Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina.
Am J Sports Med. 2018 Mar;46(4):795-800. doi: 10.1177/0363546517749586. Epub 2018 Jan 10.
The optimal management of recurrent anterior shoulder instability with significant glenoid bone loss in high-demand collision athletes remains a challenge.
To analyze the time to return to sport, clinical outcomes, and recurrences following a modified Latarjet procedure without capsulolabral repair in rugby players with recurrent anterior shoulder instability and significant glenoid bone loss.
Case series; Level of evidence, 4.
Between June 2008 and June 2015, 50 competitive rugby players (practice >2 times per week and competition during weekends) with recurrent anterior shoulder instability underwent operation with the modified congruent arc Latarjet procedure without capsulolabral repair in our institution. Cases included 18 primary repairs and 32 revisions. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale for pain in sport activity (VAS), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. The final analysis included 49 shoulders in 48 patients (31 revision cases).
The mean follow-up was 48 months (range, 24-108 months) and the mean age at the time of operation was 22.8 years (range, 17-35 years). Forty-five patients (93.7%) returned to playing rugby, all at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistically significant improvement after operation ( P < .001). The Rowe score increased from a mean of 39.5 points preoperatively to 94 points postoperatively ( P < .01). The VAS score decreased from 3.6 points preoperatively to 1.2 points postoperatively ( P < .01). The ASOSS score improved significantly from a mean of 44 points preoperatively to 89.5 points postoperatively ( P < .01). No recurrence of shoulder dislocation or subluxation was noted. The bone block healed in 43 shoulders (88%).
In rugby players with recurrent anterior shoulder instability and significant glenoid bone loss, the modified Latarjet procedure without capsulolabral repair produced excellent functional outcomes, with most athletes returning to rugby at their preinjury level of play without recurrences.
对于有明显盂肱骨缺损的高需求碰撞运动员的复发性前肩不稳定，最佳的管理仍然是一个挑战。
分析在没有盂唇修补的改良 Latarjet 手术治疗复发性前肩不稳定和明显盂肱骨缺损的橄榄球运动员中的重返运动时间、临床结果和复发情况。
病例系列；证据水平，4 级。
2008 年 6 月至 2015 年 6 月，50 名有复发性前肩不稳定的竞技橄榄球运动员（每周练习 >2 次，周末比赛）在我院接受改良的一致弧形 Latarjet 手术，不进行盂唇修补。病例包括 18 例初次修复和 32 例翻修。使用 Rowe 评分、视觉模拟评分法（VAS）在运动中的疼痛评分、运动肩部结局评分系统（ASOSS）评估功能结果。还评估了复发情况。术后用计算机断层扫描评估骨块位置和固定情况。最终分析包括 48 例患者的 49 个肩部（31 例翻修病例）。
平均随访时间为 48 个月（范围，24-108 个月），手术时的平均年龄为 22.8 岁（范围，17-35 岁）。45 名患者（93.7%）重返橄榄球运动，均恢复到受伤前的运动水平。术前和术后肩关节活动范围无显著差异。Rowe 评分、VAS 评分和 ASOSS 评分在术后均有显著改善（P<0.001）。Rowe 评分从术前的平均 39.5 分提高到术后的 94 分（P<0.01）。VAS 评分从术前的 3.6 分降低到术后的 1.2 分（P<0.01）。ASOSS 评分从术前的平均 44 分提高到术后的 89.5 分（P<0.01）。无肩脱位或半脱位复发。43 个骨块（88%）愈合。
在有复发性前肩不稳定和明显盂肱骨缺损的橄榄球运动员中，不进行盂唇修补的改良 Latarjet 手术可产生出色的功能结果，大多数运动员在受伤前的运动水平上重返运动，且无复发。
