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The Latarjet procedure is a well-known, safe and reliable technique to treat primary or recurrent anterior dislocations or subluxations, with or without hyperlaxity, with or without glenoid bone loss. Both the open and the arthroscopic methods produce excellent clinical results, with a low rate of recurrent instability. There have been concerns of...
Citations
... Although initially described as a treatment for recurrent instability, the Latarjet procedure is frequently used in both primary and revision settings, demonstrating a significant reduction in instability events (Allain, Goutallier, and Glorion 1998;Yapp, Nicholson, McCallum, et al. 2020;Werthel, Sabatier, Schoch, et al. 2020). Common indications include young, contact athletes with a high risk of recurrence and patients with glenoid bone loss (Allain, Goutallier, and Glorion 1998;Domos, Lunini, and Walch 2018;Giles, Boons, Elkinson, et al. 2013;Hurley, Schwartz, Mojica, et al. 2021;Gilat, Lavoie-Gagne, Haunschild, et al. 2020;Arner et al. 2020). ...
Purpose: The Latarjet procedure was initially described by Michel Latarjet in 1954 as a treatment for recurrent dislocations of the shoulder. Over the last decade, an arthroscopic approach has emerged as the natural evolution of the open procedure. The purpose of this study was to identify and analyze the fifty most-cited articles related to the Latarjet, analyze the associated characteristics of each article, and to evaluate whether surgeons are currently influenced by primarily higher versus lower-level studies.
Methods: Various Boolean queries were searched on the Clarivate Analytics Web of Science, which yielded final search terms of topics on “latarjet OR latarjet-bristow OR bristow-latarjet OR latarjet-patte or patte-latarjet”. Information collected included: author demographics, study type, level of evidence, journal name, number of citations, and publication year.
Results: The top fifty Latarjet articles had 5,319 citations and consisted of 0 level I, 3 level II, 8 level III, 25 level IV and 14 level V studies (date range: 1983 – 2017, median 2012). The most cited article received 454 citations. Authors from France (n = 14, 27%) contributed the most to included papers, followed by the United States (n = 8, 16%).
Conclusions: The most-cited articles on the Latarjet procedure tend to be case series, cohort studies, and expert opinions published primarily by French and American authors between 2000 and 2016. With the recent technical innovation surrounding the Latarjet procedure and glenoid bone-block reconstruction in general, these articles may form the foundation that future higher level-of-evidence studies will build upon in their research.
... While the present study lends evidence to the fact that LP can be used as a viable salvage/revision procedure with good functional outcomes, it would be remiss of us to not discuss the prevalence of complications surrounding its salvage indication. The overall complication rate of this study was 8.5% (4/47), consisting of neuropraxia, re-dislocation, hematoma, and superficial wound infection, all of which have been extensively documented post-LP [17,18]. Similar to a recent study evaluating short-term complications between the LP-FB and LP-BL, there were no statistically significant differences between complication rates between cohorts at 2 years postoperatively (P = 0.63) [19]. ...
Background:
The purpose of this study is to compare the outcomes of Latarjet-Patte procedures (LPs) performed for primary glenohumeral instability surgery in the setting of critical bone loss (LP-BL) versus salvage surgery performed after a failed primary arthroscopic Bankart repair (LP-FB).
Methods:
Patients who underwent an LP from 2017 to 2021 were identified from the senior author's database and separated into cohorts by LP indication. Data abstracted from electronic medical records included demographic information, preoperative clinical scores, radiological imaging, and complications. Postoperative clinical outcome scores collected after a 2-year minimum follow-up included: patient-reported outcomes measurement information system (PROMIS) upper extremity (UE), PROMIS Pain interference, PROMIS pain intensity, American Shoulder and Elbow Surgeons (ASES), and Visual Analog Scale pain scores.
Results:
A total of 47 patients (LP-BL: n=29, LP-FB: n=18) with a mean age of 29 years (range, 15-58 years) were included in this study. Both cohorts achieved good upper extremity functionality without significant differences as indicated by mean PROMIS UE (LP-BL: 52.6±10.0 vs. LP-FB: 54.6±7.6, P=0.442) and ASES scores (LP-BL: 89.9±15.7 vs. LP-FB: 91.5±14.4, P=0.712). However, the LP-FB cohort reported lower levels of pain (LP-FB: 0.5±1.1 vs. LP-BL: 1.9±2.7, P=0.020) at their latest follow-up. There were no significant differences in complication rates including re-dislocation between cohorts (LP-BL: 2/29 [6.9%] vs. LP-FB: 2/18 [11.1%], P=0.629).
