- Email: [email protected]
Clinical Outcomes after Coracoid Transfer Surgery for Anterior Shoulder Instability: Modified Bristow vs. Latarjet
e28
ASES Abstracts
fracture on the screened and treated populations versus controls.
8 CLINICAL OUTCOMES AFTER CORACOID TRANSFER SURGERY FOR ANTERIOR SHOULDER INSTABILITY: MODIFIED BRISTOW VS. LATARJET Michael B. Banffy, MD, Stephen T. Gardner, MD, Diego C. Villacis, MD, Laurence D. Higgins, MD, George F. Hatch, MD, Neal S. ElAttrache, MD, Kerlan Jobe Orthopaedic Clinic and the Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA; Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA Background: Coracoid transfer procedures are effective for restoring stability to shoulders with significant glenoid bone loss. Both the modified Bristow and Latarjet have been described coracoid transfer procedures, however they differ in their difficulty and invasiveness. To date, no study has shown that the Latarjet and modified Bristow procedures differ in terms of clinical outcome. Methods: Utilizing a retrospective comparative study design, patients from three institutions having a coracoid transfer procedure performed during the years 2003 to 2010 were identified. Patients completed post-operative ROWE scores and postoperative WOSI indices. ROWE and WOSI scores were compared between the two groups utilizing a student’s t-test with significance set at p<0.05. Results: WOSI and ROWE data were received for 26 modified Bristow patients and 24 Latarjet patients. Of the 26 modified Bristow patients, 13 (50%) patients had glenoid bone loss >20%. Twenty-one (87.5%) of the Latarjet patients had glenoid bone loss >20%. Comparing Latarjet patients to modified Bristow patients with >20% glenoid bone loss, average WOSI scores were 72.84 vs. 77.53 (p¼0.56) and average ROWE scores were 81.95 vs. 83.08 (p¼0.87) respectively. Complication rate in the Latarjet group was 20.8% and in the modified Bristow group 15.4%. Conclusion: There was no difference in clinical outcome based on WOSI and ROWE scoring between the Latarjet and modified Bristow procedures for recurrent anterior instability in our study populations. Level of Evidence: Level III Keywords: Coracoid transfer, Bristow, Latarjet, glenoid, shoulder instability.
9 ARTHROSCOPIC RECONSTRUCTION IN PATIENTS WITH SHOULDER INSTABILITY AND MODERATE BONE LOSS Michael P. McCabe, MD, Felix H. Savoie III, MD, Larry D. Field, MD, E. Rhett Hobgood, MD, Doug Weinberg, David G. Brown, MD, Tulane University, New Orleans, Louisiana, USA; Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, USA Background: Reconstruction in patients with instability with moderate bone loss has been shown to have a much higher failure rate than standard Bankart repair. It has been postulated that the addition of an arthroscopic infraspinatus tenodesis with posterior capsulodesis (‘‘remplissage’’) may improve the success rate of arthroscopic reconstruction in these higher risk patients. We report our results with this technique in this patient population. Methods: A retrospective review was performed to identify patients who underwent arthroscopic remplissage in conjunction with anterior capsulolabral reconstruction for anterior glenohumeral instability with moderate glenoid bone loss (greater than 10% but less than
J Shoulder Elbow Surg October 2013
30%) at our institution. Thirty-six shoulders in 35 patients with minimum 2 years follow-up were identified. The following data was reviewed: American Shoulder and Elbow Surgeons (ASES) score, incidence of recurrent instability, and post-operative Rowe instability score. Follow up was available for 29 patients (30 shoulders). Mean age at the time of surgery was 24.6 years (range 15-44), with a mean follow-up of 39 months (range 24-60). Eleven patients had failed prior instability surgery and underwent capsulolabral reconstruction and remplissage in the context of revision surgery. Results: The mean ASES score improved from 50.7 preoperatively to 90.7 post-operatively (p < 0.001). The mean post-operative Rowe score was 84.6. Four failures (13%) occurred (1 dislocation, 3 patients with subluxation events); all were traumatic in nature. No patients have undergone further surgery. All failures occurred in patients who had prior instability surgery, yielding a 36% failure rate in revision cases. There were no failures in the 19 primary instability patients (p ¼ 0.02). Conclusions: Aggressive capsulolabral reconstruction with posterior infraspinatus tenodesis in traumatic instability patients with moderate grade bone loss and a humeral Hill-Sachs lesion yields acceptable outcomes in primary instability surgery. However, it does not appear to provide a reliable solution to this complicated problem in the revision setting.
