Modified Latarjet procedure for patients with glenoid bone defect accompanied with anterior shoulder instability

Abstract

Objective: The aim of this study was to assess the effects of coracoid bone block (modified Latarjet) procedure on clinical and functional results in cases with glenoid bone defect accompanied with anterior shoulder instability.
Methods: The study included 35 patients (average age: 35 years; range: 20 to 58 years) with glenoid bone defect and recurrent dislocations treated with the modified Latarjet procedure. There were 12 sports injuries, 5 post-epileptic cases and 18 recurrent anterior shoulder dislocation following non-sports-related injuries. Recurrence was reported in 7 patients formerly treated with the Bankart procedure. Average number of preoperative dislocations was 10.8±6.5 and average time range between the first dislocation and surgery was 14.9±13.2 months. All patients underwent preoperative diagnostic arthroscopy. Postoperative isometric exercises in braces were assigned for the first 6 weeks, followed by active strengthening exercises. Pre- and postoperative functional results were evaluated using the ASES (American Shoulder and Elbow Surgeons) and Rowe scores and pain using the VAS (Visual Analog Scale).
Results: Osseous union of coracoid graft was achieved in all patients. Average follow-up was 24±12.2 (range: 12 to 74) months. No degenerative arthritis or continuing instability was detected in any of the patients. Average forward flexion was 165°±20° and external rotation 59°±13°. Mean preoperative ASES and Rowe scores of 49.6±10.6 and 47.9±21.5 increased postoperatively to 91.3±11 and 89.1±9.2, respectively. Mean VAS scores decreased significantly from 6.2±2.4 to 1.8±0.6 postoperatively (p<0.05).
Conclusion: Shoulder functionality and former activity levels can be successfully achieved in terms of increased patient satisfaction through use of the modified Latarjet surgery in the treatment of glenoid bone defect and anterior shoulder instability.

Keywords

• Glenoid bone defect
• Latarjet
• shoulder instability

Omuz anterior instabilitesine eşlik eden glenoid kemik defektli hastalarda modifiye Latarjet prosedürü

Öz

Amaç: Bu çalışmanın amacı anterior omuz instabilitesine eşlik eden glenoid kemik defektli olgularda korakoid kemik blok (modifiye Latarjet) prosedürünün klinik ve fonksiyonel sonuçlara etkilerinin değerlendirilmesi idi. Çalışma planı: Tekrarlayan çıkık nedeniyle başvuran ve modifiye Latarjet prosedürü ile tedavi edilen, glenoid kemik defektli 35 hasta (ortalama yaş: 35, dağılım: 20-58) çalışmaya alındı. On iki hastada spor travması, 5’inde epilepsi nöbetleri sonrası, 18’inde ise spor dışı travma sonrası tekrarlayan anterior omuz çıkığı hikayesi mevcuttu. Daha önce Bankart onarımı uygulanan 7 hastada nüks vardı. Hastaların ameliyat öncesi ortalama çıkık sayısı 10.8±6.5, ilk çıkıktan ameliyata kadar geçen ortalama süre ise 14.9±13.2 ay olarak kaydedildi. Girişim öncesinde tüm hastalara tanısal artroskopi yapıldı. Hastalara ameliyat sonrası ilk 6 hafta askı içinde izometrik egzersizler, sonrasında aktif güçlendirme egzersizleri uygulandı. Ameliyat öncesi ve sonrası fonksiyonel sonuçlar ASES (American Shoulder and Elbow Surgeons) ve Rowe skorları ile, ağrı ise VAS (Visual Analog Scale) ile değerlendirildi. Bulgular: Ortalama 24±12.2 (dağılım: 12-74) ay takip edilen hastaların tümünde greft kaynaması sağlandı. Hiçbir hastada dejeneratif artrit bulgusu ve devam eden instabilite saptanmadı. Ortalama öne fleksiyon 165°±20°, dış rotasyon 59°±13° olarak ölçüldü. Ameliyat öncesi ASES ve Rowe skorları, sırasıyla, ortalama 49.6±10.6 ve 47.9±21.5 iken bu değerlerin son kontrollerinde 91.3±11 ve 89.1±9.2’ye yükseldiği görüldü. Hastaların ortalama VAS skorları ise 6.2±2.4’ten iken ameliyat sonrasında 1.8±0.6 değerlerine geriledi (p<0.05). Çıkarımlar: Anterior omuz instabilitesi ve glenoid kemik defekti varlığında uygulanacak modifiye Latarjet cerrahisi ile omuz fonksiyonelliğinin kazanılması ve eski aktivite düzeyine dönüşle birlikte hasta memnuniyeti açısından başarılı sonuçlar almak mümkündür.

Anahtar Kelimeler

• Glenoid kemik defekti; Latarjet; omuz instabilite

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