The Open Capsular Shift-Latarjet Procedure for Recurrent Anterior Shoulder Instability

Background: Capsular management is having an increasingly important place during the open Latarjet procedure especially in preventing postoperative glenohumeral arthritis. The open capsular shift-Latarjet procedure consists of the classic Latarjet procedure associated with a glenoid T-based capsular shift to treat patients with high risk of recurrent anterior shoulder instability. Indications: Patients presenting with humeral and/or glenoid bone loss, patients practicing professional activities or sports at risk of recurrence and without any previous capsular surgery, or major capsular deficiency. Technique Description: After a classic deltopectoral approach and the osteotomy of the coracoid process, a horizontal split of the subscapularis is performed. Then a glenoid T-based capsulotomy is performed, and 2 passing wire suture threads are passed through the inferior flap of the capsule to prepare the capsular shift. A first, soft, all-sutured anchor is inserted at the inferior part of the glenoid medially to the articular surface. The coracoid graft is then positioned with a first inferior cancellous screw to be flush with the articular surface and fixed using a second cancellous screw. A second anchor is placed laterally and superiorly to the coracoid at the anterior scapular neck. The capsular shift is performed using a passing wire technique to suture the capsular flap to both anchors and to ensure the extraarticular positioning of the coracoid. Results: Bouju et al found a low rate of recurrence with no revision surgeries and a significative lower incidence of osteoarthritis (8.6%) at 10-year follow-up compared with the current literature when suturing the capsule to the coracoid process. Itoigawa et al concluded that suturing the capsule on the coracoid may increase the risk of osteoarthritis due to a direct contact between the humeral head and the transferred coracoid, thus we suggest attaching the capsule over the glenoid. Discussion/Conclusion: With appropriate patient selection, this technique is safe and reliable to treat patients with anterior instability without any specific risk related to the surgery. The association of the capsular repair is an appropriate solution to better restore the anatomy and to prevent the long-term risk of glenohumeral arthritis.

Autologous osteochondral transplantation method of treatment for recurrent anterior shoulder instability

BackgroundGenerally, the treatment of recurrent anterior shoulder instability is a challenge in the orthopedics with various treatment methods. There is a high recurrence rate for those patients with high activity and glenoid bone lesion less than 20% after Bankart procedure. The authors present a novel surgical technique using autologous osteochondral transplantation (AOT) method for recurrent anterior shoulder instability.MethodsBetween 2019 to 2021, 7 patients (five man and two women; mean age 35.1 years (range 17–55 years)) with recurrent anterior shoulder instability and glenoid bone lesion of 20% or less were treated with AOT method. All patients were available for follow-up at a mean of 25.4 months (range, 16 to 32 months), including Rowe score, Oxford Shoulder Score (OSS), Simple Shoulder Test (SST), and 3-dimensional computed tomography examination.ResultsThe mean preoperative and postoperative Rowe score were calculated to be 25.7 ± 6.7 (range, 20–35) and 90.6 ± 2.4 (range, 85–95), respectively (p < 0.01). The mean preoperative and postoperative Oxford score were 36.4 ± 5.6 (range, 30–40) and 54.6 ± 2.4 (range, 50–57), respectively (p < 0.01). The mean preoperative and postoperative SST score were 6.9 ± 0.7 (range, 6–8) and 11.5 ± 0.7 (range, 11–12), respectively (p < 0.01). The average final forward flexion was 176° (affected shoulder), compared with 177° on the non-affected shoulder (P = 0.81). The average final abduction in external rotation was 86.6° (affected shoulder), compared with 89° on the non-affected shoulder (P = 0.31). Analysis of Computed Tomography (CT) data at an average 1 years postoperative showed that a mean glenoid bony gain of 16.7% was observed (range, 11.2%-19%, SD 3.6).ConclusionThis technique can be a useful option, particularly in patients with glenoid bone defect less than 20%. In addition, AOT technique may be considered as alternative to the Latarjet procedure. Nonetheless, further biomechanical and clinical studies are needed to determine the effect of this procedure to more commonly utilized techniques.Level of EvidenceLevel IV; Case series

Outcomes of the Latarjet Procedure in Recurrent Anterior Shoulder Instability due to Tramadol-Induced Seizure

Background: This study was aimed to evaluate the final results of surgical treatment (Latarjet procedure) in the recurrent anterior shoulder instability following episodes of tramadol-induced seizure. Methods: From January 2005 to March 2013, 47 patients with recurrent anterior shoulder dislocation after suffering a seizure episode following tramadol use underwent surgical procedure. There were 53 shoulders in 47 male patients (six had bilateral recurrent dislocations). The mean age of the patients at the time of operation was 24.7 years (ranging from 20 to 44 years). The average number of episodes of anterior shoulder dislocation before surgery was 16. Results: External rotation with the elbow at the side improved from 45.8 ± 9.3° (30°-60°) pre-operatively to 61.5 ± 7.8° (45°-90°) postoperatively (P < 0.001). Forward elevation also increased significantly post-operatively (P = 0.002). Mean pre-operative Rowe score was 28.41 ± 4.30 (30-85) which increased to 73.57 ± 8.40 post-operatively. The Western Ontario Shoulder Instability Index (WOSI) score decreased from 1352 ± 74 to 618 ± 46 (P < 0.0001). Conclusion: Correcting glenoid bone loss by Latarjet procedure combined, if necessary, with humeral head defect reconstruction could be a proper treatment method in patients experiencing recurrent anterior shoulder dislocation after idiosyncratic seizure reaction of tramadol.