Comparative study of open and arthroscopic coracoid transfer for shoulder anterior instability (Latarjet)—clinical results at short term follow-up

Abstract

Results Average time of surgery was significantly shorter in ARTHRO than OPEN: respectively 110 and 120 minutes. The number of intra-operative complications was six (12.5%) in OPEN and five (8.1%) in ARTHRO. The results were comparable in both groups, with no significant difference between OPEN and ARTHRO group: satisfaction rate -96.8% and 91.9%, shoulder function -92.2% and 90%, Walch-Duplay score -83.9 and 76.7 respecively. A significant difference was reported in Rowe score: 87.8 in OPEN and 78.9 in ARTHRO. Another significant difference was found in the presence of Bsubjective apprehension^-a term referring to the subjective perception of instability with no signs of instability at clinical examination -28.7% in OPEN and 50% in ARTHRO. Range of motion in both groups were comparable, however patients in OPEN had significantly lower loss of external rotation in adduction to the side comparing to the contralateral shoulder: 7°versus 14°in ARTHRO. Recurrence was reported in three cases in each group: 6.2% in OPEN and 4.8% in ARTHRO. A revision surgery was performed in four patients (9.3%) in OPEN and six (9.7%) in ARTHRO. Radiographic evaluation showed a significantly lower rate (5%) of graft healing problems (fracture, non-union and osteolysis) after arthroscopic stabilisation, however a partial osteolysis of the proximal part of the bone block was significantly more frequent (53.5%). Conclusions The arthroscopic Latarjet stabilisation showed satisfactory and comparable results to open procedure. We recommend further investigation and development of arthroscopic technique.Level of evidence: III

Editorial Commentary: Healthy Skepticism: An Invaluable Trait

“…The authors point out that a tight sling in relative adduction may explain greater restriction of external rotation in adduction than abduction. Similar findings were reported by Kordasiewicz et al 3 In that study comparing 62 arthroscopic versus 48 open Latarjet procedures, although the rate of "recurrent instability" was similarly low (4.8% arthroscopic; 6.2% open), "subjective apprehension" was reported to be 50% for the arthroscopic and 28% for the open procedures. Inadequate sling tension related to the location of the subscapularis split and coracoid graft placement is a possible contribution to the persistent apprehension in half of the arthroscopic cases.…”

Open versus arthroscopic Latarjet procedures for the treatment of shoulder instability: a systematic review of comparative studies

“…However one study found no difference in VAS pain scores once patients had reached 30 days post-operatively [ 14 ]. One study ( n = 286 arthroscopic, 104 open, p < 0.05) found significantly better post-operative Walch-Duplay scores in the arthroscopic group [ 15 ], whereas the other two studies (n = 28 arthroscopic, 36 open, p > 0.05; n = 62 arthroscopic, 48 open, p > 0.05) reporting post-operative Walch-Duplay scores did not [ 10 , 16 ]. Interestingly one study ( n = 99 arthroscopic, 85 open, p < 0.05) reported significantly better post-operative WOSI scores in the arthroscopic group [ 14 ], whereas another study ( n = 36 arthroscopic, 22 open, p = 0.03) found significantly better WOSI scores in the open group [ 13 ].…”

“…Interestingly one study ( n = 99 arthroscopic, 85 open, p < 0.05) reported significantly better post-operative WOSI scores in the arthroscopic group [ 14 ], whereas another study ( n = 36 arthroscopic, 22 open, p = 0.03) found significantly better WOSI scores in the open group [ 13 ]. Similarly, one study (n = 62 arthroscopic, 48 open, p < 0.05) found significantly better Rowe scores in the open group [ 16 ], one study ( n = 286 arthroscopic, 104 open, p < 0.05) found better Rowe scores in the arthroscopic group [ 14 ], and one study ( n = 44 arthroscopic, 46 open, p = 0.181) found no significant difference [ 17 ]. No studies found significant differences in ASES or Constant-Murley scores.…”

“…Persistant apprehension - 4(5.5%) Walch Duplay score − 91. Persistant apprehension - 0(0.0%) Walch Duplay score - no significant difference Marion B, 2017 [ 13 ] VAS (1 week) - 1.2 +/−1.4 WOSI (2 years) - 372.1+/− 140.9 VAS (1 week) - 2.5+/− 1.4 WOSI (2 years) - 451+/− 158.7 VAS p = .002 WOSI p = 0.03 Kordasiewicz B, 2017 [ 16 ] Walch - Duplay score - 76.7 Rowe - 78.9 VAS- 1.38 Satisfaction% - 91.9 Residual subjective apprehension - 31% Walch - Duplay score - 83.9 Rowe - 87.8 VAS- 0.77 Satisfaction% - 96.8 Residual subjective apprehension 28.7% p < 0.05 for Rowe and Subjective apprehension only. The rest did not reach statistical significance.…”

Arthroscopic anatomic glenoid reconstruction demonstrates its safety with short-term to medium-term results for anteroinferior shoulder instability: a systematic review

“…Multiple studies have compared the results of open and AL, finding equivalent outcomes between the two 53 59 60. The only study to date comparing open versus arthroscopic anatomic glenoid techniques compared immediate radiographic results 15.…”