10 RECURRENCE OF ANTERIOR SHOULDER INSTABILITY IS HIGHER AFTER ARTHROSCOPIC BANKART THAN AFTER OPEN LATARJET PROCEDURE: A CASE-CONTROL STUDY Charles Bessi ere, MD, Christophe Trojani, MD, PhD, Michel Carles, MD, Pascal Boileau, MD, Department of Orthopaedic Surgery & Sports Traumatology, L’Archet 2 Hospital, Medical University of Nice-Sophia-Antipolis, Nice, France Hypothesis: The rate of recurrence of anterior shoulder instability after arthroscopic Bankart repair is higher than the one following open Latarjet coracoid bone-block procedure. Patients and Methods: Retrospective monocentric comparative paired study: patients with recurrent traumatic anterior instability operated between 2002-2006 were included. 93 patients operated by open Latarjet (OL) were matched by age at time of surgery with 93 patients who underwent arthroscopic Bankart (AB). All patients completed an original subjective questionnaire. Recurrence of instability was defined by at least one episode of anterior subluxation or dislocation. Results: Both groups were statistically comparable for age at surgery, gender, number of preoperative episodes of instability, hyperlaxity, sport (contact/armed-countered), level of sport practice (competition/leisure), and type of soft tissue or bony lesions. At a mean follow-up of five years, the recurrence rate of anterior instability was 22% (20/93) in the AB group and 10% (9/93) in the OL group; this difference was statistically significant (p ¼ 0.026). All the Latarjet failures occured in the first year after surgery, while half ot the Bankart failures occured after two years (p<0.001). There was no difference in the subjective result between the two groups. Conclusion: Our hypothesis is confirmed: at an over 5 years follow-up, the rate of recurrent instability after arthroscopic Bankart is significantly higher than the one observed after Latarjet coracoid bone block. This series also confirms that results after arthroscopic Bankart deteriorate lately and that a minimum two year follow-up is needed to evaluate the results of any stabilization procedure of the shoulder.
ASES Abstracts
fracture on the screened and treated populations versus controls.
8 CLINICAL OUTCOMES AFTER CORACOID TRANSFER SURGERY FOR ANTERIOR SHOULDER INSTABILITY: MODIFIED BRISTOW VS. LATARJET Michael B. Banffy, MD, Stephen T. Gardner, MD, Diego C. Villacis, MD, Laurence D. Higgins, MD, George F. Hatch, MD, Neal S. ElAttrache, MD, Kerlan Jobe Orthopaedic Clinic and the Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA; Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA Background: Coracoid transfer procedures are effective for restoring stability to shoulders with significant glenoid bone loss. Both the modified Bristow and Latarjet have been described coracoid transfer procedures, however they differ in their difficulty and invasiveness. To date, no study has shown that the Latarjet and modified Bristow procedures differ in terms of clinical outcome. Methods: Utilizing a retrospective comparative study design, patients from three institutions having a coracoid transfer procedure performed during the years 2003 to 2010 were identified. Patients completed post-operative ROWE scores and postoperative WOSI indices. ROWE and WOSI scores were compared between the two groups utilizing a student’s t-test with significance set at p<0.05. Results: WOSI and ROWE data were received for 26 modified Bristow patients and 24 Latarjet patients. Of the 26 modified Bristow patients, 13 (50%) patients had glenoid bone loss >20%. Twenty-one (87.5%) of the Latarjet patients had glenoid bone loss >20%. Comparing Latarjet patients to modified Bristow patients with >20% glenoid bone loss, average WOSI scores were 72.84 vs. 77.53 (p¼0.56) and average ROWE scores were 81.95 vs. 83.08 (p¼0.87) respectively. Complication rate in the Latarjet group was 20.8% and in the modified Bristow group 15.4%. Conclusion: There was no difference in clinical outcome based on WOSI and ROWE scoring between the Latarjet and modified Bristow procedures for recurrent anterior instability in our study populations. Level of Evidence: Level III Keywords: Coracoid transfer, Bristow, Latarjet, glenoid, shoulder instability.
