Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Shoulder Department, Clinique de l'Union, Saint Jean, France.
J Shoulder Elbow Surg. 2020 Apr;29(4):681-688. doi: 10.1016/j.jse.2019.10.022. Epub 2020 Jan 22.
The open Latarjet procedure is a standard surgical treatment option for anterior shoulder instability in patients with a high risk of failure following soft tissue stabilization. The arthroscopic technique has potential advantages of minimal invasiveness, reduced postoperative stiffness, and faster rehabilitation but is regarded as technically challenging with concern over surgical risk during the learning curve. The aim of this study was to undertake a multisurgeon, large-volume learning curve analysis of the arthroscopic Latarjet procedure using continuous learning curve analysis.
Individual patient data from 12 surgeons across 5 countries were retrospectively reviewed. A total of 573 patients undergoing the arthroscopic Latarjet procedure were included. Outcome measures of learning were collected, including operative time, computed tomography (CT) bone-block positioning, complications, and patient-reported outcome measures (PROMs). A segmented linear regression modeling technique was used for learning curve analysis.
High-volume surgeons converged to an operative time steady state after 30-50 cases. Surgeons completing fewer procedures demonstrated a constant reduction in operative time without reaching a plateau. Low-volume surgeons completing fewer than 14 operations did not demonstrate a reduction in operative time. Accuracy of bone-block positioning on postoperative CT demonstrated constant improvement without reaching a plateau after 53 cases. There was no change in PROMs or complications with increased operative volume.
Specialist shoulder surgeons require 30-50 arthroscopic Latarjet procedures to attain steady-state operative efficiency, during which there is improvement in bone-block positioning. Only surgeons expecting to undertake the arthroscopic Latarjet in high volume should consider adopting this procedure.
对于软组织稳定术后失败风险高的前肩不稳患者，开放式 Latarjet 手术是一种标准的手术治疗选择。关节镜技术具有微创、术后僵硬减少和康复更快的潜在优势，但被认为具有技术挑战性，在学习曲线期间存在手术风险。本研究的目的是采用连续学习曲线分析，对关节镜 Latarjet 手术进行多外科医生、大样本量的学习曲线分析。
回顾性分析来自 5 个国家的 12 名外科医生的个体患者数据。共纳入 573 例行关节镜 Latarjet 手术的患者。收集学习的结局指标，包括手术时间、计算机断层扫描 (CT) 骨块定位、并发症和患者报告的结局指标 (PROMs)。采用分段线性回归建模技术进行学习曲线分析。
高容量外科医生在完成 30-50 例手术后达到手术时间稳定状态。完成较少手术的外科医生的手术时间持续减少，但没有达到平台期。完成少于 14 例手术的低容量外科医生的手术时间没有减少。术后 CT 上骨块定位的准确性在完成 53 例手术后持续改善，没有达到平台期。随着手术量的增加，PROMs 或并发症没有变化。
专业肩部外科医生需要完成 30-50 例关节镜 Latarjet 手术才能达到稳定的手术效率，在此期间骨块定位会得到改善。只有预计要进行大量关节镜 Latarjet 手术的外科医生才应考虑采用该手术。
