Latarjet-Patte Procedure Research Articles

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

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.

Computerized tomographic assessment and clinical evaluation in shoulder instability treated with the Latarjet-Patte procedure using one screw and washer

Computerized tomographic assessment and clinical evaluation in shoulder instability treated with the Latarjet-Patte procedure using one screw and washer

Surgical Treatment of Anterior Shoulder Instability by Latarjet-Patte Procedure

The standard of treatment in anterior shoulder instability is arthroscopic Bankart repair, with shoulder stabilization success rates between 85% and 90%. The main cause of failure is related to unaddressed osseous defects of either the glenoid rim or the humeral head; arthroscopic Bankart repair is insufficient for safe shoulder stabilization with loss of ≥20% of the overall glenoid width. Latarjet-Patte procedures with coracoid transfer is considered the treatment of choice for these defects and in patients in whom the arthroscopic procedure has failed. We retrospectively reviewed 34 male and 2 female patients who experienced instability post trauma. Mean follow-up was 2 years. Mean patient age at first shoulder dislocation was 20 years. The mean preoperative Rowe score was 38 (range, 15 to 70), compared with 91 postoperative. Complete bone union was achieved in all cases. The Latarjet-Patte procedure can be a valuable surgical option for the treatment of recurrent anterior shoulder instability in cases of bone defects that are ≥20% of the glenoid width, providing good clinical results and a low rate of complication. Watch the video trailer: https://links.lww.com/JAAOS/A54.

Accuracy of Coracoid Bone Graft Placement: Open versus Arthroscopic Latarjet.

Purpose The aim of this study was to compare the accuracy of the coracoid bone graft placement with the open Latarjet-Patte and arthroscopic Latarjet (arthro-Latarjet) procedures in the treatment of anterior instability of the shoulder. Methods Forty-six patients affected by anterior shoulder instability were divided into two groups. In group A ( n = 25), patients were operated by arthroscopic Latarjet (arthro-Latarjet) procedure and in group B ( n = 21), patients were operated by open Latarjet-Patte procedure. Instrumental investigation was based on three-dimensional computed tomography (3D-CT) at a minimum 1-year follow-up. Graft placement and integration, divergence and posterior protrusion of the screws, and glenohumeral osteoarthritis were considered as outcomes. Statistical analysis was performed with chi-square or Fisher's exact test. Significance was set at p < 0.05. Results Positioning of the coracoid graft proved to be optimal in 76% (19/25) of patients of group A and in 100% (21/21) of patients of group B (Fisher's exact test, p = 0.025). Screw placement with respect to the glenoid surface showed a posterior divergence in 44% (11/25) of patients in group A and in 24% (5/21) of patients in group B ( p = 0.15). Posterior protrusion of screw was observed in 76% (19/25) of patients in group A and 71.4% (15/21) of patients in group B ( p = 0.73). Graft integration was present in 76% (19/25) of patients in group A and 85.7% (18/21) of patients in group B (Fisher's exact test, p = 0.48). Mild signs of glenohumeral osteoarthritis were observed in 12% (3/25) of patients in group A and 28.6% (6/21) of patients in group B (Fisher's exact test, p = 0.26). Conclusion Patients operated with open Latarjet-Patte procedure showed better results than those of the arthro-Latarjet group in reference to the positioning of the graft on the coronal plane ( p = 0.025). No significant differences between the groups were observed for graft integration, divergence of the screws, posterior protrusion of the screws, and osteoarthritis. Level of Evidence Level II, nonrandomized prospective comparative study.

Computerized tomographic assessment and clinical evaluation in shoulder instability treated with the Latarjet-Patte procedure using one screw and washer.

The Latarjet-Patte (L-P) procedure is indicated in anterior instability of the shoulder with a glenoid or humeral bone loss. Our purpose is to evaluate clinical outcome and computerized tomographic (CT) findings as position and resorption of the graft and articular degeneration. From 2006 to 2009 50 patients underwent to L-P, 48 was contacted by telephone and 26 were available for follow-up (3 to 6 years). Quick-DASH and Rowe scores was used, 22 patients perform CT. None of contacted patients reported a new dislocation. The clinical outcome in the 26 followed patients was excellent: mean Quick DASH score: 1.9; mean ROWE score was 94.7. CT scans showed no evidence of articular degeneration of humeral head. There was partial resorption of the graft in 13 patients. We found a correlation between the zone of partial resorption and position of the graft. CT scan is appropriate to study position and the healing of coracoid graft. A correct choice of where to place the graft together with a wide bone contact and stable synthesis does not cause degenerative changes after 6 years in our series. IV.

