Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA.
Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA.
J Shoulder Elbow Surg. 2021 Apr;30(4):e157-e164. doi: 10.1016/j.jse.2020.07.027. Epub 2020 Aug 4.
The Latarjet procedure has become a treatment of choice for glenohumeral instability in the setting of large glenoid osseous defects (>20%) and for prior failed soft tissue repairs. However, surgical techniques and postoperative rehabilitation protocols vary among expert shoulder surgeons. The purpose of this survey study was to characterize the variation in current practice patterns among fellowship-trained orthopedic shoulder surgeons and identify factors related to variation.
A 9-question survey was created (SurveyMonkey, San Mateo, CA, USA) and distributed to orthopedic surgeons who are active members of the American Shoulder and Elbow Surgeons or American Orthopaedic Society for Sports Medicine. The survey asked questions regarding surgeon experience with the Latarjet procedure, fellowship training, open vs. arthroscopic approach, method of coracoid-to-glenoid fixation, period of sling use postoperatively, and time before clearance to return to sport. Subgroup analysis was performed to determine whether further variation was evident between surgeons who completed sports medicine vs. shoulder and elbow fellowship training.
In total, 242 surgeons completed the survey. Of these, 55% indicated performing a sports medicine fellowship and 39% indicated completing a shoulder and elbow fellowship. Among all surgeons, the classic open Latarjet procedure was the strongly preferred technique (79%), followed by the open congruent-arc (17%) and all-arthroscopic (3%) techniques. With respect to fixation, 98% used screw fixation and only 1% indicated cortical button use. With respect to the postoperative course, >85% of surgeons preferred immobilization for 3-6 weeks after the procedure and 42% of respondents stated they waited ≥6 months prior to clearing their patients to return to sport. Subgroup analysis revealed that surgeons who completed a shoulder and elbow fellowship performed the classic open technique 89% of the time compared with 63% of those who completed a sports medicine fellowship (P < .001).
The results of our survey study indicate an overall strong preference for the open classic Latarjet technique as well as an overall strong preference for screw fixation of the coracoid graft to the glenoid among all surgeons. Shoulder and elbow fellowship-trained surgeons are significantly more likely to perform open surgery with a classic technique compared with sports medicine fellowship-trained surgeons. Furthermore, the significant variation in postoperative sling use and return to sport suggests that further research is needed to develop an evidence-based postoperative Latarjet rehabilitation protocol.
对于肩盂骨缺损大于 20%的复发性肩关节不稳定和先前失败的软组织修复患者，Latarjet 手术已成为治疗的首选。然而，手术技术和术后康复方案在各专家肩关节外科医生之间存在差异。本调查研究的目的是描述 fellowship 培训的骨科肩关节外科医生之间当前实践模式的差异，并确定与差异相关的因素。
创建了一个 9 个问题的调查（SurveyMonkey，San Mateo，CA，USA），并分发给美国肩肘外科医师协会或美国运动医学协会的活跃骨科肩关节外科医生。该调查询问了外科医生进行 Latarjet 手术的经验、 fellowship 培训、开放与关节镜入路、喙突到肩盂的固定方法、术后吊带使用时间以及重返运动前的时间。进行了亚组分析，以确定在完成运动医学 fellowship和肩肘 fellowship的外科医生之间是否存在进一步的差异。
共有 242 名外科医生完成了调查。其中，55%的人表示完成了运动医学 fellowship，39%的人表示完成了肩肘外科 fellowship。在所有外科医生中，经典的开放式 Latarjet 手术是最受欢迎的技术（79%），其次是开放式一致弧形（17%）和全关节镜（3%）技术。关于固定方式，98%使用螺钉固定，只有 1%表示使用皮质扣固定。关于术后过程，超过 85%的外科医生喜欢在手术后 3-6 周内保持固定，42%的受访者表示他们等待≥6 个月后才让患者重返运动。亚组分析显示，完成肩肘外科 fellowship的外科医生 89%的时间采用经典开放式技术，而完成运动医学 fellowship的外科医生为 63%（P<0.001）。
我们的调查研究结果表明，所有外科医生普遍强烈倾向于开放式经典 Latarjet 技术，以及普遍强烈倾向于使用螺钉固定喙突移植物到肩盂。与运动医学 fellowship培训的外科医生相比，肩肘外科 fellowship培训的外科医生更有可能进行开放式经典手术。此外，术后吊带使用和重返运动的显著差异表明，需要进一步研究以制定基于证据的 Latarjet 术后康复方案。
