Anterior arthroscopic bone block with double cortical button fixation system and posterior guide for anterior shoulder instability with glenoid defect. Surgical technique

We report a technique of an arthroscopic concomitant Bankart repair with a transfer of the coracoid bone block and conjoint tendons for revision anterior shoulder instability. The operative procedure consists of an arthroscopic transfer of the conjoined tendon with a coracoid and arthroscopic Bankart repair. First, a typical Bankart suture anchor procedure with two suture anchors was performed into the antero-inferior part of the glenoid rim. After, tenodesis of the coraco-biceps tendon was performed in the middle of the subscapularis tendon fixing the coracoid bony fragment into a glenoid socket with a bioabsorbable interference screw. This operative technique is an alternative in the treatment of revision anterior shoulder instability in patients with deficient anterior capsule.

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Minimum twenty-year follow-up after Bankart repair for the treatment of anterior shoulder instability without significant bony glenoid defect

Sports Orthopaedics and Traumatology ◽

10.1016/j.orthtr.2015.03.021 ◽

2015 ◽

Vol 31 (2) ◽

pp. 167

Author(s):

Philipp Moroder ◽

M. Odorizzi ◽

S. Pizzinini ◽

E. Demetz ◽

H. Resch ◽

...

Keyword(s):

Shoulder Instability ◽

Bankart Repair ◽

Anterior Shoulder Instability ◽

Glenoid Defect

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

The American Journal of Sports Medicine ◽

10.1177/0363546517749586 ◽

2018 ◽

Vol 46 (4) ◽

pp. 795-800 ◽

Cited By ~ 13

Author(s):

Maximiliano Ranalletta ◽

Luciano A. Rossi ◽

Agustin Bertona ◽

Ignacio Tanoira ◽

Ignacio Alonso Hidalgo ◽

...

Keyword(s):

Bone Loss ◽

Shoulder Instability ◽

Functional Outcomes ◽

Glenoid Bone Loss ◽

Anterior Shoulder Instability ◽

Bone Block ◽

Latarjet Procedure ◽

The Mean ◽

Rugby Players ◽

Recurrent Anterior Shoulder Instability

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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Outcomes of the Latarjet Procedure Versus Free Bone Block Procedures for Anterior Shoulder Instability: A Systematic Review and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546520925833 ◽

2020 ◽

pp. 036354652092583

Author(s):

Ron Gilat ◽

Eric D. Haunschild ◽

Ophelie Z. Lavoie-Gagne ◽

Tracy M. Tauro ◽

Derrick M. Knapik ◽

...

Keyword(s):

Systematic Review ◽

Shoulder Instability ◽

Meta Analysis ◽

Anterior Shoulder Instability ◽

Bone Block ◽

Return To Sports ◽

Latarjet Procedure ◽

Shoulder Stabilization ◽

Recurrent Instability

Background: Free bone block (FBB) procedures for anterior shoulder instability have been proposed as an alternative to or bail-out for the Latarjet procedure. However, studies comparing the outcomes of these treatment modalities are limited. Purpose: To systematically review and perform a meta-analysis comparing the clinical outcomes of patients undergoing anterior shoulder stabilization with a Latarjet or FBB procedure. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, Embase, and the Cochrane Library databases were systematically searched from inception to 2019 for human-participants studies published in the English language. The search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement including studies reporting clinical outcomes of patients undergoing Latarjet or FBB procedures for anterior shoulder instability with minimum 2-year follow-up. Case reports and technique articles were excluded. Data were synthesized, and a random effects meta-analysis was performed to determine the proportions of recurrent instability, other complications, progression of osteoarthritis, return to sports, and patient-reported outcome (PRO) improvement. Results: A total of 2007 studies were screened; of these, 70 studies met the inclusion criteria and were included in the meta-analysis. These studies reported outcomes on a total of 4540 shoulders, of which 3917 were treated with a Latarjet procedure and 623 were treated with an FBB stabilization procedure. Weighted mean follow-up was 75.8 months (range, 24-420 months) for the Latarjet group and 92.3 months (range, 24-444 months) for the FBB group. No significant differences were found between the Latarjet and the FBB groups in the overall random pooled summary estimate of the rate of recurrent instability (5% vs 3%, respectively; P = .09), other complications (4% vs 5%, respectively; P = .892), progression of osteoarthritis (12% vs 4%, respectively; P = .077), and return to sports (73% vs 88%; respectively, P = .066). American Shoulder and Elbow Surgeons scores improved after both Latarjet and FBB, with a significantly greater increase after FBB procedures (10.44 for Latarjet vs 32.86 for FBB; P = .006). Other recorded PRO scores improved in all studies, with no significant difference between groups. Conclusion: Current evidence supports the safety and efficacy of both the Latarjet and FBB procedures for anterior shoulder stabilization in the presence of glenoid bone loss. We found no significant differences between the procedures in rates of recurrent instability, other complications, osteoarthritis progression, and return to sports. Significant improvement in PROs was demonstrated for both groups. Significant heterogeneity existed between studies on outcomes of the Latarjet and FBB procedures, warranting future high-quality, comparative studies.

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