone loss were operated with the Latarjet procedure. Return to sports, range of motion, and the Rowe and the Athletic Shoulder Outcome Scoring System score were used to assess functional outcomes. Complications and bone consolidation were also evaluated. Results The mean follow-up was 58 months and the mean age was 16.3 years. Overall, 93% were able to return to sports and 84% returned at the same level. The Rowe and Athletic Shoulder Outcome Scoring System scores showed statistical improvement after operation ( P < .001). The total complication rate was 22% and the revision rate was 1.6%. The recurrence rate was 3.3%. The bone block healed in 93% of the cases. Conclusions In competitive athletes younger than 20 years old with a significant glenoid bone loss, the Latarjet procedure resulted in excellent functional outcomes, with most of the patients returning to sports and at the same level they had before injury with a low rate of recurrences. However, this procedure is associated with a significant rate of complications and should preferably be performed by experienced surgeons.

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Recurrence and Revision Rates With Arthroscopic Bankart Repair Compared With the Latarjet Procedure in Competitive Rugby Players With Glenohumeral Instability and a Glenoid Bone Loss <20%

The American Journal of Sports Medicine ◽

10.1177/0363546520988154 ◽

2021 ◽

Vol 49 (4) ◽

pp. 866-872

Author(s):

Luciano A. Rossi ◽

Ignacio Tanoira ◽

Tomás Gorodischer ◽

Ignacio Pasqualini ◽

Maximiliano Ranalletta

Keyword(s):

Bone Loss ◽

Functional Outcomes ◽

Return To Sport ◽

Glenoid Bone Loss ◽

Bankart Repair ◽

Latarjet Procedure ◽

Glenohumeral Instability ◽

Arthroscopic Bankart Repair ◽

Significant Difference ◽

Rugby Players

Background: There is a lack of evidence in the literature comparing outcomes between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%. Purpose: To compare return to sport, functional outcomes, and complications between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2010 and February 2018, 130 competitive rugby players with anterior shoulder instability were operated on in our institution. The first 80 patients were operated on with the arthroscopic Bankart procedure and the other 50 with the open Latarjet procedure. Return to sport, range of motion (ROM), the Rowe score, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences, reoperations, and complications were also evaluated. Results: In the total population, the mean follow-up was 40 months (range, 24-90 months) and the mean age was 24.2 years (range, 16-33 years). Ninety-two percent of patients were able to return to rugby, 88% at their preinjury level of play. Eighty-nine percent of patients in the Bankart group and 87% in the Latarjet group returned to compete at the same level ( P = .788). No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe and ASOSS scores showed statistical improvement after operation ( P < .01). No significant difference in functional scores was found between the groups The Rowe score in the Bankart group increased from a preoperative mean (± SD) of 41 ± 13 points to 89.7 points postoperatively, and in the Latarjet group, from a preoperative mean of 42.5 ± 14 points to 88.4 points postoperatively ( P = .95). The ASOSS score in the Bankart group increased from a preoperative mean of 53.3 ± 3 points to 93.3 ± 6 points postoperatively, and in the Latarjet group, from a preoperative mean of 53.1 ± 3 points to 93.7 ± 4 points postoperatively ( P = .95). There were 18 recurrences (14%). The rate of recurrence was 20% in the Bankart group and 4% in the Latarjet group ( P = .01). There were 15 reoperations (12%). The rate of reoperation was 16% in the Bankart group and 4% in the Latarjet group ( P = .03). There were 6 complications (5%). The rate of complications was 4% in the Bankart group and 6% in the Latarjet group ( P = .55). The proportion of postoperative osteoarthritis was 10% in the Bankart group (8/80 patients) and 12% (6/50 patients) in the Latarjet group ( P = .55). Conclusion: In competitive rugby players with glenohumeral instability and a glenoid bone loss <20%, both the arthroscopic Bankart repair and the Latarjet procedure produced excellent functional outcomes, with most athletes returning to sport at the same level they had before the injury. However, the Bankart procedure was associated with a significantly higher rate of recurrence (20% vs 4%) and reoperation (16% vs 4%) than the Latarjet procedure.

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Clinical Outcomes of Shoulder Stabilization in Females With Glenoid Bone Loss

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211007525 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110075

Author(s):

Rachel M. Frank ◽

Hytham S. Salem ◽

Catherine Richardson ◽

Michael O’Brien ◽

Jon M. Newgren ◽

...

Keyword(s):

Bone Loss ◽

Clinical Outcomes ◽

Shoulder Instability ◽

Glenoid Bone Loss ◽

Anterior Shoulder Instability ◽

Latarjet Procedure ◽

Shoulder Stabilization ◽

Simple Shoulder Test ◽

Female Patients

Background: Nearly all studies describing shoulder stabilization focus on male patients. Little is known regarding the clinical outcomes of female patients undergoing shoulder stabilization, and even less is understood about females with glenoid bone loss. Purpose: To assess the clinical outcomes of female patients with recurrent anterior shoulder instability treated with the Latarjet procedure. Study Design: Case series; Level of evidence, 4. Methods: All cases of female patients who had recurrent anterior shoulder instability with ≥15% anterior glenoid bone loss and underwent the Latarjet procedure were analyzed. Patients were evaluated after a minimum 2-year postoperative period with scores of the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale. Results: Of the 22 patients who met our criteria, 5 (22.7%) were lost to follow-up, leaving 17 (77.2%) available for follow-up with a mean ± SD age of 31.7 ± 12.9 years. Among these patients, 16 (94.1%) underwent 1.6 ± 0.73 ipsilateral shoulder operations (range, 1-3) before undergoing the Latarjet procedure. Preoperative indications for surgery included recurrent instability with bone loss in all cases. After a mean follow-up of 40.2 ± 22.9 months, patients experienced significant score improvements in the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale ( P < .05 for all). There were 2 reoperations (11.8%). There were no cases of neurovascular injuries or other complications. Conclusion: Female patients with recurrent shoulder instability with glenoid bone loss can be successfully treated with the Latarjet procedure, with outcomes similar to those of male patients in the previously published literature. This information can be used to counsel female patients with recurrent instability with significant anterior glenoid bone loss.

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