ICR-Institute for Sports and Reconstructive Bone & Joint Surgery, Clinique Kantys Centre, Groupe Kantys, Nice, France.
ICR-Institute for Sports and Reconstructive Bone & Joint Surgery, Clinique Kantys Centre, Groupe Kantys, Nice, France.
J Shoulder Elbow Surg. 2024 Dec;33(12):2819-2825. doi: 10.1016/j.jse.2024.07.030. Epub 2024 Sep 6.
Arthroscopic Latarjet using suture-button fixation has shown good clinical results and low recurrent instability in patients with significant glenoid bone loss. However, the presence of an associated Hill-Sachs lesion (HSL) is a risk factor for recurrent instability after isolated Latarjet. The aim of the study was to report clinical and radiologic results following all-arthroscopic Latarjet combined with Hill-Sachs remplissage (HSR).
Monocentric prospective study including 41 patients (mean age 28 ± 7 years) who underwent the combined procedure between 2014 and 2019 with minimum 2 years' follow-up (mean 40 ± 13 months). Indications were glenoid bone loss >10% (mean 23.9% ± 7.5%) and large, deep HSL (Calandra 3). Five (13%) patients had signs of osteoarthrosis stage I preoperatively, 4 (10%) had previous stabilization surgery (3 cases isolated Bankart and 1 case Bankart combined with HSR), and 4 (13%) were epileptic. The HSR was performed first followed by guided Latarjet procedure. Primary outcome measures included shoulder stability and function represented by Walch-Duplay and Rowe scores, and Subjective Shoulder Value (SSV) for daily life/sports. Secondary outcome measures included coracoid graft position and union, and glenohumeral osteoarthritis using radiographs and computed tomography.
Three patients (7%) had recurrent instability: 1 due to seizure, 1 following fall, and 1 related to graft osteolysis. Two patients were revised because of recurrence with arthroscopic distal clavicle autograft. There were no infections, neurologic complications, or hardware failures. The Walch-Duplay score was 90 (95% CI 76.8-93.2), and the Rowe score 95 (95% CI 77.2-92.2). The median SSV averaged 96% (95% CI 87.5-97.0) for daily life and 90% (95% CI 75.7-90.2) for sports. Mean external rotation with the arm at the side was 60° (95% CI 59°-70°) with a median loss 10° (95% CI 3°-17°) compared to the contralateral side. Among patients playing sport preoperatively, 36 (95%) were able to return to sport: 25 (67%) at the same level and 7 (18%) at a lower level, whereas 4 had to change sport. The coracoid graft was flush with the glenoid surface in 96% of cases and subequatorial in 89%. The graft developed nonunion in 11% and fractured in 5%. Seven patients (18%) had radiographic signs of grade I osteoarthritis.
Combined arthroscopic Latarjet and HSR is an efficient solution for dealing with significant bipolar glenohumeral bone loss. The combined procedure deserves consideration in high-risk patients including combined bone loss, recurrent anterior instability after failed stabilization procedures and/or seizure.
关节镜下 Latarjet 术采用缝线纽扣固定，在有明显肩盂骨缺损的患者中显示出良好的临床效果和低复发不稳定性。然而，存在相关的 Hill-Sachs 病变（HSL）是单纯 Latarjet 术后复发不稳定的危险因素。本研究的目的是报告联合关节镜下 Latarjet 和 Hill-Sachs 填充（HSR）治疗后的临床和影像学结果。
这是一项单中心前瞻性研究，纳入了 2014 年至 2019 年期间接受联合手术的 41 例患者（平均年龄 28 ± 7 岁），随访时间至少 2 年（平均 40 ± 13 个月）。适应证为肩盂骨缺损>10%（平均 23.9% ± 7.5%）和大而深的 HSL（Calandra 3 型）。5 例（13%）患者术前存在 I 期骨关节炎表现，4 例（10%）有既往稳定手术史（3 例单纯 Bankart 术，1 例 Bankart 联合 HSR），4 例（13%）为癫痫患者。首先进行 HSR，然后进行引导下的 Latarjet 手术。主要结局指标包括采用 Walch-Duplay 和 Rowe 评分评估的肩部稳定性和功能，以及日常活动/运动的主观肩部值（SSV）。次要结局指标包括喙突移植物的位置和愈合情况，以及 X 线和 CT 评估的肩肱关节炎。
3 例患者（7%）出现复发性不稳定：1 例与癫痫有关，1 例与跌倒有关，1 例与移植物骨溶解有关。2 例患者因复发而行关节镜下远端锁骨自体移植术。无感染、神经并发症或内固定失败。Walch-Duplay 评分 90 分（95%可信区间 76.8-93.2），Rowe 评分 95 分（95%可信区间 77.2-92.2）。日常活动的平均 SSV 为 96%（95%可信区间 87.5-97.0），运动的平均 SSV 为 90%（95%可信区间 75.7-90.2）。手臂在体侧时的平均外旋为 60°（95%可信区间 59°-70°），与对侧相比，中位数外旋丢失 10°（95%可信区间 3°-17°）。术前进行运动的患者中，36 例（95%）能够恢复运动：25 例（67%）回到原运动水平，7 例（18%）降低运动水平，4 例改变了运动项目。96%的病例喙突移植物与肩盂表面平齐，89%的病例位于肩胛下。移植物出现非愈合 11%，骨折 5%。7 例（18%）有 I 级骨关节炎的放射学表现。
关节镜下 Latarjet 和 HSR 联合治疗是处理严重双极肩盂骨缺损的有效方法。对于存在联合骨缺损、初次稳定手术后复发不稳定和/或癫痫的高危患者，应考虑采用联合治疗。
