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Clinical and radiographic results in the latarjet procedure
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154
J. Shoulder Elbow Surg. March/April 1996
Abstracts
INTERIuM RESULTS OF THE TREATMENT OF RECURRENT DISLOCATIONS OF THE SHOULDERACCORDING TO LATARJET. A. Maehner, H. Merk, G. Pap, Dep. of Orthopaedic Surgery, Otto-vanGuericke- University Magdeburg, Germany. Materials and methods': Between January 1991 and December 1993 at our department coraeoid transferring operations by LATARIET have been performed in 31 patients with recurrent anterior dislocation of the shoulder. All patients reported on recurrent shoulder dislocations with an average of 9,4 dislocation per patient. At preoperative examination shoulder instabilities were found in 90% of all cases. At our follow up we examined 20 patients with a mean follow - up time of 14.7 months. Results; The clinical outcome was rated both according to the score of ROWE and ZARINS and of CONSTANT and MURLEY. The mean total score by ROWE rose significantly from 26.5 preoperatively to 80.3 at the follow up examination. In 15 patients (75%) the results according to the ROWE -Score could be esttmated as excellent or good. The average score according to CONSTANT lose from 50.3 points preoperatively to 83 points at our follow-up. At our follow up we did not see any kind of shoulder instability and no patient reported on new shoulder dislocations; 3 patients showed serious deficits in their external rotation (table). deficit of external <.30 0 300.60 0 ~60 0
preoperative patients I patients 15 3 2
156
The aim of this retrospective study was to evaluate the incidence and the etiology of glenohumeral arthwsis after Latarjet procedure for recurrent anterior shoulder instability. M a t e r i a l s a n d methods 58 shoulders out of the 95 shoulders operated on between 1969 and 1983 were revised in 1993. The preoperative instability was a recurrent dislocation for 50 shoulders (86 %). The average follow-up was 14,3 years (from 10 to 23 years). No recurrent dislocation occured. Occasional subluxations occured for one shoulder and 6 (10 %) had an apprehension. 51 (88 %) had no more instability. 4 X Rays were done for all the patients (3 antero-posterior and 1 Bernageau's profil views). We used a modified Samilson's classification for glenohumeral arthrosis. Results At follow-up 22 shoulders (38 %) had no sign of arthrosis ; 25 shoulders (43 %) presented a stage 1 arthrosis, 4 (7 %) a stage 2, 3 (5 %) a stage 3 and 4 (7 %) a stage 4 (with a narrowing of the glenohumeral space). 2 non union of the coracoid graft occured. D i s c u s s i o n Shoulders with a stage 1 arthrosis gave the same functional result than with a stage 0. The functional result really decreased in case of stages 3 and mainly 4 arthrosis. Statisticaly the arthrosis changes occured in case of pre-operative rotator cuff tear (the arthrosis was always of stages 3 or 4), in case of pre-operative arthrosis, and when a per or post-operative complication occured. But, a too lateral position of the coracoid block, according to the glenoid rim was also statistically a gleno-humeral arthrosis factor. C o n c l u s i o n The Latarjet procedure, perfectly executed, on a non arthrosis shoulder, with no rotator cuff tear give good functional result without glanohumeral arthrosis after 14,3 years follow-up.
at follow-up 11 3 0
Conclusion: Our results can be estimated as good, although the range of external rotation at time of follow-up is not satisfying. Especially the positive judgement by the patients themselves and the marked improvement in shoulder stability makes this method worth being recommended.
155
CLINICAL AND RADIOGRAPHIC RESULTS IN THE LATARJET PROCEDURE. Bassini F., R'eseazzi R., Murena PF.Dept. o f Orthopaedics, Hospital of San Daniele, ITALY. Aim o f this paper is to evaluate the correlation between clinical and radiographic results in the Latarjet procedure for recurrent anterior dislocation of the shoulder. Material a n d Methods: 27 patients operated from 1986 to 1993 ; 24 male, 3 female; average age 26 years. Radiographic and clinical evaluation with an average follow-up o f 3.7 years. Results: Clinical score: Excellent 13 (48.1%); Good g (29.6%); Fair 4 (14.8%); Poor 2 (7.4%). Patients satisfaction: Very satisfied 18, Satisfied 7, Disatisfied 2. Radiographic results: non union of the transplant 8 (29.6%); short screw (unicortical) 6 (22.2%); transplant subequatoriaiis 27 (100%); transplant corresponding to the glenoid rim 2l (77.8%); transplant too lateral 6 (22.2%); arthritis stage 1 o f Samilson score 8 (29.6%). Clinical results: with a good fusion and with non union of the transplant: Exc. or Good 93.2% vs. 50%, Fair 6.8% Vs. 25%, Poor 0 vs. 25%. Nonunion of the transplant: with unicertieal and bicortieai screw 83.3% vs. 14.3%. Arthritis stage 1: with a too lateral transplant and with a correct longitude position 66% vs. 20%. Exc. or Good results: with arthritis and without arthritis 87.5% vs. 73.7%. Conclusions: 1) Non hnion of the transplant makes the clinical result worse. 2) A screw not engaging the posterior cortex of the scapula increases the percentage of non union o f the transplant. 3) An excessive lateral position o f the transplant seems to lead to arthritis. 4) Arthritis stage 1 o f Samilson score has no influence in the clinical result.
