ObjectiveEvaluate the results and complications of Latarjet procedure in patients with anterior recurrent dislocation of the shoulder.MethodsFifty-one patients (52 shoulders) with anterior recurrent dislocation, surgically treated by Latarjet procedure, were analyzed retrospectively. The average follow-up time was 22 months, range 12–66 months; The age range was 15–59 years with a mean of 31; regarding sex, 42 (82.4%) patients were male and nine (17.6%) were female. The dominant side was affected in 29 (55.8%) shoulders. Regarding the etiology, 48 (92.3%) reported trauma and four (7.6%) had the first episode after a convulsion.ResultsThe average elevation, lateral rotation and medial rotation of the operated shoulder were, respectively, 146° (60–80°), 59° (0–85°) and T8 (T5 gluteus), with statistical significance for decreased range of motion in all planes, compared with the other side. The scores of Rowe and UCLA were 90.6 and 31.4, respectively, in the postoperative period. Eleven shoulders (21.2%) had poor results: signs of instability (13.4%), non-union (11.5%) and early loosening of the synthesis material (1.9%). There was a correlation between poor results and convulsive patients (p = 0.026).ConclusionWe conclude that the Latarjet procedure for correction of anterior recurrent dislocation leads to good and excellent results in 82.7% of cases. Complications are related to errors in technique.

ObjectiveTo evaluate the results of arthroscopic releases performed in patients with adhesive capsulitis refractory to conservative treatment.MethodsThis was a retrospective study, conducted between 1996 and 2012, which included 56 shoulders (52 patients) that underwent surgery; 38 were female, and 28 had the dominant side affected. The mean age was 51 (29–73) years. The mean follow-up was 65 (12–168) months and the mean preoperative time was 8.9 (2–24) months. According to Zukermann's classification, 23 cases were considered primary and 33 secondary. With the patient in the lateral decubitus position, circumferential release of the joint capsule was performed: joint debridement; rotator interval opening; coracohumeral ligament release; anterior, posterior, inferior, and finally antero-inferior capsulotomy. A subscapularis tenotomy was performed when necessary. All patients underwent intense physical therapy in the immediate postoperative period. In 33 shoulders, an interscalene catheter was implanted for anesthetic infusion. Functional results were evaluated by the UCLA criteria.ResultsImproved range of motion was observed: mean increase of 45° of elevation, 41° of external rotation and eight vertebral levels of medial rotation. According to the UCLA score excellent results were obtained in 25 (45%) patients; good, in 24 (45%); fair, in two (3%); and poor, in two (7%). Patients who had undergone inferior capsulotomy achieved better results. Only 8.8% of patients who used the anesthetic infusion catheter underwent postoperative manipulation. Seven patients had complications.ConclusionThere was improvement in pain and range of motion. Inferior capsulotomy leads to better results. The use of the interscalene infusion catheter reduces the number of re-approaches.

This study provides evidence suggesting that patient-related known factors such as higher ASA score predisposes to shoulder arthroplasty-associated infection. Furthermore, unusual pathogens associated with PSI were identified.

No abstract

Como citar este artigo: da Silva LA, et al. Avaliação dos resultados e das complicaç ões em pacientes com instabilidade anterior de ombro tratados pela técnica de Latarjet. Rev Bras Ortop. 2015. http://dx.doi.org/10.1016/j.rbo.2014.09.012 No. of Pages 8 r e v b r a s o r t o p . 2 0 1 5;x x x(x x):xxx-xxx w w w . r b o . o r g . b r Artigo original informações sobre o artigo Histórico do artigo: Recebido em 7 de agosto de 2014 Aceito em 22 de setembro de 2014 On-line em xxx Palavras-chave: Instabilidade articular/cirurgia Luxação glenoumeral Ombro r e s u m o Objetivo: Avaliar os resultados e as complicaç ões da cirurgia de Latarjet em pacientes acometidos pela instabilidade recorrente anterior de ombro. Métodos: Foram analisados, retrospectivamente, 51 pacientes (52 ombros) com diagnóstico de luxação recidivante anterior, operados pela técnica de Latarjet. O tempo médio de seguimento foi de 22 meses, variação de 12 a 66 meses; a faixa etária variou de 15 a 59 anos, com média de 31; em relação ao sexo, 42 (82,4%) pacientes eram do masculino e nove (17,6%) do feminino. O lado dominante foi acometido em 29 (55,8%) ombros. Quanto à etiologia, 48 (92,3%) referiram trauma e quatro (7,6%) tiveram o primeiro episódio após um quadro de convulsão. ARTICLE IN PRESSResultados: As médias de elevação, rotação lateral e rotação medial ativas do membro operado foram, respectivamente, de 146 • (60 • a 180 • ), 59 • (0 • a 85 • ) e T8 (T5 a glúteo), houve significância estatística quanto à diminuição da amplitude de movimento em todos os planos, quando comparado com o lado contralateral (não operado). As médias de pontuação de Rowe e UCLA foram de 90,6 e 31,4, respectivamente, no período pós-operatório. Onze ombros (21,2%) apresentaram maus resultados: sinais de instabilidade (13,4%), pseudoartrose (11,5%) e soltura precoce do material de síntese (1,9%). Houve correlação entre maus resultados e pacientes convulsivos (p = 0,026).Conclusão: O procedimento de Latarjet para correção da luxação anterior recidivante leva a bons e excelentes resultados em 82,7% dos casos.

