Does the Arthroscopic Latarjet Procedure Effectively Correct “Off-Track” Hill-Sachs Lesions?

Plath, Johannes E.; Henderson, Daniel; Coquay, Julien; Dück, Klaus; Haeni, David; Lafosse, Laurent

doi:10.1177/0363546517728717

Cited by 22 publications

(11 citation statements)

References 42 publications

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“…Latarjet surgery is able to convert many, but not all, preoperative OFF-HS, and there is a difference in the recurrence rate between the persistent OFF-HS group versus the converted ON-HS group. Our findings differ from the results of Plath et al, 18 who described arthroscopic Latarjet as an isolated procedure and were able to convert all preoperative OFF-HS lesions to ON-HS lesions in a study of 23 shoulders with preand postoperative CT scans and a mean final follow-up of 23 months. Plath et al 18 also evaluated the role of a potential postoperative remodeling process of the coracoid graft on the final GT and concluded that remodeling occurred in the first 6 postoperative months.…”

Section: Discussioncontrasting

confidence: 99%

“…Our findings differ from the results of Plath et al, 18 who described arthroscopic Latarjet as an isolated procedure and were able to convert all preoperative OFF-HS lesions to ON-HS lesions in a study of 23 shoulders with preand postoperative CT scans and a mean final follow-up of 23 months. Plath et al 18 also evaluated the role of a potential postoperative remodeling process of the coracoid graft on the final GT and concluded that remodeling occurred in the first 6 postoperative months. In our study, no osteolysis or remodeling was observed on follow-up CT scan at a minimum 12-months follow-up, supporting the validity of our conclusions.…”

Section: Discussioncontrasting

confidence: 99%

“…11,12,23,25 Among other indications, Latarjet surgery is a glenoid bone graft technique suitable for anterior glenoid defects that has been recently proposed to indirectly manage OFF-HS defects. 18 As the procedure transfers the coracoid process to the anterior glenoid, this might effectively convert an OFF-HS into an on-track (ON-HS) or nonengaging HS defect by increasing the glenoid surface. However, there are concerns regarding the capability of the Latarjet procedure to turn all OFF-HS lesions into ON-HS, as the coracoid graft might not be big enough to accomplish this mission in certain shoulders with severe bone defects.…”

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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: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

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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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“…We did not perform any remplissage procedures in the presence of a concomitant Hill-Sachs lesion. Plath et al 25 demonstrated that the Latarjet procedure transformed “off-track” Hill-Sachs lesions into “on-track” Hill-Sachs lesions. Those authors showed that at a mean of 23 months postoperatively, a mean persisting enlargement of the glenoid arc of 14% beyond native dimensions remained, avoiding a recurrent off-track lesion in 32% of patients, which would otherwise have occurred with complete remodeling.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Modified Latarjet Performed as a Primary or Revision Procedure in Competitive Athletes: A Comparative Study of 100 Patients With a Minimum 2-Year Follow-up

Rossi

Bertona

Tanoira

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:The literature lacks evidence comparing outcomes between the Latarjet procedure performed as a primary procedure versus a revision procedure in competitive athletes.Purpose:To compare return to sport, functional outcomes, and complications of the modified Latarjet performed as a primary or revision procedure in competitive athletes.Study Design:Cohort study; Level of evidence, 3.Methods:Between June 2008 and June 2015, a total of 100 competitive athletes with recurrent anterior shoulder instability underwent surgery with the congruent arc Latarjet procedure without capsulolabral repair. There were 46 patients with primary repairs and 54 with revisions. Return to sport, range of motion (ROM), the Rowe score, a visual analog scale (VAS) for pain in sport activity, 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 by computed tomography.Results:The mean follow-up period was 58 months (range, 24-108 months). A total of 96 patients (96%) returned to competitive sports; 91% returned to 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 improvements after surgery (P < .001). The Rowe score increased from a preoperative mean of 43.8 to a postoperative mean of 96.1 (P < .01). Subjective pain during sports improved from a preoperative VAS score of 3.3 to a postoperative score of 1.2 (P < .01). The ASOSS score improved significantly from a preoperative mean of 46.3 to a postoperative mean of 88.1 (P < .001). No significant differences in shoulder ROM and functional scores were found between patients who underwent a primary versus a revision procedure. No recurrence of shoulder dislocation or subluxation was noted. The bone block healed in 91 patients (91%).Conclusion:In competitive athletes with recurrent anterior glenohumeral instability, the modified Latarjet procedure produced excellent functional outcomes, with most athletes returning to sport at the same level they had before surgery and without recurrence, regardless of whether the surgery was performed as a primary or a revision procedure.

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“… 2 , 10 , 15 , 19 , 25 While traditionally performed in open fashion, the Latarjet procedure is increasingly being performed arthroscopically, with limited albeit promising evidence. 7 , 11 , 20 , 29 , 36 …”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Bankart Repair Versus Open Latarjet for Recurrent Shoulder Instability in Athletes

Hurley

Davey

Montgomery

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: In athletes with recurrent shoulder instability, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are commonly indicated to restore stability and allow them to return to play (RTP). Purpose: To compare the outcomes of ABR and OL in athletes with recurrent shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of patients with recurrent shoulder instability who underwent ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. The patients were pair-matched in a 1:1 ratio (OL and ABR) by age, sex, sport, and level of preoperative play. We evaluated the rate, level, and timing of RTP, and the Shoulder Instability–Return to Sport after Injury (SIRSI) score between procedures. Additionally we compared the recurrence rate, visual analog scale (VAS) pain score, Subjective Shoulder Value (SSV), Rowe score, satisfaction, and whether patients would undergo the same surgery again. Results: Participants included 62 athletes who underwent ABR and 62 who underwent OL, with a mean follow-up of 47.7 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, SIRSI score, VAS score, SSV, or patient satisfaction. OL resulted in a significantly lower recurrence rate (1.6% vs 16.1% for ABR; P = .009) and a significantly higher Rowe score (mean ± SD, 90.5 ± 12.2 vs 82.2 ± 20.8 for ABR; P = .008). In collision athletes, there was no significant difference between ABR and OL regarding RTP rate (89.1% vs 94.5%; P = .489) or SIRSI score (70.4 ± 24.8 vs 73.8 ± 19.6; P = .426), but OL resulted in a lower recurrence rate (14.5% vs 1.8%; P = .031). Conclusion: ABR and OL resulted in excellent clinical outcomes, with high rates of RTP in athletes. However, lower recurrence rates were seen with OL.

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Does the Arthroscopic Latarjet Procedure Effectively Correct “Off-Track” Hill-Sachs Lesions?

Cited by 22 publications

References 42 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

Comparison Between Modified Latarjet Performed as a Primary or Revision Procedure in Competitive Athletes: A Comparative Study of 100 Patients With a Minimum 2-Year Follow-up

Arthroscopic Bankart Repair Versus Open Latarjet for Recurrent Shoulder Instability in Athletes

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