Conclusions:
When performed after failed Bankart repair, the LP results in similar postoperative functional outcomes and similar rates of complications and re-dislocations when compared to the primary indication of recurrent glenohumeral instability in the setting of critical bone loss.
... Screw fixation of glenoid bone blocks has long been the gold standard surgical technique. However, a high rate of surgical and mechanical complications, with overall complications reported in up to 15% and hardware complications at excess of 7%, has led various surgeons to seek alternate methodologies [24][25][26]. Common complications include neurovascular injury attributable to screw prominence (typically suprascapular), the anatomical dangers of the medial portal necessary for screw placement with arthroscopic techniques, screw impingement on the subscapularis, and increased screw prominence with graft resorption [21]. Despite new techniques being developed, screw fixation remains the primary, and most studied, method utilized with numerous resulting biomechanical considerations being reported (Table 1). ...
Purpose of Review
Anterior shoulder instability is associated with concomitant injury to several stabilizing structures of the shoulder, including glenoid bone loss. While instability is most common in young athletes and patients with predisposing conditions of hyperlaxity, recurrent shoulder instability can occur throughout various age ranges and may lead to longer term effects including pain and shoulder arthritis. Glenoid bone loss exceeding certain thresholds is generally treated by glenoid reconstruction via bone block augmentation to adequately stabilize the glenohumeral joint. These procedures increase the width of the articular surface on which the humeral head can translate before dislocation and, based on the procedure performed, provide a sling effect via the conjoined tendon, and increase tension to support the anterior capsule. The purpose of this review is to summarize the available literature regarding bone block fixation techniques.
Recent Developments
Various fixation techniques have been utilized to secure bone block transfers. Though screw fixation has traditionally been used for bone block fixation, suture buttons, suture anchors, and all-suture techniques have been utilized in attempts to avoid complications associated with the use of screws. Biomechanical studies report variable force-resistance, displacement, and mode of failure when comparing screw to suture button–based fixation of glenoid bone blocks. Clinical and radiographic studies have shown these novel suture-based techniques to be comparable, and in some cases advantageous, to traditional screw fixation techniques.
Summary
While screw fixation has long been the standard of care in glenoid bone block procedures, it is associated with high complication rates, leading surgeons to endeavor toward new fixation techniques. In available biomechanical studies, screw fixation has consistently demonstrated high maximal load-to-failure and displacement with cyclic loading. Studies have reported similar clinical and radiographic outcomes in both screw and suture-based fixation methods, with evidence of reduced bone resorption with suture fixation. While suture button fixation is associated with a higher rate of recurrent instability, overall complication rates are low. Future research should address biomechanical shortcomings of suture-based fixation techniques and continue to assess long-term follow-up of patients treated with each fixation method.
... When the humeral head moves abnormally in relation to the glenoid during shoulder movements, it can cause pain or anxiety. This condition is known as shoulder instability [1]. Generally speaking, instability is de ned as a clinical condition that appears when signs of shoulder laxity are present. ...
... After an initial search of the literature, Boolean operators and keyword combinations were used to create the nal search terms included in table (1). During the literature search no date restrictions were applied. ...
Objective
The aim of the study to collect relevant studies that examined the effects of Electrical Muscular Stimulation (EMS) on Shoulder Instability.
Background
The Shoulder instability is described as emerging when there are indications of shoulder laxity. The most common cause of primary shoulder dislocation in athletes is glenohumeral subluxation and dislocation. Roughly ninety-five percent of the first cases of shoulder dislocation result from an abrupt twisting motion, a forceful blow, or landing on an outstretched arm.
Methods
The review was carried out by searching scientifically recognized medical databases, including PubMed, Scopus, Pedro Database, ICTRP Database and WILEY Online Library. Date restrictions were not applied.
Results
The studies that were included demonstrated that patients with Functional Posterior Shoulder Instability who received NMES-enhanced physical therapy had a significantly better main outcome. At the 3-month follow-up, the frequency of instability episodes improved significantly in the NMES-enhanced physical therapy group, and shoulder subluxation was significantly lower in position-triggered ES than in passive ES.
Conclusion
The posterior shoulder instability was significantly and clinically alleviated by electrical muscle stimulation. On the other hand, position-triggered electrical stimulation (ES) might be more effective than passive ES for treating poststroke shoulder subluxation.
... However, this phenomenon can cause more pressure on the posterior glenohumeral joint and may generate glenohumeral osteoarthritis in the long term. 9 Furthermore, decreased external rotation and posterior tilt of the scapula could lead to subacromial impingement. In addition, increased posterior translation will increase internal impingement and posterior labral pathology. ...
