Latarjet procedure using subscapularis split approach offers better rotational endurance than partial tenotomy for anterior shoulder instability

Erşen, Ali; Birişik, Fevzi; Özben, Hakan; Atalar, Ata Can; Şahinkaya, Türker; Seyahi, Aksel; Demirhan, Mehmet

doi:10.1007/s00167-017-4480-3

Cited by 19 publications

(14 citation statements)

References 20 publications

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“…Previous data suggested that subscapularis tenotomy may lead to subscapularis muscular atrophy and fatty degeneration, 50 as well as weaker internal rotation strength and durability with isometric and isokinetic testing. 12,44 However, the clinical data in this study did not show any significant difference between the techniques. Furthermore, younger age is a risk factor for repeat dislocation.…”

Section: Independent Risk Factors For Failure To Meet Rtp Criteriacontrasting

confidence: 56%

Are Patients Who Undergo the Latarjet Procedure Ready to Return to Play at 6 Months? A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group Cohort Study

et al. 2020

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Background: The Latarjet procedure is growing in popularity for treating athletes with recurrent anterior shoulder instability, largely because of the high recurrence rate of arthroscopic stabilization, particularly among contact athletes with bone loss. Purpose: (1) To evaluate return of strength and range of motion (ROM) 6 months after the Latarjet procedure and (2) to determine risk factors for failure to achieve return-to-play (RTP) criteria at 6 months. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 65 athletes (83% contact sports, 37% overhead sports; mean ± SD age, 24.5 ± 8.2 years; 59 male, 6 female) who enrolled in a prospective multicenter study underwent the Latarjet procedure for anterior instability (29% as primary procedure for instability, 71% for failed prior stabilization procedure). Strength and ROM were assessed preoperatively and 6 months after surgery. RTP criteria were defined as return to baseline strength and <20° side-to-side ROM deficits in all planes. The independent likelihood of achieving strength and motion RTP criteria at 6 months was assessed through multivariate logistic regression modeling with adjustment as needed for age, sex, subscapularis split versus tenotomy, preoperative strength/motion, percentage bone loss, number of prior dislocations, preoperative subjective shoulder function (American Shoulder and Elbow Surgeons and Western Ontario Shoulder Instability Index percentage), and participation in contact versus overhead sports. Results: Of the patients, 55% failed to meet ≥1 RTP criteria: 6% failed for persistent weakness and 51% for ≥20° side-to-side loss of motion. There was no difference in failure to achieve RTP criteria at 6 months between subscapularis split (57%) versus tenotomy (47%) ( P = .49). Independent risk factors for failure to achieve either strength or ROM criteria were preoperative American Shoulder and Elbow Surgeons scores (per 10-point decrease: adjusted odds ratio [aOR], 1.61; 95% CI, 1.14-2.43; P = .006), Western Ontario Shoulder Instability Index percentage (per 10% decrease: aOR, 0.61; 95% CI, 0.38-0.92; P = .01), and a preoperative side-to-side ROM deficit ≥20° in any plane (aOR, 5.01; 95% CI, 1.42-21.5; P = .01) or deficits in external rotation at 90° of abduction (per 10° increased deficit: aOR, 1.64; 95% CI, 1.06-2.88; P = .02). Conclusion: A large percentage of athletes fail to achieve full strength and ROM 6 months after the Latarjet procedure. Greater preoperative stiffness and subjective disability are risk factors for failure to meet ROM or strength RTP criteria.

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Section: Independent Risk Factors For Failure To Meet Rtp Criteriacontrasting

confidence: 56%

Are Patients Who Undergo the Latarjet Procedure Ready to Return to Play at 6 Months? A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group Cohort Study

et al. 2020

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“…6,29,31 Its common surgical treatments include Bankart (labral) repairs, which involve sewing the joint capsule and detached labrum to the glenoid, 25,32 and Latarjet (bone block) procedures, which require transferring the coracoid process, with attached soft tissue, to the anteroinferior border of the glenoid through a split in the subscapularis muscle. 12,13,40 The Latarjet procedure enables fast recovery 2 and return to sports, 22 has a low recurrence of instability (\7%), 9,19 and includes favorable long-term outcomes, 14,20,41 despite some complications, such as pain at the tip of the screw, 11,28,33 bone-block lyses, malposition, nonunion, 11,23,33,35 and neurological dysfunction. 14,15,39 Some of these complications are due to soft tissue impingements that could be resolved by screw removal, as performed after 0.8% to 3% of Latarjet procedures.…”

