Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, 20 Ilsan-Ro, Wonju, 26426, Republic of Korea.
Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Korea.
Knee Surg Sports Traumatol Arthrosc. 2023 Jul;31(7):2662-2669. doi: 10.1007/s00167-023-07393-0. Epub 2023 Mar 23.
This study aimed at analyzing the range of motion (ROM) and other clinical outcomes in patients with > 20% glenoid bone loss who underwent the Latarjet procedure with or without anterior capsule repair.
This retrospective study included 47 patients with > 20% glenoid bone loss who underwent the classic Latarjet procedure from 2016 to 2021. Of these, 25 did not undergo capsular repair (no-capsular-repair group; group I) whereas 22 patients did (capsular-repair group; group II). The Rowe score, American Shoulder and Elbow Surgeons score, Visual Analogue Scale, ROM, recurrence, and complications were evaluated before and 3, 6, and 12 months after the surgery. A goniometer was used to measure the forward flexion and external rotation (arm adducted, 90° abducted) of both shoulders. The ROM deficit was measured as the difference from the contralateral healthy shoulder.
The external rotation in arm adduction at 3 and 6 months after surgery showed significantly better results in group I than group II(p = 0.002 at 3 months; p = 0.005 at 6 months). The deficit in external rotation with arm adduction was also significantly lower in group I at 3 months (p = 0.001) and 6 months (p = 0.001) after surgery. However, external rotation with arm adduction at 12 months after surgery did not significantly differ between the groups. Moreover, the ROM in external rotation with 90° arm abduction was significantly better in group I than that in group II at 3, 6, and 12 months postoperatively (p = 0.002, p = 0.001, and p = 0.005, respectively). The deficit in external rotation with 90° arm abduction gradually decreased with time after surgery and differed significantly between the groups. However, the difference in deficit between the two groups at 12 months after surgery did not exceed the measurement error. All clinical scores significantly improved after surgery compared to before surgery; however, the improvement did not significantly differ between the two groups.
The Latarjet procedure without capsular repair showed good laxity restoration and clinical results with less early postoperative external rotation limitation than that achieved by the same procedure with capsular repair. However, external rotation deficit at 1 year after surgery did not show a clinically relevant difference difference between the two groups.
Level III.
本研究旨在分析盂肱骨缺损>20%的患者行 Latarjet 手术时，是否联合前关节囊修复对关节活动度（ROM）和其他临床结果的影响。
本回顾性研究纳入了 2016 年至 2021 年间盂肱骨缺损>20%的 47 例行经典 Latarjet 手术的患者。其中 25 例未行关节囊修复（无关节囊修复组；I 组），22 例行关节囊修复（关节囊修复组；II 组）。术前、术后 3、6、12 个月采用 Rowe 评分、美国肩肘外科评分、视觉模拟评分、ROM、复发和并发症进行评估。使用量角器测量双侧肩关节的前屈和外展（手臂内收，外展 90°）。将患侧与健侧的 ROM 差值定义为 ROM 缺失。
术后 3 个月和 6 个月时，I 组患者的手臂内收时外旋角度明显优于 II 组（3 个月时 p=0.002；6 个月时 p=0.005）。术后 3 个月（p=0.001）和 6 个月（p=0.001）时，I 组患者的手臂内收时外旋角度缺失也明显更低。然而，术后 12 个月时两组间手臂内收时外旋角度无显著差异。此外，术后 3、6、12 个月时，I 组患者的外展 90°时外旋角度明显优于 II 组（p=0.002、p=0.001、p=0.005）。外展 90°时外旋角度缺失逐渐减少，术后两组间差异具有统计学意义。然而，术后 12 个月时两组间的缺失差异未超过测量误差。与术前相比，所有临床评分在术后均显著改善，但两组间的改善无显著差异。
与行关节囊修复的 Latarjet 手术相比，不联合关节囊修复的 Latarjet 手术可更好地恢复肩关节松弛度，且术后早期外旋活动度受限程度较轻。然而，术后 1 年时两组间的外旋角度缺失差异无临床意义。
III 级。
