Jegatheesan Vinosh, Patel Dhruv, Lu Victor, Domos Peter
University College London Medical School, London, United Kingdom.
School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.
J Shoulder Elbow Surg. 2023 Dec;32(12):2599-2612. doi: 10.1016/j.jse.2023.07.002. Epub 2023 Aug 2.
Latarjet has become an increasingly popular treatment option for recurrent anterior shoulder instability. With the reported complication rates for primary Latarjet surgery, there are concerns about the complications of Latarjet as a revision surgery. It remains unclear if poor results after previous surgical management can be improved with revision Latarjet as well as with primary Latarjet. The aim of this systematic review and meta-analysis is to compare the outcomes of primary Latarjet and revision Latarjet for the treatment of anterior shoulder instability.
A systematic search was performed on 3 databases for studies that compared primary Latarjet with revision Latarjet used after failed arthroscopic stabilization or failed free bone block procedures. From the included studies, demographic data, clinical outcome scores, range of motion measurements, and postoperative complications were obtained.
A total of 11 studies were included for data analysis. Compared with the primary Latarjet cohort, revision Latarjet cohorts had a higher infection rate (1.2% vs. 2.6%; RR 0.46, P = .039). The primary Latarjet group showed a greater rate of return to sport (89.7% vs. 80.5%; RR 1.12, P = .41) and less subjective feeling of instability (12.6% vs. 20.9%; RR 0.60, P = .085) compared with the revision Latarjet group; however, this was not statistically significant. There were no significant differences in complication rates, reoperation, recurrence, and range of motion between primary Latarjet and revision Latarjet groups. Clinical outcome scores such as visual analog scale and Rowe scores were not significantly different between the cohorts.
Based on the current evidence, primary Latarjet presents reduced infection rates but similar clinical outcome measures, overall complication, and range of motion measurements than revision Latarjet performed after failed prior operative treatment.
拉塔热手术已成为复发性前肩不稳越来越常用的治疗选择。鉴于初次拉塔热手术报告的并发症发生率，人们对拉塔热作为翻修手术的并发症存在担忧。目前尚不清楚，与初次拉塔热手术一样，翻修拉塔热手术能否改善先前手术治疗效果不佳的情况。本系统评价和荟萃分析的目的是比较初次拉塔热手术和翻修拉塔热手术治疗前肩不稳的疗效。
对3个数据库进行系统检索，查找比较初次拉塔热手术与关节镜稳定手术失败或游离骨块手术失败后使用的翻修拉塔热手术的研究。从纳入的研究中获取人口统计学数据、临床结局评分、活动范围测量值和术后并发症。
共纳入11项研究进行数据分析。与初次拉塔热手术队列相比，翻修拉塔热手术队列的感染率更高（1.2%对2.6%；相对危险度0.46，P = 0.039）。与翻修拉塔热手术组相比，初次拉塔热手术组的运动恢复率更高（89.7%对80.5%；相对危险度1.12，P = 0.41），主观不稳定感更低（12.6%对20.9%；相对危险度0.60，P = 0.085）；然而，这在统计学上并不显著。初次拉塔热手术组和翻修拉塔热手术组在并发症发生率、再次手术、复发率和活动范围方面无显著差异。队列之间的视觉模拟量表和罗伊评分等临床结局评分无显著差异。
基于目前的证据，与先前手术治疗失败后进行的翻修拉塔热手术相比，初次拉塔热手术的感染率较低，但临床结局指标、总体并发症和活动范围测量值相似。
