Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany.
Arthroscopy. 2013 Apr;29(4):630-7. doi: 10.1016/j.arthro.2012.12.003. Epub 2013 Feb 6.
To biomechanically compare the effectiveness of the standard open and arthroscopic techniques of the Latarjet procedure to address a critical anterior glenoid defect in combination with a capsular insufficiency.
Translation testing of 12 human cadaveric shoulder specimens was performed in a robot-assisted setup under 3 different conditions: (1) intact/vented shoulder joint, (2) combined anterior glenoid bone and capsular defect, and (3) open and arthroscopic Latarjet procedures. Testing was performed for each condition in 2 test positions: 60° of glenohumeral abduction with neutral rotation (ABD position) and 60° of abduction and external rotation (ABER position). Each position was tested with a passive humerus load of 30 N in the anterior, inferior, and anteroinferior directions. Translational movement of the humeral head was evaluated with and without the application of a 10-N load to the conjoint tendon (CJT).
In the ABD position, translations after the open Latarjet procedure significantly differed from the arthroscopic technique in the anterior and anteroinferior directions when testing was performed with loading of the CJTs (CJT loading). Without CJT loading, the open Latarjet technique showed significantly lower translations in the anterior, inferior (P = .004), and anteroinferior (P = .001) testing directions in the ABD position. In the ABER position, the arthroscopic procedure showed no significant difference compared with the standard open procedure.
We found a superior stabilization effect of the open Latarjet technique in the ABD position. The difference is ascribed to the anterior capsular repair, which was performed within the open technique and omitted during the arthroscopic procedure.
The reduction of translation in a pure abduction position of the arm is more effectively performed with a conventional open Latarjet technique that includes a capsular repair. In combined ABER position, there was no difference found between the open and arthroscopic Latarjet techniques.
生物力学比较标准的开放式和关节镜下 Latarjet 手术治疗伴有囊状不足的临界前盂唇缺损的疗效。
在机器人辅助设置下，对 12 个人体尸体肩关节标本进行翻译测试，在 3 种不同情况下进行：（1）完整/通风肩关节，（2）前盂唇骨和囊状缺损联合，（3）开放式和关节镜下 Latarjet 手术。在 2 种测试位置下，对每种情况进行测试：肩肱关节 60°外展中立位（ABD 位置）和 60°外展外旋位（ABER 位置）。在每个位置，在前、下和前下方向施加 30N 的被动肱骨头负荷。在有无联合腱（CJT）加载的情况下评估肱骨头的平移运动。
在 ABD 位置，当对 CJT 进行加载时（CJT 加载），与关节镜技术相比，开放式 Latarjet 手术后的前向和前下向的平移明显不同。在没有 CJT 加载的情况下，开放式 Latarjet 技术在 ABD 位置的前向、下向（P =.004）和前下向（P =.001）测试方向的平移明显较低。在 ABER 位置，关节镜手术与标准的开放式手术相比，没有显著差异。
我们发现开放式 Latarjet 技术在 ABD 位置具有更好的稳定性。差异归因于开放式技术中进行的前囊修复，而关节镜手术中省略了该修复。
在手臂纯外展位置，通过常规的开放式 Latarjet 技术（包括囊状修复）可更有效地减少平移。在结合 ABER 位置，开放式和关节镜下 Latarjet 技术之间没有发现差异。
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