Arthroscopic Remplissage and Open Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Severe Bipolar Bone Loss

Katthagen, J. Christoph; Anavian, Jack; Tahal, Dimitri S.; Millett, Peter J.

doi:10.1016/j.eats.2016.06.006

Cited by 24 publications

(11 citation statements)

References 15 publications

(36 reference statements)

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“…Recently described open and arthroscopic techniques to add a remplissage to the Latarjet procedure could be valid alternatives in this situation. 9,19,21 There are several limitations of this study that should be considered. First, it is a retrospective study of prospectively recorded data, and only patients with a preoperative OFF-HS and a complete set of preoperative images and minimum 12-month follow-up CT scan were collected; thus, 17 patients were excluded, raising the possibility of a selection bias.…”

Section: Discussionmentioning

confidence: 97%

Clinical Relevance of Persistent Off-Track Hill-Sachs Lesion After Arthroscopic Latarjet Procedure

Calvo

Rojas

et al. 2021

Am J Sports Med

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Background: The Latarjet procedure is often used to address off-track Hill-Sachs lesions (OFF-HS) in shoulders with anterior instability. There are concerns as to whether the Latarjet procedure is able to convert all OFF-HS into on-track Hill-Sachs lesions (ON-HS) and whether this limitation could explain the cases of recurrent postoperative instability. Hypothesis: Latarjet surgery converts many preoperative OFF-HS lesions, but not all of them, and there is a difference in the failure rate between shoulders with converted lesions and those with persistent OFF-HS lesions. Study Design: Case series; Level of evidence, 4. Methods: Patients with anterior shoulder instability and an OFF-HS lesion treated with an arthroscopic classic Latarjet procedure between January 2010 and September 2017 were retrospectively evaluated. Patients with moderate or severe shoulder arthrosis, rotator cuff tears, or age older than 50 years were excluded. Glenoid track (GT), HS, HS interval (HSI), and the difference between HSI and GT (ΔHSI-GT) were measured preoperatively. A postoperative computed tomography scan and a clinical evaluation, including the Rowe and Western Ontario Shoulder Instability scores, were performed at a minimum 1- and 2-year follow-up, respectively. Postoperatively, 2 groups of patients were obtained: (1) patients with postoperative persistent OFF-HS; (2) patients with postoperative ON-HS. Clinical and imaging data were compared between the 2 groups. Results: A total of 51 patients (n = 51 shoulders), with a mean age of 29.8 ± 8.4 years (range, 15-50 years), met the inclusion criteria. Six shoulders (11.8%) still showed OFF-HS lesions despite Latarjet surgery. There were no postoperative dislocations, but 3 patients reported subluxations. The subluxation rate was significantly higher in the postoperative persistent OFF-HS group (2 [33%] vs 1 [2.2%]; P = .033). There was a wider preoperative HSI (29.8 ± 2.4 mm vs 22.9 ± 3.5 mm; P < .001) and a larger preoperative ΔHSI-GT (12.2 ± 3.8 mm vs 4.82 ± 3.2 mm; P < .001) in the persistent OFF-HS group. A receiver operating characteristic curve was performed based on preoperative ΔHSI-GT values. A preoperative ΔHSI-GT value ≥7.45 mm predicted a persistent OFF-HS after Latarjet surgery (sensitivity, 100%; specificity, 87%; positive predictive value, 50%; and negative predictive value, 100%). Conclusion: Latarjet surgery converted many preoperative OFF-HS lesions into ON-HS lesions, but not all of them. Six patients (11.8%) retained an OFF-HS and had a statistically significantly higher failure rate after Latarjet surgery compared with those with postoperative ON-HS lesions. Because there were few postoperative OFF-HS lesions and few recurrences, findings are statistically fragile and should be confirmed with larger series.

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Section: Discussionmentioning

confidence: 97%

Clinical Relevance of Persistent Off-Track Hill-Sachs Lesion After Arthroscopic Latarjet Procedure

Calvo

Rojas

et al. 2021

Am J Sports Med

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“…26 If there is an off-track lesion with less than 25 percent glenoid bone loss, a combined arthroscopic Bankart and remplissage is the procedure of choice. 36,39 A Bankart repair may be done both by open and arthroscopic routes, with the arthroscopic technique having advantages like smaller incision, shorter operative time, less effect on the range of movements of the shoulder, and lesser blood loss. The main disadvantages are the long learning curve and cost.…”

Section: Discussionmentioning

confidence: 99%

The Shoulder Instability: An Overview

Zacharia

Prakas

Vaidyanathan

et al. 2021

International Journal of Recent Surgical and Medical Sciences

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Instability of the shoulder joint is common but most of the time it is unrecognized by the treating surgeon. The symptoms can vary from subtle pain to shoulder dislocation. In many cases, there is no history of trauma. The shoulder joint is stabilized by both static and dynamic factors, and treatment is complex, with recurrence more common in young athletic individuals. Open and arthroscopic techniques of stabilization are available with specific indications for each of these methods. In this narrative review of shoulder instability, we describe the pathological anatomy, evaluation, natural history, classification, and treatment of shoulder instability.

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“…Thus, indications for the arthroscopic Bankart repair plus remplissage procedure include patients with less than 25% bone loss and offtrack Hill-Sachs lesions. 41…”

Section: Bankart Repair and Remplissagementioning

confidence: 99%

An Algorithmic Approach to the Management of Shoulder Instability

et al. 2019

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The recurrence of anterior shoulder instability can be as high as 86.7% in high-risk patients who are treated nonoperatively after their first incident of instability. CT and MR arthrography are necessary for preoperative imaging and assessment of glenoid bone loss. Patient expectations in conjunction with appropriate preoperative imaging are critical for surgical planning. Arthroscopic shoulder stabilization is often sufficient in most cases where glenoid bone loss is minimal, with recurrent dislocation rates close to 4% in the literature. Open stabilization procedures are generally indicated in patients with greater than 20% glenoid bone loss.

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Arthroscopic Remplissage and Open Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Severe Bipolar Bone Loss

Cited by 24 publications

References 15 publications

Clinical Relevance of Persistent Off-Track Hill-Sachs Lesion After Arthroscopic Latarjet Procedure

Clinical Relevance of Persistent Off-Track Hill-Sachs Lesion After Arthroscopic Latarjet Procedure

The Shoulder Instability: An Overview

An Algorithmic Approach to the Management of Shoulder Instability

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