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confidence: 99%

Screw Removal Can Resolve Unexplained Anterior Pain Without Recurrence of Shoulder Instability After Open Latarjet Procedures

et al. 2020

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Background: Anterior shoulder instability can be successfully treated using Latarjet procedures, although a small proportion of patients report unexplained pain. Purpose/Hypothesis: The purpose was to report the prevalence and characteristics of patients with unexplained pain without recurrent instability after open Latarjet procedures and to determine whether screw removal can alleviate pain. The hypothesis was that unexplained pain without recurrent instability might be due to soft tissue impingements against the screw heads and that the removal of screws would alleviate or reduce pain. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed the clinical and radiographic records of 461 consecutive shoulders treated by open Latarjet procedures for anterior instability between 2002 and 2014. Unexplained anterior pain was present in 21 shoulders (4.6%) and treated by screw removal at 29 ± 37 months (mean ± SD). Postoperative assessment at >12 months after screw removal included complications, visual analog scale for pain (pVAS), subjective shoulder value, Rowe score, Walch-Duplay score, and ranges of motion. The study cohort comprised the shoulders of 20 patients (9 women, 11 men) aged 25 ± 6 years (median, 25 years; range, 16-34 years) at screw removal and involved the dominant arm in 13 (62%) shoulders. Results: Screw removal alleviated pain completely in 14 shoulders (67%; pVAS improvement, 6.4 ± 1.8; median, 6; range, 3-8) and reduced pain in the remaining 7 (33%; pVAS improvement, 2.4 ± 1.4; median, 2; range, 1-5). At 38 ± 23 months after screw removal, 2 recurrences of instability unrelated to screw removal occurred. The subjective shoulder value was 79% ± 22% (median, 90%; range, 0%-95%); Rowe score, 85 ± 20 (median, 95; range, 30-100); and Walch-Duplay score, 82 ± 19 (median, 85; range, 25-100). Mobility improved in active forward elevation (171°± 14°), external rotation with the elbow at the side (61°± 12°), and external rotation with the arm at 90° of abduction (67°± 13°) and especially in internal rotation, with only 2 shoulders (10%) limited to T12 spine segment. Conclusion: The present findings confirm that unexplained anterior pain after Latarjet procedures can be related to the screws used to fix bone blocks, which can safely be alleviated or reduced by screw removal.

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“…9 Consequences of subscapularis split had been widely studied in the context of open instability surgeries and open Latarjet. 5,[11][12][13]17,[36][37][38][39] However, outcomes of arthroscopic subscapularis split are still relatively unknown. This is the first study on the clinical, radiologic, and isokinetic performance of the subscapularis after arthroscopic Latarjet procedure at long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Subscapularis structural integrity and function after arthroscopic Latarjet procedure at a minimum 2-year follow-up

Valencia

Fernández-Bermejo

Martín-Ríos

et al. 2020

Journal of Shoulder and Elbow Surgery

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Latarjet procedure using subscapularis split approach offers better rotational endurance than partial tenotomy for anterior shoulder instability

Abstract: Retrospective cohort study, Level III.

Cited by 19 publications

References 20 publications

Are Patients Who Undergo the Latarjet Procedure Ready to Return to Play at 6 Months? A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group Cohort Study

Are Patients Who Undergo the Latarjet Procedure Ready to Return to Play at 6 Months? A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group Cohort Study

Screw Removal Can Resolve Unexplained Anterior Pain Without Recurrence of Shoulder Instability After Open Latarjet Procedures

Subscapularis structural integrity and function after arthroscopic Latarjet procedure at a minimum 2-year follow-up

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