Abstract
Background: The purpose of this case series was to retrospectively compare radiological, clinical and functional outcomes and complications of diagnostic arthroscopy with open Latarjet procedures pre- and postoperatively within one year after surgery. Additionally we compared the pathologic findings during diagnostic arthroscopy with the radiological findings in preoperative contrast enhanced CT or MRI scans. Methods: Between 07/2009 and 11/2013 46 cases with unidirectional antero-inferior shoulder instability were enrolled, 4 cases were lost during the follow-up within one year postoperatively. Plain radiographs, contrast enhanced multislice studies, Instability Severity Index, Constant, Duplay and Rowe Scores were obtained preoperatively. Diagnostic arthroscopy was performed in all cases prior to open Latarjet procedure. At one year follow-up Constant, Duplay and Rowe Scores were obtained; position and consolidation of the coracoid transfer were assessed by conventional x-ray studies. Results: At one year follow-up a significant improvement of all scores was recorded (Constant Score 95.8 vs. 86.7; Duplay Score 93.7 vs. 25.2, Rowe Score 98.1 vs. 31.7, (p < 0.001)). During arthroscopy 28 of 42 Hill-Sachs-lesions were considered as engaging. 8 HAGL (humeral avulsions of the gleno-humeral ligaments) and 4 IGHL (inferior gleno-humeral ligaments) lesions were detected of which none were suggested during the preoperative radiological investigation. Complications observed were: screw migration (5), hematoma (1), infection (1) and recurrence (1). Conclusion: The Latarjet procedure is a reliable technique with very good clinical outcomes. Diagnostic arthroscopy is a valuable tool to detect HAGL- and IGHL-lesions and to visualize the engaging potential of Hill-Sachs-lesions. An additional arthroscopy may help to indicate a Latarjet procedure and to address concomitant pathologies. Level of evidence: Level IV, case series.
Highlights
Shoulder stabilization surgery for antero-inferior shoulder instability has advanced in the last three decades with further developments in arthroscopy methods and suture anchors to address shoulder instability [1] [2] [3]
The Latarjet procedure is a reliable technique with very good clinical outcomes
Unsatisfactory outcomes have been described regarding the Bankartrepair in presence of miscellaneous pathologies associated with shoulder instability, including humeral avulsions of the gleno-humeral ligaments (HAGL-lesion) [7] [8], lesions of the inferior gleno-humeral ligaments (IGHL-lesion), bony glenoid defects/osseous Bankart-lesions and engaging Hill-Sachs-lesions [2] [9]
Summary
Unsatisfactory outcomes have been described regarding the Bankartrepair in presence of miscellaneous pathologies associated with shoulder instability, including humeral avulsions of the gleno-humeral ligaments (HAGL-lesion) [7] [8], lesions of the inferior gleno-humeral ligaments (IGHL-lesion), bony glenoid defects/osseous Bankart-lesions and engaging Hill-Sachs-lesions [2] [9] In these aforementioned situations or previous failed Bankart-repair the Latarjet procedure, the transfer of the coracoid with the attached conjoined tendon to the anterior glenoid rim, has been described as useful alternative technique for anterior shoulder stabilization [1] [10] [11] [12]. Despite technical improvements certain pathologies such as HAGL-lesions, IGHLlesions or the significance of an engaging Hill-Sachs-lesion may be underestimated in CT and MRI investigations, as these are static and not dynamic inves- The purpose of this case series was to retrospectively compare radiological, clinical and functional outcomes and complications of diagnostic arthroscopy with open Latarjet procedures pre- and postoperatively within one year after surgery.
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