Department of Shoulder Surgery, Centre Hospitalier Privé, Saint-Grégoire, France.
MC Grenoble Medical School, Biviers, France.
Am J Sports Med. 2018 May;46(6):1408-1415. doi: 10.1177/0363546518759730. Epub 2018 Mar 28.
In cases of shoulder stabilization for anterior instability, the main goals of the surgery are a rapid and efficient return to sports and excellent long-term outcomes without recurrence of dislocation, particularly in young and competitive athletes.
To determine whether outcomes of open Latarjet procedure (OLPs) depend on the level of sports practiced by patients and to report clinical scores and complication rates for OLP at a minimum follow-up of 2 years.
Cohort study; Level of evidence, 3.
A retrospective comparative study was conducted for all patients who underwent OLP by the senior author (J.B.) between July 2007 and December 2012. The indication for OLP at the authors' institution was a minimum of 2 episodes of dislocation and/or subluxation, a positive apprehension test result in the cocking position, an Instability Severity Index Score more than 2, and evidence of anterior instability lesions on computed tomography arthrograms. The 106 included patients (110 shoulders) with a mean follow-up of 46 months were compared in 2 groups depending on sport activities: 57 (54%) competitive athletes and 49 (46%) recreational athletes. The principal outcome measure was evidence of recurrent instability. The secondary outcome measures were clinical scores related to anterior instability and related to sport practice: Rowe score, Oxford Shoulder Instability Score (OSIS), Western Ontario Shoulder Instability Index, and level of satisfaction.
Of the 106 patients, 3 reported recurrence of shoulder dislocation: 2 competitive athletes (3.5%; 95% CI, 0.9%-11.2%) and 1 recreational athlete (2%; 95% CI, 0.4%-10.7%) ( P = .684). The persistent apprehension test result was positive in 7 competitive athletes (11.5%) and in 5 recreational athletes (10%) ( P = .566). The Rowe scores improved from 56.3 ± 13.2 (range, 30-80) preoperatively to 84.2 ± 16.4 (range, 30-100) postoperatively in competitive athletes and from 55.0 ± 11.0 (range, 35-80) to 69.5 ± 22.0 (range, 15-100) in recreational athletes ( P < .001). The net improvement in Rowe scores was significantly greater in competitive athletes (27.9 ± 21.7) compared with recreational athletes (14.5 ± 24.4) ( P = .006). The scores unrelated to sport activity (Oxford Shoulder Instability Score and Simple Shoulder Test) were similar for the 2 groups. All 57 (100%) competitive athletes and 34 (69.4%) recreational athletes resumed their previous sports practice, at the same level or higher than before their injury (respectively, 78.9% and 42.9%; P = .004).
The OLP could be considered for primary shoulder stabilization, particularly in competitive athletes, who have high functional demands and great risks of redislocation.
在治疗肩关节前向不稳定时，手术的主要目标是快速、有效地恢复运动能力，避免再次脱位，并取得良好的长期效果，尤其是对于年轻且竞技状态活跃的运动员。
探讨开放性 Latarget 术（OLP）的治疗效果是否与患者运动水平相关，并报告至少随访 2 年的 OLP 临床评分和并发症发生率。
回顾性队列研究；证据等级 3 级。
对作者（J.B.）于 2007 年 7 月至 2012 年 12 月期间进行的所有 OLP 患者进行回顾性比较研究。作者所在机构进行 OLP 的适应证为：至少有 2 次脱位和/或半脱位病史，前向撞击试验 Cocking 位阳性，不稳定严重程度指数评分＞2 分，以及 CT 关节造影显示有前向不稳定的证据。106 例患者（110 个肩关节）接受了 OLP 治疗，平均随访 46 个月。根据运动活动情况将患者分为 2 组：57 例（54%）竞技运动员和 49 例（46%）休闲运动员。主要结局指标为复发性不稳定的证据。次要结局指标包括与前向不稳定和运动实践相关的临床评分：Rowe 评分、牛津肩不稳定评分（OSIS）、西部安大略肩不稳定指数和满意度。
在 106 例患者中，3 例（3.5%；95%CI，0.9%-11.2%）报告出现肩关节再脱位，其中 2 例为竞技运动员（3.5%），1 例为休闲运动员（2%）（P =.684）。7 例竞技运动员（11.5%）和 5 例休闲运动员（10%）持续存在前向撞击试验阳性（P =.566）。竞技运动员的 Rowe 评分从术前的 56.3 ± 13.2（范围，30-80）改善至术后的 84.2 ± 16.4（范围，30-100），休闲运动员的 Rowe 评分从术前的 55.0 ± 11.0（范围，35-80）改善至术后的 69.5 ± 22.0（范围，15-100）（P＜.001）。竞技运动员的 Rowe 评分改善程度明显大于休闲运动员（27.9 ± 21.7）（P =.006）。与运动活动无关的评分（牛津肩不稳定评分和简单肩试验）在 2 组之间相似。57 例（100%）竞技运动员和 34 例（69.4%）休闲运动员均恢复了之前的运动水平，或高于受伤前的运动水平（分别为 78.9%和 42.9%；P =.004）。
OLP 可作为肩关节初次稳定治疗的选择，尤其是对功能需求高、再脱位风险大的竞技运动员。
