Outcomes After Latarjet Procedure: Patients With First-Time Versus Recurrent Dislocations

Abstract

Background: The preoperative number of dislocations has been previously proved to be a major factor influencing the results after Bankart repair with more preoperative dislocations correlated with higher recurrence rates and more reoperations. This could possibly be because of the lower quality of the tissue repaired during the procedure after multiple dislocations. On the other hand, the Latarjet procedure does not ''repair'' but rather reconstructs and augments the anterior glenoid.Purpose/Hypothesis: The main objective was to report the clinical outcomes of patients undergoing a Latarjet procedure after 1 dislocation versus multiple (2) dislocations. The hypothesis was that the preoperative number of dislocations would not influence clinical results.Study Design: Cohort study; Level of evidence, 3.Methods: Patients older than 18 years who had undergone a primary Latarjet procedure for shoulder instability with at least 2 years of follow-up were included. Three different techniques were used: a mini-open technique using 2 screws, an arthroscopic technique using 2 screws, and an arthroscopic technique using 2 cortical buttons. Patients were evaluated and answered a questionnaire to assess the number of episodes of dislocation before surgery, the time between the first dislocation and surgery, recurrence of the dislocation, revision surgery, the Walch-Duplay score, the Simple Shoulder Test score, and the visual analog scale (VAS) score for pain.Results: A total of 308 patients were included for analysis with a mean follow-up of 3.4 6 0.8 years. Of that, 83 patients were included in the first-time dislocation group and 225 in the recurrent dislocation group. At last follow-up, the rates of recurrence and reoperation were not significantly different between groups: 4.8% in the first-time dislocation group versus 3.65% in the recurrent dislocation group and 6.1% versus 4.0%, respectively. The overall Walch-Duplay scores at last follow-up were also comparable between the 2 groups, 67.3 6 24.85 and 71.8 6 25.1, even though the first-time dislocation group showed a lower pain subscore (15.0 6 8.6 vs 18.0 6 7.5; P = .003). The VAS for pain was also significantly higher in the first-time dislocation group compared with the recurrent dislocation group (1.8 6 2.3 vs 1.2 6 1.7; P = .03). Conclusion:The number of episodes of dislocation before surgery does not affect postoperative instability rates and reoperation rates after the Latarjet procedure. However, patients with first-time dislocations had more postoperative pain compared with patients with recurrent dislocations before surgery.

Outcomes of the Latarjet Procedure Versus Free Bone Block Procedures for Anterior Shoulder Instability: A Systematic Review and Meta-analysis

“… # References 1, 3, 9-11, 13, 15, 16, 18, 21, 22, 24, 26, 32-36, 38, 42, 43, 46, 50-52, 56, 57, 60, 62, 64, 65, 68, 70-72, 80, 84-86, 93, 95, 97, 101-105, 107, 109-112. …”

Modified Arthroscopic Latarjet Procedure: Suture-button Fixation will not Cause Obvious Increasement of Superior Instability at 5-Year Follow-up

“…In another cadaveric study, the upward movement of the humeral head was more pronounced when upward axial stress was applied to the shoulder joint specimens after cutting off the CAL. This nding also clari es that the CAL restricts the upward movement of the humeral head [3]. Several scholars believe that in patients with massive rotator cuff tear, the CAL should be preserved to avoid subsequent anterosuperior instability postoperatively [7].…”

“…Anterior subluxation and dislocation account for 52.1% of all shoulder instability injuries, and approximately 30% of which requires surgical treatment [1]. At present, the arthroscopic Latarjet procedure has gradually become popular for the treatment of shoulder dislocation with evident glenoid defect, and many reports have con rmed that Latarjet procedure has excellent clinical results [2,3,4].…”

Placing the Latarjet in Context

“…In this month’s The American Journal of Sports Medicine , 2 multicentric French studies use a comparative cohort design to explore the success of the Latarjet procedure in different patient populations. In the first, Hardy and colleagues 8 compare the outcomes of patients who underwent the Latarjet following their primary shoulder dislocation with others who experienced a mean of almost 9 dislocations prior to surgery. The authors noted that operations like the Bankart procedure, which aim to repair the damaged anatomy directly, tend to have worse results after the native tissue has been damaged by multiple episodes of instability.…”

“…16,25 As screws are often used to fix the coracoid in place, a theoretical consequence of excessive absorption is exposure of the screws 18 and subsequent pain or secondary injury. 8 Graft absorption may be more likely when the Latarjet is used in shoulders with little to no glenoid bone loss. 5,6 In 2011, Di Giacomo and colleagues 5 reported their findings from computed tomography scans of 26 shoulders an average of 17.5 months postoperatively.…”