Objective: To assess the clinical results obtained of patients who underwent arthroscopic surgical treatment following a first episode of traumatic anterior shoulder dislocation. Methods: Between August 2000 and October 2008, 14 shoulders of 14 patients were treated by the Shoulder and Elbow Group of Santa Casa Hospital, São Paulo. Thirteen patients (93%) were male and one (7%) was female; their ages ranged from 17 to 41 years, with a mean of 28 years. All of the patients evaluated were regularly practicing a sports activity (which required physical vigor of the upper limbs). The time that had elapsed between the trauma and the surgical treatment ranged from seven to 60 days, with a mean of 20 days. The surgical procedure was performed with arthroscopic viewing, with the patient positioned in lateral decubitus. Fixation of the labral-ligamentous complex was achieved using bioabsorbable anchors. The postoperative clinical assessment was made using Rowe and UCLA criteria. Joint mobility was measured according to the guidance from ASES (American Shoulder and Elbow Surgeons). The length of postoperative follow-up ranged from 24 to 120 months, with a mean of 45 months. Results: All the patients achieved satisfactory results, (85% excellent and 15% good), as shown by UCLA, while 100% of the results were excellent according Rowe. The “grip test” was negative for all the patients. Conclusion: Surgical treatment after a first episode of traumatic anterior shoulder dislocation seems to be a good therapeutic option for young active patients who practice sports activities.

Objective: To evaluate the clinical results from patients with traumatic anterior shoulder instability that was treated surgically through arthroscopic viewing, using bioabsorbable anchors and a technique for remove the cartilage of the anterior glenoid rim for repairing a Bankart lesion. Method: Between March 2006 and October 2008, 27 shoulders in 27 patients with a diagnosis of traumatic anterior shoulder instability were operated. The patients’ mean age was 28 years and they had had between two and 25 previous episodes of dislocation. The patients were predominantly male (24; 89%). The minimum length of follow-up was 24 months and the mean was 36 months. None of the patients had previously undergone surgery on the affected shoulder or had any significant bone lesion at the glenoid margin. The postoperative clinical assessment was done using the Rowe scale. To measure the preoperative and postoperative joint range of motion, we used the method described by the American Academy of Orthopaedic Surgeons (AAOS). Results: According to the Rowe criteria, 25 patients (93%) achieved excellent results and two (7%) had poor results. None of the patients presented good or fair results. Twenty-three patients were satisfied with the results obtained (85%), and returned to their activities without limitations, while four patients (15%) had some degree of limitation. There was recurrence of instability in two patients (7%). Conclusion: Treatment of traumatic anterior shoulder instability through arthroscopic viewing using a technique for remove the cartilage of the anterior glenoid rim for repairing a Bankart lesion provided excellent results for 93% of the patients operated.

ResumoNo contexto do tratamento cirúrgico dos pacientes jovens com lesões irreparáveis da porção posterossuperior do manguito rotador, a técnica mais usada é a transferência do tendão do grande dorsal para a porção superolateral do tubérculo maior, conforme descrita e preconizada por Gerber et al. Entretanto, duas características dessa técnica podem levar a resultados ruins e complicações: (i) a deiscência da origem do deltoide, que ocorre devido à sua violação durante a criação da via em golpe de sabre e (ii) a ruptura pós-operatória da inserção da transferência. Na tentativa de solucionar esses dois problemas, as seguintes modificações foram feitas à técnica cirúrgica original. Por meio de uma única via deltopeitoral, o tendão do grande dorsal é isolado e desinserido do úmero. Ele é então alongado e reforçado com um enxerto tendíneo homólogo, transferido ao redor do úmero e fixado à porção superolateral do tubérculo maior. Não foi usada imobilização pós-operatória com órtese toracobraquial rígida.