Sahu Dipit
Sir H.N. Reliance Foundation Hospital, Mumbai, India; Jupiter Hospital Thane, Maharashtra, India; Dr R.N. Cooper Hospital & HBT Medical College, Juhu, Mumbai, India; Mumbai Shoulder institute, Mumbai, India.
J Shoulder Elbow Surg. 2022 May;31(5):948-956. doi: 10.1016/j.jse.2021.10.030. Epub 2021 Nov 19.
Patte et al noted that the Latarjet procedure works by the triple blocking effect of (1) the conjoint tendon sling effect, (2) the bone block effect, and (3) the capsular repair. However, no clinical study has specifically investigated the role of capsular repair in the Latarjet procedure.
The primary aim was to compare (1) the external rotation range of motion (ROM) achieved after the Latarjet procedure with and without the capsule to coracoacromial (CA-CAL) repair. The secondary aims were to compare the functional outcomes, forward elevation ROM, and internal rotation ROM after the Latarjet procedure with and without the CA-CAL repair.
A prospective cohort of 30 patients who underwent the Latarjet-Walch procedure with a CA-CAL repair between October 2018 and February 2020 was compared with the preceding group of 31 patients who underwent the Latarjet-Walch procedure without any capsular repair between October 2016 and September 2018, at a minimum of 1-year of follow-up.
External rotation with the elbow abducted at 90° (ER2) deficit (compared to the normal opposite side) was significantly larger after the CA-CAL repair augmentation of the Latarjet procedure (mean difference = 6°, P = .03) than that after no repair. External rotation with the elbow adducted (ER1) deficit after the CA-CAL repair augmentation was not significantly different from that after no repair. ER2 deficit of more than 15° (minimum clinically important difference) was observed in 11 patients (38%) in the CA-CAL repair group and 3 patients (10%, P = .015) in the no repair group. Walch-Duplay score, Rowe score, and Subjective Shoulder Value were not significantly different between the CA-CAL repair group and the no repair group. Covariates of hand dominance, overhead sports, and glenoid defect size did not significantly affect the ER2 deficit and ER1 deficit outcomes.
This study disproved the long-held belief that capsular repair is an essential step of the Latarjet-Walch procedure. Capsular repair to the coracoacromial ligament in the Latarjet procedure leads to a clinically insignificant restriction of external rotation (with the arm abducted), no restriction of external rotation (with the arm adducted), but functional outcomes similar to those after Latarjet without a capsular repair in a nonoverhead athlete.
帕特等人指出，拉塔热手术通过以下三重阻断效应起作用：（1）联合肌腱吊带效应，（2）骨块效应，以及（3）关节囊修复。然而，尚无临床研究专门调查关节囊修复在拉塔热手术中的作用。
主要目的是比较（1）拉塔热手术在进行和不进行关节囊至喙肩韧带（CA-CAL）修复后所达到的外旋活动范围（ROM）。次要目的是比较拉塔热手术在进行和不进行CA-CAL修复后的功能结果、前屈ROM和内旋ROM。
将2018年10月至2020年2月期间接受拉塔热-瓦尔什手术并进行CA-CAL修复的30例患者的前瞻性队列，与2016年10月至2018年9月期间接受拉塔热-瓦尔什手术且未进行任何关节囊修复的前一组31例患者进行比较，随访时间至少为1年。
拉塔热手术在进行CA-CAL修复增强后，与正常对侧相比，在肘部外展90°时的外旋（ER2）缺损显著大于未进行修复的情况（平均差异=6°，P=0.03）。在进行CA-CAL修复增强后，肘部内收时的外旋（ER1）缺损与未进行修复的情况无显著差异。在CA-CAL修复组中，11例患者（38%）观察到ER2缺损超过15°（最小临床重要差异），在未修复组中有3例患者（10%，P=0.015）。CA-CAL修复组和未修复组之间的瓦尔什-迪普莱评分、罗威评分和主观肩关节评分无显著差异。手的优势侧、过头运动和关节盂缺损大小等协变量对ER2缺损和ER1缺损结果无显著影响。
本研究反驳了长期以来认为关节囊修复是拉塔热-瓦尔什手术必不可少步骤的观点。在拉塔热手术中对喙肩韧带进行关节囊修复会导致外旋（手臂外展时）出现临床上无显著意义的受限，外旋（手臂内收时）不受限，但对于非过头运动的运动员，其功能结果与未进行关节囊修复的拉塔热手术后相似。
