Intraoperative graft-related complications are a risk factor for recurrence in arthroscopic Latarjet stabilisation

Abstract

PurposeThe goal of this study was to evaluate clinical and radiological outcomes after arthroscopic Latarjet stabilisation in anterior shoulder instability.MethodsNinety-three patients after primary arthroscopic Latarjet stabilisation were reviewed. Satisfaction, subjective shoulder value (SSV), Walch–Duplay and Rowe scores, and range of motion and stability were evaluated on clinical examination. Computed tomography (CT) was used to analyse graft position and fusion.ResultsNinety patients (96.8%) were available for clinical and 85 for CT evaluation. The mean follow-up was 23.7 months (13–50, SD 7.1) and age at surgery was 26.2 years (16–44, SD 5.6). Intraoperative complications were reported in eight patients (8.9%) and recurrence in three (3.3%). Significantly, two out of three patients with recurrence had intraoperative graft complications (p = 0.0107). Forty-one patients (45.6%) reported the feeling of “subjective return to sport anxiety”. External rotation with arm at the side was 59° (10–90°, SD 20) with 15° (0–70°, SD 17) of loss of rotation. These two factors correlated with results the most. Patient satisfaction was evaluated as 92% (40–100, SD 14) and SSV 90% (30–100, SD12). Revision rate after primary surgery was 10%. CT showed graft healing in 81 (95.3%) patients. A graft position between 2 and 5 o’clock was found in 70 (83.4%) patients and flush to the anterior glenoid rim in 34 (40.5%). Osteolysis of the superior part of the graft was found in 55 (64.7%) patients. CT evaluation showed no correlation with clinical results.ConclusionArthroscopic Latarjet stabilisation demonstrates satisfactory results in short-term follow-up; however, intraoperative graft-related complications are a risk factor for recurrence. “Subjective return to sport anxiety” and loss of external rotation with the arm at the side are factors worsening the results. Graft position imperfections and osteolysis of the superior part of the graft reported in CT evaluation do not influence the clinical results.

Editorial Commentary: Arthroscopic Latarjet: An Analysis of Outcomes and Complications Through its Learning Curve

“…Although soft-tissue dissection is reduced by the arthroscopic approach, graft positioning and intraoperative complications are still a source of concern. 4 Kordasiewicz et al reported a correct position of the graft in the axial plane in 40.5% of patients and in the sagittal plane (between 3 and 5 o'clock) in 54.6% of cases.…”

Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores

“…high complication rates, including pain due to soft-tissue impingements [17], neurologic impairments, and bone-block nonunion or malposition [11,13,15,18,25,39].…”

“…The Latarjet technique is a bone‐block procedure that gained considerable popularity in recent years, as it proved effective at preventing recurrent dislocations [2, 8, 19], while allowing rapid recovery and return to play (RTP) [3, 8, 19, 23]. The Latarjet procedure has also demonstrated satisfactory long‐term outcomes in young recreational and competitive athletes [5, 13, 20, 41], despite comparatively high complication rates, including pain due to soft‐tissue impingements [17], neurologic impairments, and bone‐block nonunion or malposition [11, 13, 15, 18, 25, 39].…”

Comparison of perioperative complications following surgical treatment of shoulder instability

“… 9 , 20 While the risk is still relatively low and the procedures are generally considered safe, complications with operative management can include, but are not limited to, infection, nerve injury, graft malposition, graft nonunion, and recurrent subluxation/dislocation. 9 , 16 , 17 , 21 , 22 , 26 , 31 , 35 , 40 Through this study, the authors are interested in specifically analyzing the perioperative complications associated with instability repair procedures by utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) registry. While previous studies have utilized the NSQIP database for similar outcome measures, the cohort of patients utilized in those analyses was limited by the availability of data at the time of publication.…”