L O N G - T E R M R A D I O L O G I C A L RESULTS OF L A T A R J E T P R O C E D U R E FOR A N T E R I O R I N S T A B I L I T Y OF THE SHOULDER J. ALLAIN, D. GOUTALLIER, Ch. GLORION
157
LONG TERM RADIOGRAPHIC FOLLOW-UP OF THE PUTTI-PLATT. THE INCIDENCE OF GLENOHUMERAL ARTHROSlS. Nicholson,Gregory P.;Gibson, Alois E.; Rapp, George Orthopaedics Indianapolis, Indianapolis, Indiana The purpose of this study is to report a long term radiographic and clinical study of Putti-Platt repairs from a single surgeon, to determine file loss of external rotation (ER) and the incidence of iate glenohumeral artlarosis. METHODS: 35 Putti-Platt repairs (33 patients) were reviewed, with 9 patients lost to follow-up, leaving 26 shoulders (24 patients) to review at minimum of 10 yrs, and avg. 15 yrs (10-22 yrs) post-operatively. There were 18 male and 8 female shoulders (57% dominant). Average age at surgery = 22 yrs (16-36 yrs), and at follow-up - 35 yrs (26-50 yrs). Evaluation was by history, physical exam, and radiographs. All patients, by history, had suffered traumatic anterior dislocations with recurrences. All patients underwent Putti-Platt repair as described by Osmond-Clarke. A sling was used for 3-4 weeks then active motion allowed. RESULTS: Radiographic analysis (Samuelson and Prieto 1983) revealed mild arthrosis in 3 cases (l 1.5%) All patients with arthrosis 0 0 0 % ) had suffered recurrent dislocations after surgery. Posterior subluxation, nor glenoid wear was seen. No cases .had radiographic evidence of moderate or severe arthrosis. The average active range of motion was: forward elevation = 176, ER at side = 68, ER in 90 of abduction = 83, and IR reached T8. The average loss of ER at side = 12 (range 0-45), and 90 abduction = 12 (0-40) for patients with unilateral involvement. cont.
154
J. Shoulder Elbow Surg. March/April 1996
Abstracts
INTERIuM RESULTS OF THE TREATMENT OF RECURRENT DISLOCATIONS OF THE SHOULDERACCORDING TO LATARJET. A. Maehner, H. Merk, G. Pap, Dep. of Orthopaedic Surgery, Otto-vanGuericke- University Magdeburg, Germany. Materials and methods': Between January 1991 and December 1993 at our department coraeoid transferring operations by LATARIET have been performed in 31 patients with recurrent anterior dislocation of the shoulder. All patients reported on recurrent shoulder dislocations with an average of 9,4 dislocation per patient. At preoperative examination shoulder instabilities were found in 90% of all cases. At our follow up we examined 20 patients with a mean follow - up time of 14.7 months. Results; The clinical outcome was rated both according to the score of ROWE and ZARINS and of CONSTANT and MURLEY. The mean total score by ROWE rose significantly from 26.5 preoperatively to 80.3 at the follow up examination. In 15 patients (75%) the results according to the ROWE -Score could be esttmated as excellent or good. The average score according to CONSTANT lose from 50.3 points preoperatively to 83 points at our follow-up. At our follow up we did not see any kind of shoulder instability and no patient reported on new shoulder dislocations; 3 patients showed serious deficits in their external rotation (table). deficit of external <.30 0 300.60 0 ~60 0
preoperative patients I patients 15 3 2
156
The aim of this retrospective study was to evaluate the incidence and the etiology of glenohumeral arthwsis after Latarjet procedure for recurrent anterior shoulder instability. M a t e r i a l s a n d methods 58 shoulders out of the 95 shoulders operated on between 1969 and 1983 were revised in 1993. The preoperative instability was a recurrent dislocation for 50 shoulders (86 %). The average follow-up was 14,3 years (from 10 to 23 years). No recurrent dislocation occured. Occasional subluxations occured for one shoulder and 6 (10 %) had an apprehension. 51 (88 %) had no more instability. 4 X Rays were done for all the patients (3 antero-posterior and 1 Bernageau's profil views). We used a modified Samilson's classification for glenohumeral arthrosis. Results At follow-up 22 shoulders (38 %) had no sign of arthrosis ; 25 shoulders (43 %) presented a stage 1 arthrosis, 4 (7 %) a stage 2, 3 (5 %) a stage 3 and 4 (7 %) a stage 4 (with a narrowing of the glenohumeral space). 2 non union of the coracoid graft occured. D i s c u s s i o n Shoulders with a stage 1 arthrosis gave the same functional result than with a stage 0. The functional result really decreased in case of stages 3 and mainly 4 arthrosis. Statisticaly the arthrosis changes occured in case of pre-operative rotator cuff tear (the arthrosis was always of stages 3 or 4), in case of pre-operative arthrosis, and when a per or post-operative complication occured. But, a too lateral position of the coracoid block, according to the glenoid rim was also statistically a gleno-humeral arthrosis factor. C o n c l u s i o n The Latarjet procedure, perfectly executed, on a non arthrosis shoulder, with no rotator cuff tear give good functional result without glanohumeral arthrosis after 14,3 years follow-up.
