Cirugía de Latarjet abierta con técnica mini-open: revisión de conceptos actuales

Abstract

The incidence of traumatic shoulder instability is 1.7% in the general population. The shoulder bone structure provides inherent instability to the joint. The surgeon must study the patient age, dominance and activity, as well as the number and direction of the dislocations, and finally the general conditions of the soft tissues. Initial radiographs include anteroposterior and axillary or Velpeau view, in case of bone injury an AP internal rotation and Stryker view or axillary view should be taken. Magnetic Resonance Imaging allows the study of associated soft tissue injuries. It has been described a number of surgical treatments for recurrent shoulder instability, nevertheless, arthroscopic Bankart repair is the most used. An anterior glenoid defect has been reported in 90% of cases with recurrent anterior shoulder instability. This kind of injuries might require other treatment methods such as transferring the coracoid process, which works by the so called triple lock concept. This surgery is also indicated in cases of glenoid bone defect and subscapularis rupture. The surgical technique has proved to be reproducible through the years and the rehabilitation process is rapid allowing an early return to sports. Complications are mostly secondary to technical mistakes. Recent studies report 96% of satisfaction with only 1% of patients requiring revision surgery. However, it is considered that there is insufficient evidence to consider Latarjet's technique a better technique, despite of better results reported when comparing subjective assessment of mobility, stability and so far by subjective functional tests. Evidence levelIV