Faculty of Medicine, Menoufia University, Al-Menoufia Governorate, Egypt.
J Shoulder Elbow Surg. 2023 Sep;32(9):1838-1849. doi: 10.1016/j.jse.2023.01.043. Epub 2023 Mar 11.
Intra-articular soft arthroscopic Latarjet technique (in-SALT) involves augmentation of arthroscopic Bankart repair (ABR) with soft tissue tenodesis of long head of biceps to upper subscapularis. This study was conducted to investigate superiority of outcomes of in-SALT-augmented ABR over those of concurrent ABR and anterosuperior labral repair (ASL-R) in management of type V superior labrum anterior-posterior (SLAP) lesion.
This prospective cohort study (conducted between January 2015 and January 2022) included 53 patients with arthroscopic diagnosis of type V SLAP lesion. Patients were allocated into 2 consecutive groups: group A of 19 patients managed with concurrent ABR/ASL-R and group B of 34 patients managed with in-SALT-augmented ABR. Outcome measurements included 2-year postoperative pain, range of motion, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Rowe instability scores. Failure was defined as frank/subtle postoperative recurrence of glenohumeral instability or objective diagnosis of Popeye deformity.
The statistically matched studied groups showed significant postoperative improvement in outcome measurements. However, group B demonstrated significantly better 3-month postoperative visual analog scale score (3.6 vs. 2.6, P = .006) and 24-month postoperative external rotation at 0° abduction (44° vs. 50°, P = .020) and ASES (84 vs. 92, P < .001) and Rowe (83 vs. 88, P = .032) scores. Rate of postoperative recurrence of glenohumeral instability was relatively lower in group B (10.5% vs. 2.9%, P = .290). No Popeye deformity was reported.
For management of type V SLAP lesion, in-SALT-augmented ABR yielded a relatively lower rate of postoperative recurrence of glenohumeral instability and significantly better functional outcomes compared with concurrent ABR/ASL-R. However, currently reported favorable outcomes of in-SALT should be validated via further biomechanical and clinical studies.
关节内软式关节镜下 Latarjet 技术（in-SALT）涉及在关节镜下 Bankart 修复术（ABR）中增加肱二头肌长头的软组织腱固定术，以增强上肩胛下肌。本研究旨在探讨关节镜下软式 Latarjet 技术增强的 ABR 治疗 V 型肩盂上唇前后向损伤（SLAP）的效果优于同期 ABR 和前上盂唇修复术（ASL-R）。
本前瞻性队列研究（2015 年 1 月至 2022 年 1 月进行）纳入了 53 例关节镜诊断为 V 型 SLAP 病变的患者。患者分为两组：A 组 19 例患者接受同期 ABR/ASL-R 治疗，B 组 34 例患者接受关节镜下软式 Latarjet 技术增强的 ABR 治疗。术后 2 年评估疼痛、活动范围和美国肩肘外科医师协会（ASES）和 Rowe 肩关节评分。失败定义为明确/隐匿性肩峰下关节不稳复发或 Popeye 畸形的客观诊断。
经统计学匹配的两组患者在术后结局测量方面均有显著改善。然而，B 组患者术后 3 个月视觉模拟评分（3.6 分比 2.6 分，P=0.006）、术后 24 个月外展 0°时外旋角度（44°比 50°，P=0.020）和 ASES（84 分比 92 分，P<0.001）和 Rowe（83 分比 88 分，P=0.032）评分明显更好。B 组患者肩峰下关节不稳定复发率相对较低（10.5%比 2.9%，P=0.290）。未报告 Popeye 畸形。
对于 V 型 SLAP 病变的治疗，关节镜下软式 Latarjet 技术增强的 ABR 与同期 ABR/ASL-R 相比，术后肩峰下关节不稳定复发率较低，功能结局明显更好。然而，目前报道的关节镜下软式 Latarjet 技术的良好效果尚需进一步的生物力学和临床研究来验证。
