Department of Orthopaedics, Sports Surgery Clinic, Dublin, Ireland.
Department of Orthopaedics, Sports Surgery Clinic, Dublin, Ireland.
J Shoulder Elbow Surg. 2022 Oct;31(10):2169-2175. doi: 10.1016/j.jse.2022.03.008. Epub 2022 Apr 21.
The purpose of this study was to systematically review the literature to ascertain the clinical outcomes of the open Latarjet (OL) procedure using either a subscapularis-split (SS) or subscapularis tenotomy (ST) via a deltopectoral (DP) approach.
Two independent reviewers performed a literature search using the PubMed, Embase, and Scopus databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Only studies reporting on outcomes of the OL procedure via a DP approach comparing both SS and ST were considered for inclusion. Meta-analysis to compare clinical outcomes was performed using RevMan software.
Our search found 5 studies that met our inclusion criteria, including 615 shoulders (80.8% male patients), with an average age of 27.8 ± 12.6 years (range, 15-79 years) and mean follow-up period of 50.1 ± 29.4 months (range, 12-180 months). A total of 410 shoulders and 205 shoulders underwent the OL procedure via a DP approach using the ST technique and the SS technique, respectively, with both techniques resulting in significant increases in the Rowe score postoperatively (P < .0001 for both). Additionally, significantly higher postoperative Constant scores were observed in patients who underwent the OL procedure via an SS technique vs. those in the ST group (91.8 ± 7.2 vs. 79.6 ± 16.1, P < .0001). However, meta-analysis showed nonsignificantly higher postoperative Rowe and American Shoulder and Elbow Surgeons scores in patients who underwent the OL procedure via an SS technique vs. those in the ST group (96.1 ± 2.6 vs. 86.4 ± 7.6 [P = .57] and 91.6 ± 1.3 vs. 80.6 ± 25.5 [P = .47], respectively). Furthermore, meta-analysis showed that significantly more patients in the ST group had positive lift-off test results (10.0%) when compared with the SS group at final follow-up (2.7%, P = .01). However, meta-analysis indicated that the rate of recurrent instability was trending toward significance in favor of the SS group (0% vs. 11.7%, P = .07).
Our systematic review established that in cases of OL procedures being carried out via a DP approach, the SS technique results in significantly better functional outcome measures and significantly lower rates of subscapularis insufficiency when compared with an L-shaped ST technique at medium-term follow-up. Furthermore, there were lower rates of recurrent instability that were trending toward significance in favor of the SS technique.
本研究旨在通过系统回顾文献，确定经三角肌胸大肌间沟（DP）入路行开放式 Latarjet（OL）手术中，采用肩胛下肌劈开（SS）或肩胛下肌切断（ST）技术的临床疗效。
两名独立的审查员根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，使用 PubMed、Embase 和 Scopus 数据库进行文献检索。仅纳入比较 DP 入路 SS 和 ST 两种技术的 OL 手术的研究。使用 RevMan 软件进行比较临床结果的荟萃分析。
我们的搜索共发现 5 项符合纳入标准的研究，共纳入 615 例肩关节（80.8%为男性患者），平均年龄 27.8±12.6 岁（15-79 岁），平均随访时间 50.1±29.4 个月（12-180 个月）。共有 410 例肩关节和 205 例肩关节分别采用 ST 技术和 SS 技术经 DP 入路行 OL 手术，两种技术术后 Rowe 评分均显著增加（均 P<.0001）。此外，采用 SS 技术行 OL 手术的患者术后 Constant 评分明显高于 ST 组（91.8±7.2 vs. 79.6±16.1，P<.0001）。然而，荟萃分析显示，采用 SS 技术行 OL 手术的患者术后 Rowe 和美国肩肘外科协会评分高于 ST 组，但差异无统计学意义（96.1±2.6 vs. 86.4±7.6[P=.57]和 91.6±1.3 vs. 80.6±25.5[P=.47]）。此外，荟萃分析显示，ST 组终末随访时阳性提离试验结果的患者比例明显高于 SS 组（10.0% vs. 2.7%，P=.01）。然而，荟萃分析表明，复发性不稳定的发生率在 SS 组有优势趋势（0% vs. 11.7%，P=.07）。
本系统回顾研究表明，在经 DP 入路行 OL 手术中，与 L 形 ST 技术相比，SS 技术在中期随访时可显著改善功能测量结果，且肩胛下肌功能不全的发生率更低。此外，SS 技术的复发性不稳定发生率较低，且有优势趋势。