at follow-up 11 3 0
Conclusion: Our results can be estimated as good, although the range of external rotation at time of follow-up is not satisfying. Especially the positive judgement by the patients themselves and the marked improvement in shoulder stability makes this method worth being recommended.
155
CLINICAL AND RADIOGRAPHIC RESULTS IN THE LATARJET PROCEDURE. Bassini F., R'eseazzi R., Murena PF.Dept. o f Orthopaedics, Hospital of San Daniele, ITALY. Aim o f this paper is to evaluate the correlation between clinical and radiographic results in the Latarjet procedure for recurrent anterior dislocation of the shoulder. Material a n d Methods: 27 patients operated from 1986 to 1993 ; 24 male, 3 female; average age 26 years. Radiographic and clinical evaluation with an average follow-up o f 3.7 years. Results: Clinical score: Excellent 13 (48.1%); Good g (29.6%); Fair 4 (14.8%); Poor 2 (7.4%). Patients satisfaction: Very satisfied 18, Satisfied 7, Disatisfied 2. Radiographic results: non union of the transplant 8 (29.6%); short screw (unicortical) 6 (22.2%); transplant subequatoriaiis 27 (100%); transplant corresponding to the glenoid rim 2l (77.8%); transplant too lateral 6 (22.2%); arthritis stage 1 o f Samilson score 8 (29.6%). Clinical results: with a good fusion and with non union of the transplant: Exc. or Good 93.2% vs. 50%, Fair 6.8% Vs. 25%, Poor 0 vs. 25%. Nonunion of the transplant: with unicertieal and bicortieai screw 83.3% vs. 14.3%. Arthritis stage 1: with a too lateral transplant and with a correct longitude position 66% vs. 20%. Exc. or Good results: with arthritis and without arthritis 87.5% vs. 73.7%. Conclusions: 1) Non hnion of the transplant makes the clinical result worse. 2) A screw not engaging the posterior cortex of the scapula increases the percentage of non union o f the transplant. 3) An excessive lateral position o f the transplant seems to lead to arthritis. 4) Arthritis stage 1 o f Samilson score has no influence in the clinical result.
L O N G - T E R M R A D I O L O G I C A L RESULTS OF L A T A R J E T P R O C E D U R E FOR A N T E R I O R I N S T A B I L I T Y OF THE SHOULDER J. ALLAIN, D. GOUTALLIER, Ch. GLORION
157
LONG TERM RADIOGRAPHIC FOLLOW-UP OF THE PUTTI-PLATT. THE INCIDENCE OF GLENOHUMERAL ARTHROSlS. Nicholson,Gregory P.;Gibson, Alois E.; Rapp, George Orthopaedics Indianapolis, Indianapolis, Indiana The purpose of this study is to report a long term radiographic and clinical study of Putti-Platt repairs from a single surgeon, to determine file loss of external rotation (ER) and the incidence of iate glenohumeral artlarosis. METHODS: 35 Putti-Platt repairs (33 patients) were reviewed, with 9 patients lost to follow-up, leaving 26 shoulders (24 patients) to review at minimum of 10 yrs, and avg. 15 yrs (10-22 yrs) post-operatively. There were 18 male and 8 female shoulders (57% dominant). Average age at surgery = 22 yrs (16-36 yrs), and at follow-up - 35 yrs (26-50 yrs). Evaluation was by history, physical exam, and radiographs. All patients, by history, had suffered traumatic anterior dislocations with recurrences. All patients underwent Putti-Platt repair as described by Osmond-Clarke. A sling was used for 3-4 weeks then active motion allowed. RESULTS: Radiographic analysis (Samuelson and Prieto 1983) revealed mild arthrosis in 3 cases (l 1.5%) All patients with arthrosis 0 0 0 % ) had suffered recurrent dislocations after surgery. Posterior subluxation, nor glenoid wear was seen. No cases .had radiographic evidence of moderate or severe arthrosis. The average active range of motion was: forward elevation = 176, ER at side = 68, ER in 90 of abduction = 83, and IR reached T8. The average loss of ER at side = 12 (range 0-45), and 90 abduction = 12 (0-40) for patients with unilateral involvement. cont.