Section of Trauma- and Reconstructive Surgery, Department of Orthopaedics, Trauma- and Reconstructive Surgery, University Hospital Halle, Ernst-Grube-Str, 40, 06120 Halle Saale, Germany; Department of Trauma- and Reconstructive Surgery, Berufsgenossenschaftliche Kliniken Bergmannstrost, Merseburger Str,. 165, 06112 Halle Saale, Germany.
Department of Trauma- and Reconstructive Surgery, Berufsgenossenschaftliche Kliniken Bergmannstrost, Merseburger Str,. 165, 06112 Halle Saale, Germany; Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany.
Orthop Traumatol Surg Res. 2021 Sep;107(5):102977. doi: 10.1016/j.otsr.2021.102977. Epub 2021 Jun 4.
The Latarjet procedure is an attractive surgical option for the management of chronic anterior shoulder instability. The original surgical approach involves the vertical tenotomy of the subscapularis tendon. Alternatively, the subscapularis muscle is split longitudinally and the tendon left attached at the lesser tuberosity.
The hypothesis is that the longitudinal split is of functional advantage and may lead to better functional results and earlier return to sports activities compared to the vertical tenotomy.
Thirty-two patients were included in this retrospective cohort study. In 14 patients, the subscapularis tendon was vertically incised (group A), whereas in 18 patients, the subscapularis muscle was split longitudinally (group B). Patients were evaluated at 1 year (FU1) and 2 years (FU2) after the Latarjet procedure. Results at follow-up were correlated with patient-specific data and compared with the preoperative status. Primary outcomes were the functional assessment based on Western Ontario Shoulder Instability (WOSI) index and Constant Score (CS) and the assessment of the return to sports activity. Patients' demographics, duration of surgery, and the rate of recurrent dislocations were recorded as secondary variables.
All patients started their sports activities with a mean±SD of 12.41±1.24 weeks. Interestingly, the time from surgery to full recovery of sports activities was significantly longer for group A (mean±SD of 30.17±10.36 weeks) compared to group B (mean±SD of 20.71±3.67 weeks). There is a statistically significant decrease of the WOSI score from the preoperative level compared to FU1 and FU2, indicating a decrease in instability related symptoms during the entire follow up period with no statistically significant difference between group A and B. There is an increase in shoulder function during the entire follow up period based on the CS. Most interestingly, there is a statistically significant difference between group A and B at FU1, indicating a significantly better shoulder function for group B at the early follow up timepoint (FU1). At the later follow up timepoint (FU2), no difference exists in the individual items. However, a significantly better total CS remains in group B, indicating an overall improved function compared to group A.
DISCUSSION/CONCLUSION: The longitudinal split of subscapularis muscle is a safe approach which leads to quicker functional recovery and return to sports activity compared to the vertical tenotomy, which is a benefit especially for active individuals. It is therefore recommended as the standard surgical approach.
III; Retrospective cohort study.
Latarjet 手术是治疗慢性肩关节前不稳定的一种有吸引力的手术选择。最初的手术方法包括肩胛下肌腱的垂直切开。或者，肩胛下肌纵向劈开，肌腱附着在小结节上。
假设纵向劈开具有功能优势，与垂直切开相比，可能导致更好的功能结果和更早地恢复体育活动。
这项回顾性队列研究纳入了 32 名患者。在 14 名患者中，肩胛下肌腱被垂直切开（A 组），而在 18 名患者中，肩胛下肌被纵向劈开（B 组）。患者在 Latarjet 手术后 1 年（FU1）和 2 年（FU2）进行评估。随访结果与患者特定数据相关，并与术前状态进行比较。主要结果是基于 Western Ontario Shoulder Instability（WOSI）指数和 Constant 评分（CS）的功能评估以及重返体育活动的评估。记录患者的人口统计学数据、手术持续时间和复发性脱位率作为次要变量。
所有患者开始进行体育活动的平均时间±标准差为 12.41±1.24 周。有趣的是，A 组（平均±标准差为 30.17±10.36 周）从手术到完全恢复体育活动的时间明显长于 B 组（平均±标准差为 20.71±3.67 周）。与 FU1 和 FU2 相比，WOSI 评分从术前水平呈统计学显著下降，表明整个随访期间与不稳定相关的症状减少，但 A 组和 B 组之间无统计学显著差异。CS 显示整个随访期间肩部功能均有增加。最有趣的是，FU1 时 A 组和 B 组之间存在统计学显著差异，表明 B 组在早期随访时间点（FU1）肩部功能明显更好。在较晚的随访时间点（FU2），个体项目之间没有差异。然而，B 组的总 CS 明显更好，表明与 A 组相比，整体功能得到改善。
讨论/结论：与垂直切开相比，肩胛下肌的纵向劈开是一种安全的方法，可导致更快的功能恢复和更早地恢复体育活动，这对于活跃的个体尤其有益。因此，建议将其作为标准手术方法。
III；回顾性队列研究。
