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

Yıl 2013, Cilt: 47 Sayı: 6, 393 - 399, 07.02.2014

Ata Atalar Kerem Bilsel Ilker Eren Derya Celik Hilal Cil Mehmet Demirhan

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• Gartsman GM, Roddey TS, Hammerman SM. Arthroscopic treatment of anterior-inferior glenohumeral instability. Two to five-year follow-up. J Bone Joint Surg Am 2000;82-A:991100
• Gill TJ, Micheli LJ, Gebhard F, Binder C. Bankart repair for anterior instability of the shoulder. Long-term outcome. J Bone Joint Surg Am 1997;79:850-7.
• Kim SH, Ha KI, Cho YB, Ryu BD, Oh I. Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up. J Bone Joint Surg Am 2003;85-A:1511-8.
• Boileau P, Villalba M, Héry JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am 2006;88: 1755Provencher MT, Bhatia S, Ghodadra NS, Grumet RC, Bach BR Jr, Dewing CB, et al. Recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am 2010;92 Suppl 2:133-51.
• Rowe CR, Zarins B, Ciullo JV. Recurrent anterior dislocation of the shoulder after surgical repair. Apparent causes of failure and treatment. J Bone Joint Surg Am 1984;66:159-68.
• Gill TJ, Warren RF, Rockwood CA Jr, Craig EV, Cofield RH, Hawkins RJ. Complications of shoulder surgery. Instr Course Lect 1999;48:359-74.
• Spatschil A, Landsiedl F, Anderl W, Imhoff A, Seiler H, Vassilev I, et al. Posttraumatic anterior-inferior instability of the shoulder: arthroscopic findings and clinical correlations. Arch Orthop Trauma Surg 2006;126:217-22.
• Porcellini G, Campi F, Pegreffi F, Castagna A, Paladini P. Predisposing factors for recurrent shoulder dislocation after arthroscopic treatment. J Bone Joint Surg Am 2009;91:2537-42. Bankart AS. The pathology and treatment of recurrent dislocation of the shoulder-joint. Br J Surg 1938;26:23-39.
• Neviaser TJ. The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior instability of the shoulder. Arthroscopy 1993;9:17-21.
• Ozbaydar M, Elhassan B, Diller D, Massimini D, Higgins LD, Warner JJ. Results of arthroscopic capsulolabral repair: Bankart lesion versus anterior labroligamentous periosteal sleeve avulsion lesion. Arthroscopy 2008;24:1277-83.
• Postacchini F, Gumina S, Cinotti G. Anterior shoulder dislocation in adolescents. J Shoulder Elbow Surg 2000;9:470-4.
• Loud KJ, Micheli LJ. Common athletic injuries in adolescent girls. Curr Opin Pediatr 2001;13:317-22.
• Meyer DC, Gerber C. Failure of anterior shoulder instability repair caused by eyelet cutout of absorbable suture anchors. Arthroscopy 2004;20:521-3.
• Rowe CR. Prognosis in dislocations of the shoulder. J Bone Joint Surg Am 1956;38-A:957-77.
• Good CR, MacGillivray JD. Traumatic shoulder dislocation in the adolescent athlete: advances in surgical treatment. Curr Opin Pediatr 2005;17:25-9.
• Huber H, Gerber C. Voluntary subluxation of the shoulder in children. A long-term follow-up study of 36 shoulders. J Bone Joint Surg Br 1994;76:118-22.
• Handoll HH, Almaiyah MA, Rangan A. Surgical versus nonsurgical treatment for acute anterior shoulder dislocation. Cochrane Database Syst Rev 2004;(1):CD004325.
• Kim SH, Ha KI, Jung MW, Lim MS, Kim YM, Park JH. Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: a prospective randomized clinical study. Arthroscopy 2003;19:722-31.
• Warner JJ, Gill TJ, O'hollerhan JD, Pathare N, Millett PJ. Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with glenoid deficiency using an autogenous tricortical iliac crest bone graft. Am J Sports Med 2006;34:205-12.
• Helfet AJ. Coracoid transplantation for recurring dislocation of the shoulder. J Bone Joint Surg Br 1958;40-B:198-202.
• Binnet MS, Gurkan I, Karakas MA, Fazeli AR. Modified Bristow procedure: Is it effective in recurrent instabilities of the shoulder? [Article in Turkish] Acta Orthop Traumatol Turc 1998;32:8-14.
• Latarjet M. Treatment of recurrent dislocation of the shoulder. [Article in French] Lyon Chir 1954;49:994-7.
• Burkhart SS, De Beer JF, Barth JR, Cresswell T, Criswell T, Roberts C, Richards DP. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy 2007;23:1033-41.
• Walch G, Boileau P. Latarjet-Bristow procedure for recurrent anterior instability. Tech Shoulder Elbow Surg 2000;1: 256Hovelius L, Saeboe M. Neer Award 2008: Arthropathy after primary anterior shoulder dislocation – 223 shoulders prospectively followed up for twenty-five years. J Shoulder Elbow Surg 2009;18:339-47.
• Hovelius L, Sandström B, Sundgren K, Saebö M. One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: study I – clinical results. J Shoulder Elbow Surg 2004;13:509-16.
• Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 2000;16:677-94.
• Garth WP Jr, Slappey CE, Ochs CW. Roentgenographic demonstration of instability of the shoulder: the apical oblique projection. A technical note. J Bone Joint Surg Am 1984;66:1450-3.
• Rokous JR, Feagin JA, Abbott HG. Modified axillary roentgenogram. A useful adjunct in the diagnosis of recurrent instability of the shoulder. Clin Orthop Relat Res 1972; (82):84-6.
• Pavlov H, Warren RF, Weiss CB Jr, Dines DM. The roentgenographic evaluation of anterior shoulder instability. Clin Orthop Relat Res 1985;(194):153-8.
• Detterline AJ, Provencher MT, Ghodadra N, Bach BR Jr, Romeo AA, Verma NN. A new arthroscopic technique to determine anterior-inferior glenoid bone loss: validation of the secant chord theory in a cadaveric model. Arthroscopy 2009;25:1249-56.
• Ghodadra N, Gupta A, Romeo AA, Bach BR Jr, Verma N, Shewman E, et al. Normalization of glenohumeral articular contact pressures after Latarjet or iliac crest bone-grafting. J Bone Joint Surg Am 2010;92:1478-89.
• Allain J, Goutallier D, Glorion C. Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am 1998;80:841-52.