Gilles Clowez1, Patick Gendre2, Pascal Boileau3. 1. University Institute for Locomotion & Sports (iULS), Hôpital Pasteur 2, Côte d'Azur University, (UCA), 30, voie Romaine, 06000 Nice, France. 2. Pôle Antibes Saint Jean, 2160 av Michard Pellissier, 06600 Antibes, France. 3. ICR - Institut de Chirurgie Réparatrice - Locomoteur & Sport, 7 av Durante, 06000 Nice, France. Electronic address: pr.boileau@icr-nice.com.
Abstract
BACKGROUND: Recurrence of anterior instability after arthroscopic Bankart prevents return to sport and remains a surgical challenge. AIM: To assess clinical and radiological outcomes after coracoid bone-block performed either open or under arthroscopy, for the management of failed arthroscopic Bankart. PATIENTS AND METHODS: fifty-nine consecutive patients with anterior instability recurrence after arthroscopic Bankart were revised with a Bristow or Latarjet procedure performed either open (25 cases) or under arthroscopy (34 cases). Patients were reviewed for clinical and radiological examination at a minimum two years follow-up. Glenohumeral bony lesions were evaluated preoperatively with CT-scans. Postoperative bone-block position, union and post-instability arthritis were also evaluated. RESULTS: The mean follow-up was 89 months (24-193). The epidemiological analysis showed that patients with failed arthroscopic Bankart were young (< 23y), 58 (98%) were practicing sports, with contact/forced overhead sports (53%), often in competition (53%), had hyperlaxity (71%) and for the most part of them glenohumeral bone loss (88%). Their mean preoperative ISIS score was 5.4 points ± 2.2. After revision with Bristow-Latarjet procedure, 53 patients (91%) returned to sports, 37 (70%) to their previous sports activity and 17 (46%) to their previous level. No patient suffered recurrent dislocation. Four patients (7%) had recurrent subluxations, all after open procedure; eight patients (14.5%) had persistent anterior apprehension. A large and deep Hill-Sachs lesion was a risk factor for persistent anterior apprehension (p = 0.002) and lower level when returned to sports (p = 0.04). Ninety-two percent of bone-blocks were positioned flush with the glenoid anterior rim, with 84% of bone union. At last follow-up, 5% of patients had severe post-instability osteoarthritis (Samilson 4). CONCLUSION: The Bristow-Latarjet performed either open or under arthroscopy, is an efficient procedure to restore shoulder stability and allow returning to sport in patients with failed arthroscopic Bankart and glenoid bone loss. Patients with a large and deep Hill-Sachs lesion had more persistent anterior apprehension and a lower sports level.
BACKGROUND: Recurrence of anterior instability after arthroscopic Bankart prevents return to sport and remains a surgical challenge. AIM: To assess clinical and radiological outcomes after coracoid bone-block performed either open or under arthroscopy, for the management of failed arthroscopic Bankart. PATIENTS AND METHODS: fifty-nine consecutive patients with anterior instability recurrence after arthroscopic Bankart were revised with a Bristow or Latarjet procedure performed either open (25 cases) or under arthroscopy (34 cases). Patients were reviewed for clinical and radiological examination at a minimum two years follow-up. Glenohumeral bony lesions were evaluated preoperatively with CT-scans. Postoperative bone-block position, union and post-instability arthritis were also evaluated. RESULTS: The mean follow-up was 89 months (24-193). The epidemiological analysis showed that patients with failed arthroscopic Bankart were young (< 23y), 58 (98%) were practicing sports, with contact/forced overhead sports (53%), often in competition (53%), had hyperlaxity (71%) and for the most part of them glenohumeral bone loss (88%). Their mean preoperative ISIS score was 5.4 points ± 2.2. After revision with Bristow-Latarjet procedure, 53 patients (91%) returned to sports, 37 (70%) to their previous sports activity and 17 (46%) to their previous level. No patient suffered recurrent dislocation. Four patients (7%) had recurrent subluxations, all after open procedure; eight patients (14.5%) had persistent anterior apprehension. A large and deep Hill-Sachs lesion was a risk factor for persistent anterior apprehension (p = 0.002) and lower level when returned to sports (p = 0.04). Ninety-two percent of bone-blocks were positioned flush with the glenoid anterior rim, with 84% of bone union. At last follow-up, 5% of patients had severe post-instability osteoarthritis (Samilson 4). CONCLUSION: The Bristow-Latarjet performed either open or under arthroscopy, is an efficient procedure to restore shoulder stability and allow returning to sport in patients with failed arthroscopic Bankart and glenoid bone loss. Patients with a large and deep Hill-Sachs lesion had more persistent anterior apprehension and a lower sports level.