Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France.
Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France.
Arthroscopy. 2019 Apr;35(4):1050-1061. doi: 10.1016/j.arthro.2018.11.012. Epub 2019 Mar 8.
To evaluate mid-term clinical outcomes, complications, bone-block healing, and positioning using suture-button fixation for an arthroscopic Latarjet procedure.
Patients with traumatic recurrent anterior instability and glenoid bone loss underwent guided arthroscopic Latarjet with suture-button fixation. We included patients with anterior shoulder instability, glenoid bone loss >20%, and radiographic and clinical follow-up minimum of 24 months. Patients with glenoid bone loss <20% or those that refused computed tomography imaging were excluded. Bone-block fixation was accomplished with 2 cortical buttons connected with a looped suture (4 strands). The looped suture was tied posteriorly with a sliding-locking knot. After transfer of the bone block on the anterior neck of the scapula, compression (100 N) was obtained with the help of a tensioning device. Clinical assessment was performed at 2 weeks, 3 months, 6 months, and then yearly with computed tomography completed at 2 weeks and 6 months to confirm bony union.
A consecutive series of 136 patients underwent arthroscopic Latarjet with 121 patients (89%; mean age 27 years) available at final follow-up (mean follow-up, 26 months; range, 24-47 months). No neurologic complications or hardware failures were observed; no patients had secondary surgery for implant removal. The transferred coracoid process healed to the scapular neck in 95% of the cases (115/121). The bone block did not heal in 4 patients; it was fractured in 1 and lysed in another. Smoking was a risk factor associated with nonunion (P < .001). The coracoid graft was positioned flush to the glenoid face in 95% (115/121) and below the equator in 92.5% (112/121). At final follow-up, 93% had returned to sports, whereas 4 patients (3%) had a recurrence of shoulder instability. The subjective shoulder value for sports was 94 ± 3.7%. Mean Rowe and Walch-Duplay scores were 90 (range, 40-100) and 91 (range, 55-100), respectively.
Suture-button fixation is an alternative to screw fixation for the Latarjet procedure, obtaining predictable healing with excellent graft positioning, and avoiding hardware-related complications. There was no need for hardware removal after suture-button fixation. The systematic identification of the axillary and musculocutaneous nerves reduced risk of neurologic injury. A low instability recurrence rate and excellent return to pre-injury activity level was found. Suture-button fixation is simple, safe, and may be used for both open and arthroscopic Latarjet procedure.
Level IV, therapeutic case series.
评估关节镜下 Latarjet 手术中使用缝线纽扣固定的中期临床结果、并发症、骨块愈合和定位。
对创伤性复发性前向不稳定伴肩胛盂骨缺失的患者进行引导下关节镜 Latarjet 手术及缝线纽扣固定。我们纳入了有前向肩不稳定、肩胛盂骨缺失>20%，以及影像学和临床随访至少 24 个月的患者。肩胛盂骨缺失<20%或拒绝 CT 成像的患者被排除。骨块固定采用 2 个皮质纽扣与一个环形缝线（4 股）相连。环形缝线在后面用滑动锁定结系紧。将骨块转移到肩胛颈前侧后，使用张力装置获得 100N 的压缩力。术后 2 周、3 个月、6 个月进行临床评估，之后每年进行评估，术后 2 周和 6 个月行 CT 检查以确认骨愈合。
连续 136 例患者接受了关节镜下 Latarjet 手术，其中 121 例（89%；平均年龄 27 岁）在末次随访时可评估（平均随访时间为 26 个月；范围 24-47 个月）。未观察到神经并发症或硬件失败；无患者因植入物取出而进行二次手术。95%（115/121）的情况下转位喙突愈合至肩胛颈，4 例（4 例）未愈合，1 例骨折，1 例溶解。吸烟是与不愈合相关的危险因素（P<0.001）。骨块的位置在 95%（115/121）的患者中与肩胛盂面平齐，在 92.5%（112/121）的患者中位于肩胛盂赤道以下。末次随访时，93%（112/121）的患者恢复运动，4 例（3%）患者出现肩不稳定复发。用于运动的主观肩部评分值为 94±3.7%。平均 Rowe 和 Walch-Duplay 评分为 90（范围 40-100）和 91（范围 55-100）。
缝线纽扣固定是 Latarjet 手术中螺钉固定的一种替代方法，可获得可预测的愈合效果，并具有良好的移植物定位，同时避免与硬件相关的并发症。缝线纽扣固定后无需取出硬件。对腋神经和肌皮神经的系统识别降低了神经损伤的风险。发现肩不稳定复发率低，活动水平恢复良好。缝线纽扣固定简单、安全，可用于开放和关节镜下 Latarjet 手术。
IV 级，治疗性病例系列。