Background
Researchers have attempted to understand the underlying mechanism of the Latarjet procedure; however, its effects on shoulder kinematics have not been well studied.
Purpose/Hypothesis
The purpose was to analyze shoulder kinematics after the Latarjet procedure. It was hypothesized that the nonanatomic transfer of the coracoid process during the procedure would affect normal shoulder kinematics.
Study Design
Controlled laboratory study.
Methods
The study included 10 patients (age range, 20-52 years) who underwent the modified Latarjet procedure between June 2016 and November 2021. Computed tomography and fluoroscopy were conducted on both shoulder joints of all patients, and 3-dimensional models were reconstructed. The 3-dimensional coordinates were encoded on the reconstructed models, and shoulder kinematics were analyzed through a 3-dimensional–2-dimensional model-image registration technique. Scapular rotation parameters (scapular upward rotation, posterior tilt, external rotation, and scapulohumeral rhythm) were compared between the Latarjet and the nonsurgical contralateral sides during humeral abduction, as was anteroposterior (AP) translation relative to the glenoid center during active humeral external rotation.
Results
The Latarjet side displayed significantly higher values of scapular upward rotation at higher degrees of humeral elevation (130°, 140°, and 150°) compared with the nonsurgical side ( P = .027). Posterior tilt, external rotation, and scapulohumeral rhythm were not significantly different between sides. AP translation at maximal humeral rotation was not significantly different between sides (Latarjet, −0.06 ± 5.73 mm vs nonsurgical, 5.33 ± 1.60 mm; P = .28). Interestingly, on the Latarjet side, AP translation increased until 40° of humeral rotation (4.27 ± 4.64 mm) but began to decrease from 50° of humeral rotation.
Conclusion
The Latarjet side demonstrated significant changes in scapular upward rotation during higher degrees of humeral elevation compared with the contralateral shoulder. Posterior movement of the humeral head at >50° of humeral rotation could be the desired effect of anterior stabilization; however, researchers should evaluate long-term complications such as osteoarthritis.
Clinical Relevance
Analysis of shoulder kinematics after the Latarjet procedure could provide information regarding long-term outcomes and whether the procedure would affect the daily activities of patients.
... Previous research has demonstrated that soft tissue repair surgeries in high-risk athletes are associated with increased recurrence risk [5,8,[23][24][25]. However, the postoperative instability rate after the Latarjet procedure varies, ranging from 1-16% [26][27][28][29], with a 1.1% recurrence rate in this study. The heterogeneity among studies may be attributed to significant differences in baseline characteristics between studies; for example, Lima et al. [29] focused on females with relatively low shoulder instability rates, while females composed only 7% of the participants in this study. ...
... However, existing studies do not provide detailed descriptions. Current research suggests that the Latarjet procedure may result in a decrease of approximately 5° in the external rotation angle, necessitating proactive rehabilitation exercises postoperatively [28]. ...
... In this study, with a minimum follow-up time of 2 years, the combined incidence of new arthritis was 3.9%,with no evidence of severe bony arthritis changes. Other adverse events included graft nonhealing, haematoma, and infection, consistent with previous research [28,[39][40][41]. While earlier studies provided high-quality research evidence through long-term follow-up, a series of changes, including surgical instruments and continued education stemming from long-term follow-up, also impact postoperative functional outcomes. ...
Background
The shoulder joint is the most commonly dislocated joint in the human body, and the recurrence rate exceeds 50% after nonsurgical treatment. Although surgical treatment reduces the recurrence rate, there is controversy regarding the optimal surgical approach. Previous studies suggest that the Latarjet procedure yields favourable outcomes for specific populations at risk of recurrence, such as competitive athletes with significant glenoid defects. However, most of the existing related research consists of nonrandomized controlled trials with small sample sizes, and there is a lack of strong evidence regarding the efficacy and safety of the Latarjet procedure.
Methods
The PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched. Athletes with ≥ 20% glenoid defects were selected for inclusion. The following data were extracted: general patient information, instability rates, return to sports (RTS) rates, imaging features (graft positioning rate and graft healing rate), functional assessments [Rowe score, Athletic Shoulder Outcome Scoring System(ASOSS), visual analogue scale (VAS), forward flexion function, and external rotation function], and complications.
