Yue Li1, Chunyan Jiang2. 1. Sports Medicine Service, Beijing Jishuitan Hospital, Xicheng District, Beijing, Republic of China liyuesportsmed@163.com. 2. Sports Medicine Service, Beijing Jishuitan Hospital, Xicheng District, Beijing, Republic of China chunyanj@hotmail.com.
Abstract
BACKGROUND: Chronic locked anterior shoulder dislocation is a difficult clinical problem for patients and surgeons. Prior studies have proposed a variety of surgical techniques to address this problem; however, the failure rate is high. To our knowledge, there have been no previously published studies on the clinical outcome of the Latarjet procedure for the treatment of chronic locked anterior shoulder dislocation. The purpose of this study was to evaluate the short-term subjective, objective, and radiographic outcomes of patients with chronic locked anterior shoulder dislocation after a Latarjet procedure. METHODS: From January 2005 to January 2013, 43 patients with chronic locked anterior shoulder dislocation were treated surgically in our institution. Open Latarjet procedures were performed in 35 patients. A subscapularis tenotomy or split was chosen on the basis of the ability to achieve open reduction. Outcomes were assessed preoperatively and postoperatively with the American Shoulder and Elbow Surgeons (ASES) score, the visual analog scale (VAS) for pain, the University of California Los Angeles (UCLA) shoulder rating scale, and the Constant-Murley rating scale. A comparison of the clinical outcomes among the patients who underwent subscapularis tenotomy and repair, those who underwent a procedure that used the subscapularis-splitting technique, and those who underwent a concomitant humeral head replacement was performed. RESULTS: Twenty-five shoulders of 25 patients were available for a mean follow-up of 31.6 months. At the time of the latest follow-up, the range of motion and the shoulder functional evaluations (VAS [p = 0.02], ASES [p = 0.01], Constant score [p = 0.01], and UCLA score [p = 0.04]) were significantly improved. The overall redislocation or subluxation rate was 48% (12 of 25): 0% (0 of 5) for the subscapularis-splitting group, 53% (8 of 15) for the subscapularis tenotomy and repair group, and 80% (4 of 5) for the humeral head replacement group. The ASES score (p = 0.006), UCLA score (p = 0.014), Constant score (p = 0.046), and external rotation (p = 0.048) were significantly better, and less severe glenohumeral osteoarthritis was found in patients who had undergone a Latarjet procedure with subscapularis-splitting compared with those who had undergone subscapularis tenotomy and repair. CONCLUSIONS: The Latarjet procedure for the treatment of chronic locked anterior shoulder dislocation can be successful if the shoulder reduction can be performed without requiring a subscapularis tenotomy. If this reduction is not possible, then other surgical reconstruction should be considered. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
BACKGROUND: Chronic locked anterior shoulder dislocation is a difficult clinical problem for patients and surgeons. Prior studies have proposed a variety of surgical techniques to address this problem; however, the failure rate is high. To our knowledge, there have been no previously published studies on the clinical outcome of the Latarjet procedure for the treatment of chronic locked anterior shoulder dislocation. The purpose of this study was to evaluate the short-term subjective, objective, and radiographic outcomes of patients with chronic locked anterior shoulder dislocation after a Latarjet procedure. METHODS: From January 2005 to January 2013, 43 patients with chronic locked anterior shoulder dislocation were treated surgically in our institution. Open Latarjet procedures were performed in 35 patients. A subscapularis tenotomy or split was chosen on the basis of the ability to achieve open reduction. Outcomes were assessed preoperatively and postoperatively with the American Shoulder and Elbow Surgeons (ASES) score, the visual analog scale (VAS) for pain, the University of California Los Angeles (UCLA) shoulder rating scale, and the Constant-Murley rating scale. A comparison of the clinical outcomes among the patients who underwent subscapularis tenotomy and repair, those who underwent a procedure that used the subscapularis-splitting technique, and those who underwent a concomitant humeral head replacement was performed. RESULTS: Twenty-five shoulders of 25 patients were available for a mean follow-up of 31.6 months. At the time of the latest follow-up, the range of motion and the shoulder functional evaluations (VAS [p = 0.02], ASES [p = 0.01], Constant score [p = 0.01], and UCLA score [p = 0.04]) were significantly improved. The overall redislocation or subluxation rate was 48% (12 of 25): 0% (0 of 5) for the subscapularis-splitting group, 53% (8 of 15) for the subscapularis tenotomy and repair group, and 80% (4 of 5) for the humeral head replacement group. The ASES score (p = 0.006), UCLA score (p = 0.014), Constant score (p = 0.046), and external rotation (p = 0.048) were significantly better, and less severe glenohumeral osteoarthritis was found in patients who had undergone a Latarjet procedure with subscapularis-splitting compared with those who had undergone subscapularis tenotomy and repair. CONCLUSIONS: The Latarjet procedure for the treatment of chronic locked anterior shoulder dislocation can be successful if the shoulder reduction can be performed without requiring a subscapularis tenotomy. If this reduction is not possible, then other surgical reconstruction should be considered. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.