The open Latarjet-Patte procedure for the treatment of anterior shoulder instability in professional handball players at a mean follow-up of 6.6 years

Abstract

The popularity of team handball is increasing with over 10 million children playing this overhead, throwing and collision sport with highest demands on the shoulder joint. Due to the risk for recurrent instability, the Latarjet-Patte (LP) procedure has been recommended to treat young competitive players. This is the first LP outcome study in professional handball. We included 20 shoulders retrospectively (18 players/17 males/mean age 22.9 years, range 17-35 years; minimum/mean follow-up: 2/6.6 years) operated on by three expert surgeons (2011-2020) with Walch's LP-technique. Preoperative hyperlaxity (25%/n=5), affected throwing arm (55%/n=11), position (backcourt, winger, goalkeeper: 22% each; full back, pivot: 17% each), >2 dislocations prior (20%/n=4), >10 dislocations (5%/n=1), previous failed Bankart/HAGL repair (10%/n=2) and large Hill-Sachs lesions (HSL: 20%/n=4) were documented. Clinical and radiographic outcomes, visual analogue scale (VAS), subjective shoulder value (SSV), Walch-Duplay (WDS), Rowe score (RS) and return to sports (RTS) parameter were recorded. RTS was 85% (n=17/20), RTS to same-level 80% (n=16/20), RTS with no throwing pain 73% (n=8/11), time to training with ball: 3.2/12 and to competition 4.9/12. The mean RS, WDS and SSV were 90, 88, 89 % respectively. Shoulder symptoms lead to giving up handball in 2 cases (10%). One player (5%) stopped for other reasons. One recurrent dislocation (5%) was recorded (non-throwing arm, winger, no recurrence after rehabilitation). Persistent apprehension occurred in one goalkeeper (5%). Four shoulders showed residual pain (20%) relieved in one by screw removal. Resistant pain (throwing shoulder) was seen in 2 backcourt players (10%/one large HSL) and one goal keeper (5%/large HSL; >10 dislocations prior), all three >30years of age. Bone block positioning was correct (no lateral overhang) in all shoulders. One shoulder (5%) showed mild arthritic changes at final follow-up (>10 dislocations, large HSL). The open Latarjet-Patte is consistent in providing shoulder stability combined with return to throwing performance in professional handball players with a short time to RTS and high same-level RTS rate without increasing the risk of arthritic changes. Throwing shoulders of backcourt players, with large HSL or shoulders at age >30 years may have an increased risk for persistent symptoms.