NYU Langone Health, New York, New York, USA; Sports Surgery Clinic, Dublin, Ireland.
Laval University, Quebec City, Quebec, Canada.
Arthroscopy. 2022 Feb;38(2):224-233.e6. doi: 10.1016/j.arthro.2021.07.023. Epub 2021 Jul 29.
The purpose of this study was to establish consensus statements via a modified Delphi process on the Latarjet procedure, remplissage, and glenoid-bone grafting for anterior shoulder instability.
A consensus process on the treatment utilizing a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability.
The technical approaches identified in the statements on the Latarjet procedure and glenoid bone-graft were that a subscapularis split approach should be utilized, and that it is unclear whether a capsular repair is routinely required. Furthermore, despite similar indications, glenoid bone-grafting may be preferred over the Latarjet in patients with bone-loss greater than can be treated with a coracoid graft, and in cases of surgeon preference, failed prior Latarjet or glenoid bone-grafting procedure, and epilepsy. In contrast, the primary indications for a remplissage procedure was either an off-track or engaging Hill-Sachs lesion without severe glenoid bone loss. Additionally, in contrast to the bone-block procedure, complications following remplissage are rare, and loss of shoulder external rotation can be minimized by performing the tenodesis via the safe-zone and not over medializing the fixation.
Overall, 89% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were the prognostic factors that are important to consider in those undergoing a glenoid bone-grafting procedure including age, activity level, Hill-Sachs Lesion, extent of glenoid bone-loss, hyperlaxity, prior surgeries, and arthritic changes. Furthermore, there was unanimous agreement that it is unclear whether a capsular repair is routinely required with a glenoid bone graft, but it may be beneficial in some cases. There was no unanimous agreement on any aspect related to the Latarjet procedure or Remplissage.
Level V, expert opinion.
本研究旨在通过改良 Delphi 法就前肩不稳定的 Latarjet 手术、填充和肩胛盂骨移植术达成共识声明。
采用改良 Delphi 技术对治疗方法进行了共识过程，来自 5 大洲 14 个国家的 65 名肩外科医生参与了该过程。专家被分配到 9 个工作组之一，这些工作组由前肩不稳定的特定子主题感兴趣的具体亚组定义。
在 Latarjet 手术和肩胛盂骨移植术的声明中确定的技术方法是，应采用肩胛下肌劈开入路，并且不清楚是否常规需要进行囊修复。此外，尽管适应症相似，但对于骨量丢失大于喙突移植术可治疗的患者，以及对于术者偏好、先前的 Latarjet 或肩胛盂骨移植术失败、以及癫痫患者，可能更倾向于进行肩胛盂骨移植术而非 Latarjet 手术。相比之下，填充术的主要适应症是轨道偏离或撞击的 Hill-Sachs 病变，且肩胛盂骨丢失不严重。此外，与骨块手术相比，填充术的并发症罕见，并且通过在安全区内进行肌腱固定术而不是使固定物向内侧化，可以最小化肩外旋丧失。
总体而言，89%的声明达成了一致或强烈共识。达成一致共识的声明是在进行肩胛盂骨移植术时需要考虑的重要预后因素，包括年龄、活动水平、Hill-Sachs 病变、肩胛盂骨丢失程度、过度松弛、先前的手术和关节炎改变。此外，一致认为不清楚肩胛盂骨移植术是否常规需要进行囊修复，但在某些情况下可能有益。对于 Latarjet 手术或 Remplissage 术的任何方面都没有达成一致意见。
五级，专家意见。
