Editorial Commentary: The Wake of the Dragon: Will the Orthopaedic Community Adopt the Shoulder Arthroscopic Latarjet Procedure as We Adopted the Arthroscopic Rotator Cuff Repair?

Abstract

The Latarjet procedure is a complex and difficult operation when performed both with an open approach and arthroscopically. The difficulties come from the fact that it is a combined intra- and extra-articular procedure, and that working close to the brachial plexus may be frightening for surgeons. Because of the high complication and reoperation rates reported in the literature, this procedure is, at the moment, rejected by a large part of the orthopaedic community, specifically in North America. The Chinese experience shows, after the European one, that arthroscopic Latarjet is an efficient and irreplaceable option for the treatment of recurrent anterior shoulder instability in the context of capsular and/or glenoid deficiency. A recent study shows that the arthroscopic procedure provides accurate bone block positioning and high rates of healing, excellent clinical results (no recurrence of instability at 2-year follow-up), and low rates of complications (no neurovascular injury). Although the arthroscopic Latarjet should be approached with caution, the learning curve should not be thought of as prohibitive. To learn how to perform an arthroscopic Latarjet, surgeons should visit an experienced surgeon and take a course to practice on cadavers first. Although it will take time and effort to learn and perform this operation correctly, we should command our Chinese colleagues to encourage us to follow their path. There is no reason that in the near future the orthopaedic community does not adopt the arthroscopic Latarjet procedure, as we adopted the arthroscopic rotator cuff repair and other complex surgical procedures. Among the strongest reasons to perform the Latarjet procedure arthroscopically are the accuracy of graft placement, the safety for neurovascular structures provided by direct visualization and magnification, and the excellent clinical results allowing young people to go back to sport, including high-risk (contact, overhead) sports.

Instability severity index score values below 7 do not predict recurrence after arthroscopic Bankart repair

“…The paper has been cited almost 500 times in 10 years [1] and is often used to guide the surgical choice in published work [7, 8, 19] and in meetings, especially in France and Europe, but also around the world [25]. Later on, Boileau and Saliken [4] and others [7, 19] have suggested that the threshold to avoid an arthroscopic Bankart repair should be lowered to 4. Our results clearly dispute this suggestion as we could not find an increased recurrence risk for patients scoring above 3 when compared to those with lower values.…”

“…The inclusion criteria were: (1) recurrent anterior instability [dislocation or subluxation] with or without hyperlaxity and (2) an arthroscopic Bankart repair The exclusion criteria were: (1) concomitant rotator cuf lesion, (2) an acute irst-time dislocation, (3) surgery for recurrent instability after a previous anterior stabilization, (4) surgery for a painful, unstable shoulder without true dislocation or subluxation; or (5) multidirectional instability. Those inclusion and exclusion criteria followed precisely those used by Balg and Boileau in their initial ISIS study [3].…”

Characterizing the Practices of Canadian Orthopedic Surgeons in the Management of patients With Anterior Glenohumeral Instability

“…Numerous surveys in other geographic regions have been completed to date outlining the areas of consensus and contention in clinical practice, as well as an evolution in practice patterns over time. [18][19][20][21][22][23][24][25] This includes a shift toward arthroscopic over open procedures, [26][27][28] a reduction in nonoperative management of those with an initial shoulder dislocation, and a subsequent acceptance that surgical stabilization may be an appropriate first course of action. 29,30 The arthroscopic Bankart repair is often the treatment of choice in the absence of bony pathology.…”

Outcome of arthroscopic triple release combined with rotator cuff repair in the treatment of rotator cuff injury combined with frozen shoulder

“… 1 Frozen shoulder is primary adhesive capsulitis that can be attributed to various factors such as shoulder joint infection, long-term immobilization of the shoulder joint, and upper limb trauma. 2 Most frozen shoulders may occur concurrently with rotator cuff injuries, with the incidence accounting for 35% of rotator cuff injuries. 3 Once combined, the limitation of shoulder joint movement and pain will be aggravated, and early treatment is needed to alleviate the symptoms.…”