9 ARTHROSCOPIC RECONSTRUCTION IN PATIENTS WITH SHOULDER INSTABILITY AND MODERATE BONE LOSS Michael P. McCabe, MD, Felix H. Savoie III, MD, Larry D. Field, MD, E. Rhett Hobgood, MD, Doug Weinberg, David G. Brown, MD, Tulane University, New Orleans, Louisiana, USA; Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, USA Background: Reconstruction in patients with instability with moderate bone loss has been shown to have a much higher failure rate than standard Bankart repair. It has been postulated that the addition of an arthroscopic infraspinatus tenodesis with posterior capsulodesis (‘‘remplissage’’) may improve the success rate of arthroscopic reconstruction in these higher risk patients. We report our results with this technique in this patient population. Methods: A retrospective review was performed to identify patients who underwent arthroscopic remplissage in conjunction with anterior capsulolabral reconstruction for anterior glenohumeral instability with moderate glenoid bone loss (greater than 10% but less than
J Shoulder Elbow Surg October 2013
30%) at our institution. Thirty-six shoulders in 35 patients with minimum 2 years follow-up were identified. The following data was reviewed: American Shoulder and Elbow Surgeons (ASES) score, incidence of recurrent instability, and post-operative Rowe instability score. Follow up was available for 29 patients (30 shoulders). Mean age at the time of surgery was 24.6 years (range 15-44), with a mean follow-up of 39 months (range 24-60). Eleven patients had failed prior instability surgery and underwent capsulolabral reconstruction and remplissage in the context of revision surgery. Results: The mean ASES score improved from 50.7 preoperatively to 90.7 post-operatively (p < 0.001). The mean post-operative Rowe score was 84.6. Four failures (13%) occurred (1 dislocation, 3 patients with subluxation events); all were traumatic in nature. No patients have undergone further surgery. All failures occurred in patients who had prior instability surgery, yielding a 36% failure rate in revision cases. There were no failures in the 19 primary instability patients (p ¼ 0.02). Conclusions: Aggressive capsulolabral reconstruction with posterior infraspinatus tenodesis in traumatic instability patients with moderate grade bone loss and a humeral Hill-Sachs lesion yields acceptable outcomes in primary instability surgery. However, it does not appear to provide a reliable solution to this complicated problem in the revision setting.
10 RECURRENCE OF ANTERIOR SHOULDER INSTABILITY IS HIGHER AFTER ARTHROSCOPIC BANKART THAN AFTER OPEN LATARJET PROCEDURE: A CASE-CONTROL STUDY Charles Bessi ere, MD, Christophe Trojani, MD, PhD, Michel Carles, MD, Pascal Boileau, MD, Department of Orthopaedic Surgery & Sports Traumatology, L’Archet 2 Hospital, Medical University of Nice-Sophia-Antipolis, Nice, France Hypothesis: The rate of recurrence of anterior shoulder instability after arthroscopic Bankart repair is higher than the one following open Latarjet coracoid bone-block procedure. Patients and Methods: Retrospective monocentric comparative paired study: patients with recurrent traumatic anterior instability operated between 2002-2006 were included. 93 patients operated by open Latarjet (OL) were matched by age at time of surgery with 93 patients who underwent arthroscopic Bankart (AB). All patients completed an original subjective questionnaire. Recurrence of instability was defined by at least one episode of anterior subluxation or dislocation. Results: Both groups were statistically comparable for age at surgery, gender, number of preoperative episodes of instability, hyperlaxity, sport (contact/armed-countered), level of sport practice (competition/leisure), and type of soft tissue or bony lesions. At a mean follow-up of five years, the recurrence rate of anterior instability was 22% (20/93) in the AB group and 10% (9/93) in the OL group; this difference was statistically significant (p ¼ 0.026). All the Latarjet failures occured in the first year after surgery, while half ot the Bankart failures occured after two years (p<0.001). There was no difference in the subjective result between the two groups. Conclusion: Our hypothesis is confirmed: at an over 5 years follow-up, the rate of recurrent instability after arthroscopic Bankart is significantly higher than the one observed after Latarjet coracoid bone block. This series also confirms that results after arthroscopic Bankart deteriorate lately and that a minimum two year follow-up is needed to evaluate the results of any stabilization procedure of the shoulder.