Preliminary clinical outcomes of Latarjet-Patte coracoid transfer by arthroscopy vs. open surgery: Prospective multicentre study of 390 cases

BackgroundThe Latarjet-Patte procedure consisting in transfer and screw fixation of the coracoid process to the anterior glenoid is a treatment of reference for anterior shoulder instability. Over time, surgical innovations translated into a number of improvements and, in late 2003, an arthroscopically assisted variant of the procedure was described. ObjectiveTo evaluate and compare clinical outcomes of the modified Latarjet-Patte procedure performed by open surgery, arthroscopy with screw fixation, or arthroscopy with endobutton fixation. Material and methodA total of 390 patients who underwent surgery to treat anterior shoulder instability between March 2013 and June 2014 were included and divided into three groups depending on whether they were managed using open surgery with screw fixation, arthroscopy with screw fixation, or arthroscopy with endobutton fixation. Clinical findings were recorded pre-operatively then 6 months post-operatively and at last follow-up (mean, 27.7 months). Range of motion and apprehension test (arm in external rotation at 0°, 90°, and 140° of abduction) were assessed and the Walch-Duplay and modified Rowe scores were determined. ResultsMotion range restriction was minimal with all three techniques, and motion range continued to improve throughout follow-up. Apprehension in external rotation was noted at 90° of abduction in 11% of cases and at 140° of abduction in 4% of cases. The mean total Walch-Duplay score improved from 46 pre-operatively to 90.6 and the mean total modified Rowe score from 46 pre-operatively to 91.1. By statistical analysis, external rotation at 90° of abduction and internal rotation at 0° of abduction were better after open surgery, but the differences were of limited clinical significance. Recurrence was noted in 3.3% of cases, nerve injury in 0.8%, and infection in 1.5%. ConclusionIn this study, the three techniques produced similar clinical outcomes, with a stable shoulder and no joint stiffness.

Shoulder stabilization by modified Latarjet-Patte procedure: Results at a minimum 10 years’ follow-up, and role in the prevention of osteoarthritis

IntroductionIn 1995, our team modified the Latarjet-Patte procedure by associating “south-north” capsule retention with reinsertion to the edge of the glenoid cavity to the coracoid bone-block. HypothesisThe present minimum 10-year follow-up study tested the hypothesis that the rate of osteoarthritis could be reduced by the strictly extra-articular position of the bone-block and stability be enhanced by the associated Bankart effect. Material and methodBetween January 1995 and December 2001, 78 shoulders were stabilized using the modified Latarjet-Patte procedure in 76 patients with a mean age at surgery of 26.7years; 89.7% could be followed up, 82.8% of whom also had radiographic follow-up. Fifty-nine were sports players, including 25 at competition level. Stability was assessed on a questionnaire, any dislocation or subluxation being counted as recurrence. ResultsAt a mean 13years’ follow-up (range, 10–15years), there had been no revision surgery. Mean Duplay score was 82.6, mean Subjective Shoulder Value 91.9% and the satisfaction rate 98.5%. The recurrence rate was 1.4% and 10 patients reported residual apprehension. The osteoarthritis rate was 8.5%. Seven bone-blocks projected, but only one was associated with osteoarthritis (stage 1) (non-significant). There were 4 non-unions and 9 lyses, without instability or pain. DiscussionThe modified procedure provided a low rate of recurrence and an incidence of osteoarthritis (8.5%) much lower than in any other published series with a minimum 10years’ follow-up. The strictly extra-capsular situation of the bone-block appeared as an important factor in limiting long-term osteoarthritis. Capsule reinsertion also seemed to alleviate the radiologic complications. Level of evidenceIV, retrospective study.

Surgical treatment of anterior instability in rugby union players: clinical and radiographic results of the Latarjet-Patte procedure with minimum 5-year follow-up

Anterior instability in rugby players is characterized by the common finding of a bony lesion, which has been identified as a potential cause of recurrence after soft-tissue reconstruction. The Latarjet-Patte procedure is effective in the treatment of recurrent anterior instability in collision sports such as rugby union. We retrospectively assessed 34 rugby players (37 shoulders) stabilized with the Latarjet-Patte procedure. The mean follow-up was 12 years. All patients underwent clinical and radiographic assessment preoperatively and at final follow-up. Functional evaluation was performed with the Walch-Duplay and Rowe scores. A visual analog scale score for the evaluation of pain and the subjective shoulder value were recorded. In addition, all patients completed a questionnaire regarding the return to playing rugby. No recurrence of either dislocation or subluxation occurred. Persistent apprehension on clinical examination was present in 5 patients (14%). A bony lesion of the glenoid was present in 73% and a Hill-Sachs lesion in 68%. Sixty-five percent of the patients returned to playing rugby; only 1 patient did not return to playing rugby because of his shoulder. The mean Walch-Duplay and Rowe scores were 86 and 93 points, respectively. The mean subjective shoulder value was 90%. Radiographic healing of the bone block was observed in 89% of cases. At final follow-up, 11 patients (30%) had minor arthritic changes, with no cases of moderate or severe arthritis. The Latarjet-Patte procedure provides a reliable method for stabilizing the shoulder, resulting in a return to playing rugby in a high number of cases without increasing the risk of long-term arthritic degradation.