Results
After excluding suspected duplicate cases, a total of 5 studies were included in this meta-analysis. The studies involved a total of 255 patients, including 237 males (93%) and 18 females (7%). The average age at the time of surgery was 25.4 ± 8.5 years. All the studies had a minimum follow-up period of 2 years, with an average follow-up time of 48.7 ± 18.9 months. The pooled rate of return to sport (RTS) was 94.3% (95% CI: 87.3%, 98.8%), and 86.1% (95% CI: 78.2%, 92.5%) of patients returned to their preoperative level of activity. The pooled redislocation rate was 1.1% (95% CI: 0%, 3.8%). Regarding the imaging results, the combined graft retention rate was 92.1% (95% CI: 88.1%, 95.5%), and the graft healing rate was 92.1% (95% CI: 88%, 95.4%). Postoperative functional evaluation revealed that the combined Rowe score, ASOSS score, and VAS score were 93.7 ± 6.5 points, 88.5 ± 4.4 points, and 1.1 ± 10 points, respectively. The forward flexion and external rotation angles were 170.9 ± 6.9 degrees and 65.6 ± 4.5 degrees, respectively. After excluding one study with unclear complications, the combined complication rate was 9.4% (95% CI: 1.0%, 23.6%).
Conclusion
For athletes with shoulder instability and a total of ≥ 20% glenoid bone defects, the Latarjet procedure can achieve excellent functional outcomes, with the majority of patients returning to preoperative levels of sports activity. This procedure also leads to a low recurrence rate. Therefore, the Latarjet procedure has been proven to be a safe and effective treatment.
... 17 Apprehension with external rotation with the arm in 90 of abduction without recurrence of instability after surgery can be problematic for professional rugby players because it affects their shoulder performance. 18 Apprehension after open and arthroscopic Latarjet is well described in the literature, and the rate of 10% found in our study is similar to that observed in multiple studies. [19][20][21] A prospective multicenter study by Metais et al. ...
Purpose
To analyze the rate of return to play, changes in athletic level, and recurrence rate and to report subjective outcomes in a series of rugby players with anterior shoulder instability who underwent an arthroscopic Latarjet procedure.
Methods
A multicenter retrospective study done in 2 centers on rugby players who were operated on between January 2011 and December 2020 was performed. Rugby players who underwent arthroscopic Latarjet procedure for anterior shoulder stabilization with a minimum follow-up period of 2 years were included. Rugby players were grouped according to their competitive level in their country (recreational, regional, national, and international). Data collected included return to sport after surgery, time to return to rugby, athletic level before and after surgery, patient satisfaction, and subjective scores. Recurrence and apprehension rates were also evaluated.
Results
A total of 73 subjects were included. Mean age at time of surgery was 23 ± 5 years. Mean duration of follow-up was 5 ± 2.6 years. Eighty-four percent of rugby players returned to rugby within a mean period of 6.6 months. Initial athletic level was a significant factor (P = .012) for not returning to sport, with 67% of patients who initially played at a recreational level not returning to rugby and 33% of patients who initially played at a regional league level not returning. All national and international players returned to play. Of the 12 non-returning rugby players, only 30% did not return because of their shoulder. Mean Subjective Shoulder Value was 90 ± 9%. Recurrence rate was 7%.
Conclusions
Arthroscopic Latarjet procedure proved its efficacy in managing recurrent anterior shoulder instability in rugby players. Return to play was achieved in almost all cases, with low recurrence rates. Despite high global return to the same level of sport, the higher the level of competition, the harder it is for rugby players to resume sport at the same level.
Level of Evidence
Level IV, therapeutic case series.
... Meanwhile, the iliac crest autograft has shown improved congruity of the glenoid as well as limitless bone graft size [10]. The standard Latarjet procedure using a coracoid autograft in patients with epilepsy could lead to excessive forces on the hardware due to muscle contractions that pull on the conjoint tendon, potentially causing hardware failure and recurrent instability [11]. A noted disadvantage with allografts is the potential for a lack of graft incorporation, while one of the main disadvantages of using an autograft is donor site morbidity and an increased risk of infection from the harvest site [12]. ...
Shoulder instability episodes are observed in high-energy injuries, such as seizures. In this case report, we highlight the management of a failed distal tibial allograft procedure for recurrent shoulder instability in a patient with a bony Bankart lesion and epilepsy. The patient was treated with an iliac crest autograft and a proximal humerus osteochondral allograft procedure. To our knowledge, the use of an iliac crest autograft for glenoid bone loss and a proximal humerus osteochondral allograft after several failed shoulder instability procedures in a patient with epilepsy has not been reported.
