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procedure, however, a section of the cora- .... glenoid to create a flat surface for the cora- coid graft. Coracoid graft ..... Postoperative axial view of computed tom-.
Functional and radiological results of modified Bristow-Latarjet procedure for anterior shoulder instability

IN C ER O V P A Y R M IG E H DI T C ® A

M. K. CANBORA 1, O. KOSE 2, A. POLAT 1, L. KONUKOGLU 1, M. GORGEC 1, F. GULER

Aim. The purpose of this study was to present the functional and radiological results of eighteen patients with anterior shoulder instability who were treated with modified Bristow-Latarjet procedure, and analyse the relationship between coracoids graft problems with functional results. Methods. The study comprised 18 cases treated with the modified Bristow-Latarjet technique and followed-up for a mean 28.3 months between 2006 and 2011. Patients were clinically rated with Rowe instability score and visual analogue scale (VAS). Radiologic evaluations of the coracoid graft regarding its position, union, condition, and lysis were performed with plain radiographs and computerized tomography. Any complication during the follow-up was recorded. Results. Postoperative Rowe instability scores were excellent or good in 77% of cases. Restriction was determined in anterior flexion in 12 cases (66.6%), and in external rotation in 14 cases (77.7%). Coracoid graft placement was determined to be appropriate in 14 cases (77.7%) and inappropriate in 4 cases (22.3%). In three cases, there was coracoid graft nonunion associated with fracture or lysis. In one case there was migration of the graft and three cases had persistent subluxation. There was suprascapular nerve irritation due to the screws that had to be extracted in one case. One case required further revision surgery due to lysis and loosening in the graft. Redislocation was not observed in any case.

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This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies (either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary information of the Publisher.

MINERVA ORTOP TRAUMATOL 2013;64:183-93

Corresponding author: M. K. Canbora, Orthopedics and Traumatology, Haydarpaşa Numune Training and Research Hospital, Barbaros mah. B 6 blok daire 3. Dereboyu cad. Ihlamur sok. Kapi no: 11 B, Zip Code 34 746 Atasehir, Istanbul, Türkiye. E-mail: [email protected]

Vol. 64 - No. 2

2

1Haydarpasa Numune Education

and Research Hospital Orthopaedics and Traumatology Clinic Istanbul, Turkey 2Antalya Education and Research Hospital Orthoapedics and Traumatology Clinic Antalya, Turkey

Conclusion. Modified Bristow-Latarjet technique provides effective stability in recurrent anterior shoulder instability. However, particularly when accompanied by laxity, there is a negative effect on coracoid graft complication rates. The coracoid graft should be evaluated carefully when there is postoperative subluxation. Key words: Shoulder - Shoulder dislocation - Surgical procedure, operative.

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lenoid bone loss has an important role in the etiology of recurrent anterior glenohumeral dislocations. Capsulolabral repair alone without reconstruction of glenoid bone loss may not be sufficient to prevent further dislocations and often results in failure. Burkhart and De Beer reported a high rate of recurrence (67%) after arthroscopic Bankart repair in patients with anterior shoulder instability and accompanying serious glenoid bone loss.1 Currently, restoration of bony defect is advocated in case of glenoid bone loss exceeding 20% of the joint surface in the treatment of anterior shoulder instability.1, 2

MINERVA ORTOPEDICA E TRAUMATOLOGICA

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Functional and radiological results of modified Bristow-Latarjet procedure

dure, and analyse the relationship between coracoid graft problems with functional results. Materials and methods Patients We have retrospectively reviewed 18 prospectively followed patients in whom mB-L procedure was performed for anterior shoulder instability between March 2006 and September 2011 at our institution. The study was approved by the committee on research ethics at the Haydarpasa Numune Education and Research Hospital�������� and informed consent from human subjects was obtained as required. The study was carried out according to the Declaration of Helsinki, and institutional review board approved the study. There were 17 male and one female patient with a mean age of 22.8±7.7 years. The previous episodes of anterior shoulder dislocations was fewer than 10 for three cases, 1050 for 10 cases and more than 50 for five cases. In 15 cases (83%) the dominant side was involved. In eight cases, the amount of glenoid bone loss was exceeding 20% of the glenoid forming an inverted pear shape glenoid together with anterior capsular hyperlaxity. Three cases had recurrent dislocations who had previous Bankart lesion repair (2 open and 1 arthroscopic procedure). One patient had a large engaging Hill-Sachs defect. Three patients were professional sportsmen who participitate in contact sports (2 wrestling and 1 kick-boxing). The demographic characteristics and the indications for surgery are summarised in Table I.

IN C ER O V P A Y R M IG E H DI T C ® A

Transfer of coracoid process together with conjoined tendon to the anterior glenoid rim through the subscapularis muscle was first described by Michael Latarjet in 1954.3 In this procedure, coracoid graft increases the glenoid surface, acts as a bone block and extends the external rotation arch of the glenohumeral joint to prevent dislocation. Furthermore, conjoined tendon increases the tension of lower fibers of the subscapularis muscle thus enhance the dynamic stability. In 1958, Helfet described suturing of the coracoid process to the anterior portion of the scapular neck through transversely sectioned subscapularis muscle and termed this operation the Bristow procedure. In the Bristow procedure, only distal section of the coracoid is transferred to the anterior glenoid rim.4 In the Latarjet procedure, however, a section of the coracoid approximately 3 cm in size is used for the transfer.5 This method, known as Bristow-Latarjet (BL), was modified from the original by Patte et al., using a larger part of the coracoid process and fixing it with two screws instead of suturing.6 Currently, the indications of modified Bristow-Latarjet (mB-L) procedure have been widened. This procedure can be used not only for anterior shoulder instability secondary to glenoid bone loss, but also in engaging Hill-Sachs lesions, revisions of failed (open or arthroscopic) capsulolabral repairs, in patients with severe capsular hyperlaxity and in patients who participitate contact sports.7-9 Although high success rates have been reported with mB-L procedure, in fact this procedure may result with a variety of minor and serious complications.5, 7, 10-12 Some authors have proposed that the position of the coracoid graft and the screws are critical to the success and responsible from the complications.11-14 Whereas others have defended the stance that problems of coracoid graft have not affected results.5, 11, 15, 16 As yet, there is no consensus on this subject. The purpose of this study was to present the functional and radiological results of eighteen patients with anterior shoulder instability who were treated with mB-L proce-

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This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies (either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary information of the Publisher.

CANBORA

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Surgical technique We have performed mB-L procedure which was that first described by Latarjet then modified by Patte et al. with the principles currently applied by Walch et al.3, 6, 9 A standard deltopectoral approach was used. After the exposure of the coracoid process and its attachments, the coracoacromial

MINERVA ORTOPEDICA E TRAUMATOLOGICA

April 2013

CANBORA

Table I.—The demographic characteristics of patients.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Age (years)

Gender

Number of dislocations

Indication form mB-L procedure

Time between the index dislocation and operation (years)

31 27 21 29 23 24 27 34 24 67 23 23 26 26 32 54 31 29

M M M M M M M M M M M M M M M M F M

>50 10-50 >50 >50 10-50 >50 >50 10-50 10-50 10-50