Etzelclinic, Pfäffikon, Switzerland.
Upper Limb Department, St. Luke's Hospital, Bielsko-Biala, Poland.
Arthroscopy. 2019 Aug;35(8):2304-2311. doi: 10.1016/j.arthro.2019.03.035. Epub 2019 Jul 23.
To analyze the learning curves of 5 experienced, fellowship-trained shoulder surgeons and their respective 25 first arthroscopic Latarjet cases in regard to surgical time, graft placement, complication rates, and recurrent instability.
The first 25 arthroscopic Latarjet procedures of 5 surgeons were retrospectively analyzed in an international multicenter setting, and thus 125 patients were included in this study. The surgical time, intraoperative and postoperative events out of the ordinary, and graft positioning were examined.
The 125 patients consisted of 16 women (12.8%) and 109 men (87.2%). In 81.6% (n = 102), surgery was undertaken as a first-line procedure, whereas 18.4% (n = 23) were revisions. Surgical time decreased significantly from an average of 123.8 minutes (range 70 to 210) to 92.6 minutes (range 50 to 160) from the first 5 cases to the last 5 cases of each surgeon within a period of <2 years. Overall, 22 events in 21 patients requiring additional treatment were reported (17.6%). Five (4%) were unlikely to affect final outcome and did not require revision surgery. Twelve (9.6%) required revision surgery that was not trauma related yet was prone to affect outcomes. Five events were trauma-related (4%), 4 requiring revision surgery and 1 treated conservatively. Overall, 6 patients (4.8%) had recurrent shoulder instability, 3 as a result of a traumatic event. Conventional radiology showed the bone-block in ideal positioning in 93 cases (74.4%), flush with the glenoid in a true anteroposterior view. In 3 cases (2.4%), it was considered too high, 15 too low (12%), 5 too lateral (4%), and 15 too medial (12%). Some patients had combinations of the above.
This analysis shows that surgical time in arthroscopic Latarjet can be significantly reduced after only 20 cases. However, complication rates did not decrease over this time. The authors believe that the arthroscopic Latarjet is a challenging yet viable technique to treat anterior shoulder instability, achieving results equal to the open technique with advantages of the arthroscopic setting.
Level IV, retrospective cohort study.
分析 5 位经验丰富、受过 fellowship培训的肩部外科医生及其各自 25 例首次关节镜下 Latarjet 手术的学习曲线，包括手术时间、移植物放置、并发症发生率和复发性不稳定。
对 5 位外科医生在国际多中心环境下进行的前 25 例关节镜下 Latarjet 手术进行回顾性分析，共纳入 125 例患者。检查手术时间、术中及术后异常事件以及移植物定位。
125 例患者中包括 16 例女性（12.8%）和 109 例男性（87.2%）。81.6%（n=102）为初次手术，18.4%（n=23）为翻修手术。从每位外科医生的前 5 例手术到最后 5 例手术，手术时间从平均 123.8 分钟（70 至 210 分钟）显著减少至 92.6 分钟（50 至 160 分钟），时间跨度小于 2 年。总体而言，21 例患者中有 22 例（17.6%）需要额外治疗的事件报告。其中 5 例（4%）不太可能影响最终结果且无需再次手术。12 例（9.6%）需要与创伤无关但可能影响结果的再次手术。5 例为创伤相关（4%），其中 4 例需要再次手术，1 例采用保守治疗。共有 6 例（4.8%）患者出现复发性肩关节不稳定，其中 3 例为创伤性事件所致。常规影像学显示 93 例（74.4%）骨块位置理想，在标准前后位片上与肩胛盂平齐。3 例（2.4%）认为骨块位置过高，15 例（12%）过低，5 例（4%）偏外侧，15 例（12%）偏内侧。部分患者存在上述多种情况的组合。
本分析表明，关节镜下 Latarjet 手术的手术时间在仅进行 20 例手术后即可显著缩短。然而，在此期间，并发症发生率并未降低。作者认为，关节镜下 Latarjet 是一种具有挑战性但可行的技术，可用于治疗前肩不稳定，其结果与开放式技术相当，且具有关节镜手术的优势。
IV 级，回顾性队列研究。