... 19,32 While clinical outcomes have been reported to be favorable, 2 enabling return-to-play rates up to 94% to 97% 1,5 and sustained long-term success, 11,19 meta-analyses data report failure rates of up to 6.2% 3,8 and complication rates as high as 16.1%. 3 Factors predictive of successful outcome include patient-specific factors 4,7 as well as technical factors such as fixation type, 23 number of screws, 7 positioning of screws, 23,26 handling of the subscapularis muscle, 2 capsular management, 2 bone block orientation, 17 and bone block positioning. 7,13 In particular, the coracoid graft position represents a cornerstone of successful results across all technical variations of the Latarjet procedure, as it influences both glenohumeral stability and osseous union 7,10,19 as well as progression to osteoarthritis. ...
Background
In the Latarjet procedure, the ideal placement of the coracoid graft in the medial-lateral position is flush with the anterior glenoid rim. However, the ideal position of the graft in the superior-inferior position (sagittal plane) for restoring glenohumeral joint stability is still controversial.
Purpose
To compare coracoid graft clockface positions between the traditional 3 to 5 o'clock and a more inferior (for the right shoulder) 4 to 6 o'clock with regard to glenohumeral joint stability in the Latarjet procedure.
Study Design
Controlled laboratory study.
Methods
A total of 10 fresh-frozen cadaveric shoulders were tested in a dynamic, custom-built robotic shoulder model. Each shoulder was loaded with a 50-N compressive load while an 80-N force was applied in the anteroinferior axes at 90° of abduction and 60° of shoulder external rotation. Four conditions were tested: (1) intact, (2) 6-mm glenoid bone loss (GBL), (3) Latarjet procedure fixed at 3- to 5-o’clock position, and (4) Latarjet procedure fixed at 4- to 6-o’clock position. The stability ratio (SR) and degree of lateral humeral displacement (LHD) were recorded. A 1-factor random-intercepts linear mixed-effects model and Tukey method were used for statistical analysis.
Results
Compared with the intact state (1.77 ± 0.11), the SR was significantly lower after creating a 6-mm GBL (1.14 ± 0.61, P = .009), with no significant difference in SR after Latarjet 3 to 5 o'clock (1.51 ± 0.70, P = .51) or 4 to 6 o'clock (1.55 ± 0.68, P = .52). Compared with the intact state (6.48 ± 2.24 mm), LHD decreased significantly after GBL (3.16 ± 1.56 mm, P < .001) and Latarjet 4 to 6 o'clock (5.48 ± 3.39 mm, P < .001). Displacement decreased significantly after Latarjet 3 to 5 o'clock (4.78 ± 2.50 mm, P = .04) compared with the intact state but not after Latarjet 4 to 6 o'clock ( P = .71).
Conclusion
The Latarjet procedure in both coracoid graft positions (3-5 and 4-6 o’clock) restored the SR to the values measured in the intact state. A more inferior graft position (fixed at 4-6 o’clock) may improve shoulder biomechanics, but additional work is needed to establish clinical relevance.
Clinical Relevance
An inferior coracoid graft fixation, the 4- to 6-o’clock position, may benefit in restoring normal shoulder biomechanics after the Latarjet procedure.
... 11 The advantages of arthroscopic Latarjet included less bleeding, less postoperative pain, less scarring, and early postoperative mobilization. 5,12,13 Intraoperative coracoid graft fractures were well documented in the literature with rates of 5.2e7% during the arthroscopic Latarjet procedure. Athwal et al. documented graft fractures, as the most common adverse effect following arthroscopic Latarjet and estimated their frequency to be 7%. ...
... 16 Graft fractures during the Latarjet procedure were due to overtightening of the metallic screws, a smaller coracoid graft and poor quality of the bone. 13,17 Athwal et al. proposed that good under-surface preparation of the coracoid graft can reduce the incidence of graft fractures. Maintaining 9-mm distance between the screw holes, using the two-finger technique for screw tightening, using top hats with metallic screws, and ensuring adequate graft length, adequate coracoid and glenoid preparation can reduce the graft fracture rates during the procedure. ...
Intraoperative vertical coracoid graft fractures during the Latarjet procedure are well-described complications, which typically have a poor prognosis or may necessitate further iliac crest bone grafting for stabilization. The vertical split coracoid fractures are reasoned to be caused by excessive tightening of the screws, poor bone quality, especially in females and the smaller dimension of the coracoid graft. In this technical note, we propose an arthroscopic salvage technique for salvaging the fractured coracoid graft and to avoid the need for additional bone graft, thereby reducing morbidity to the patient. We use two double-loaded, all-suture anchors (Stryker, India) on either side of the split coracoid graft, and double-pulley configuration of suture tightening is done, providing compression and stability to the fractured graft.
