Modified Latarjet procedure for patients with glenoid bone defect accompanied with anterior shoulder instability
The aim of this study was to assess the effects of coracoid bone block (modified Latarjet) procedure on clinical and functional results in cases with glenoid bone defect accompanied with anterior shoulder instability.
The study included 35 patients (average age: 35 years; range: 20 to 58 years) with glenoid bone defect and recurrent dislocations treated with the modified Latarjet procedure. There were 12 sports injuries, 5 post-epileptic cases and 18 recurrent anterior shoulder dislocation following non-sports-related injuries. Recurrence was reported in 7 patients formerly treated with the Bankart procedure. Average number of preoperative dislocations was 10.8±6.5 and average time range between the first dislocation and surgery was 14.9±13.2 months. All patients underwent preoperative diagnostic arthroscopy. Postoperative isometric exercises in braces were assigned for the first 6 weeks, followed by active strengthening exercises. Pre- and postoperative functional results were evaluated using the ASES (American Shoulder and Elbow Surgeons) and Rowe scores and pain using the VAS (Visual Analog Scale).
Osseous union of coracoid graft was achieved in all patients. Average follow-up was 24±12.2 (range: 12 to 74) months. No degenerative arthritis or continuing instability was detected in any of the patients. Average forward flexion was 165°±20° and external rotation 59°±13°. Mean preoperative ASES and Rowe scores of 49.6±10.6 and 47.9±21.5 increased postoperatively to 91.3±11 and 89.1±9.2, respectively. Mean VAS scores decreased significantly from 6.2±2.4 to 1.8±0.6 postoperatively (p<0.05).
Shoulder functionality and former activity levels can be successfully achieved in terms of increased patient satisfaction through use of the modified Latarjet surgery in the treatment of glenoid bone defect and anterior shoulder instability.
Available from: Randy Mascarenhas
- "Only 1 player redislocated, and 93% of patients were “happy” or “very happy” with the results. A modified Latarjet procedure with a coracoid bone block was successful in achieving increased patient satisfaction and return to former activity levels in 35 patients (mean age 35 years, range 20–58) in a study by Atalar et al. . The coracoid graft demonstrated osseous union in all patients at a mean 24 ± 12.2 months (range, 12–74) with no further instability or degenerative arthritis. "
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ABSTRACT: Recurrent shoulder instability and resultant glenoid and humeral head bone loss are not infrequently encountered in the population today, specifically in young, athletic patients. This review on the management of bone loss in recurrent glenohumeral instability discusses the relevant shoulder anatomy that provides stability to the shoulder joint, relevant history and physical examination findings pertinent to recurrent shoulder instability, and the proper radiological imaging choices in its workup. Operative treatments that can be used to treat both glenoid and humeral head bone loss are outlined. These include coracoid transfer procedures and allograft/autograft reconstruction at the glenoid, as well as humeral head disimpaction/humeroplasty, remplissage, humeral osseous allograft reconstruction, rotational osteotomy, partial humeral head arthroplasty, and hemiarthroplasty on the humeral side. Clinical outcomes studies reporting general results of these techniques are highlighted.
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ABSTRACT: BACKGROUND: Arthroscopic glenoid labrum repair is the main therapy for recurrent anterior shoulder dislocation, which cannot meet the demands of shoulder stability. How to strengthen the anterior shoulder stability is an issue that is always explored and pursued. OBJECTIVE: To explore the effectiveness of arthroscopic glenoid labrum repair and combined joint capsule and partial subscapularis suture for recurrent anterior shoulder dislocation. METHODS: Seventy patients admitted for recurrent anterior shoulder dislocation at the Department of Orthopedics, First Affiliated Hospital of Anhui Medical University in China from October 2010 to August 2013 were enrolled, who received the arthroscopic glenoid labrum repair and combined joint capsule and partial subscapularis suture. Patients undergoing post-operative systematical rehabilitation were followed up for Constant-Murley Score and the ROWE Score for Instability, and shoulder stability and motor functions were evaluated in patients. RESULTS AND CONCLUSION: The 70 patients were followed-up for 11-46 months. Complications only appeared in one patient with acute pulmonary edema and five patients with elbow or forearm skin blisters, but all were cured by treatment. Anterior shoulder dislocation disappeared postoperatively in all patients. Sixty-five patients almost recovered in the range of motion of the shoulder, who were satisfied with normal life and work activity. All the patients returned to work. At the last follow-up, the Constant-Murley score was improved from 71.2±5.3 to 94.3±4.9, and the ROWE score was increased from 32.1±4.2 to 95.1±4.7, both of which were better than before (P < 0.05). This study demonstrated arthroscopic glenoid labrum repair and combined joint capsule and partial subscapularis suture is better for recurrent anterior shoulder dislocation, which is conductive to shoulder stability and motor function recovery. © 2015, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.
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ABSTRACT: The aim of this study was to compare the effects of the use of a single anterior portal in the arthroscopic surgery treatment of traumatic anterior shoulder instability with those in the literature.
The study included 72 patients (60 males, 12 females; mean age: 23.9 years) who underwent surgery using a single arthroscopic anterior portal for the treatment of traumatic anterior shoulder instability between 2002 and 2011. Clinical outcomes were assessed using the Rowe and Oxford scales, forward flexion range and external rotation limitation. Redislocation was considered failure.
Mean follow-up was 49.3 months. Bankart lesion was determined in 38 patients and Bankart and SLAP lesions in 34. An average of 3.7 (range: 2 to 5) anchors were used. Redislocation was observed in 4 (5.6%) patients in the postoperative period. Postoperative Rowe and Oxford scores were 93.4 and 42.6, respectively.
Instability surgery performed using a single arthroscopic anterior portal provided findings comparable with the literature regarding clinical outcomes, postoperative shoulder movements and low recurrence rates, emphasizing the importance of appropriate patient selection rather than the number of the portals. The use of a single portal is less invasive and reduces the surgical period.
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