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Complications of arthroscopic latarjet: a multicenter study of 1555 cases
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Paper #7 COMPLICATIONS OF ARTHROSCOPIC LATARJET: A MULTICENTER STUDY OF 1555 CASES
Laurent Lafosse, MDa, Jan Leuzingerb, Roman Brzoska, MD, PhDc, Pierre L. Métais, MD d , Philippe Clavert, MD, PhD e , Geoffroy Nourissat, MDf, Gilles Walch, MDg, French Arthroscopy Societyh, aAlps Surgery Institute, Annecy, France; bEtzel Clinic, Pfäffikon, Switzerland; c St Lukas Clinic, Bucurest, Romania; d Clinique La Chataigneraie, Beaumont, France; e Hopitaux Universitaires de Strasbourg, Strasbourg, France; fClinique des Maussins, Paris, France; g Centre Orthopedique Santy, Lyon, France; hFrench Arthroscopy Society, Rueil Malmaison, France Introduction: The open Latarjet procedure has a proven record of success in the treatment of shoulder instability. With the recent development of arthroscopic Latatjet techniques, it is important to evaluate complication rates from six arthroscopic Latarjet specialist surgeons. Material and Methods: This study is a multicenter retrospective review of complications of 1555 arthroscopic Latarjet procedures for the treatment of chronic shoulder instability. Each of the six centers included all patients undergoing arthroscopic Latarjet since the beginning of each surgeon’s arthroscopic Latarjet experience. The same fixation technique with two screws was used. The study reports on 1 to 10 years of experience. Results: Of the 1555 cases reviewed, there were 4 (0.2%) severe neurological complications, 10 (0.6%) infections, 7 (0.4%) hematomas, 14 (1%) fractures of the graft, and 30 (2%) cases of recurrent instability. 58 (3.7%) patients required an additional surgery due to these complications. Hardware removal was not included in these complications. Conclusion: This multicenter analysis of 6 arthroscopic Latarjet specialists shows a lower complication rate than previously reported in the literature. This retrospective analysis demonstrates that the arthroscopic Latarjet technique was reproducible among the six surgeons. While we report a low complication rate in this series of expert surgeons, the difficulty of this procedure should not be underestimated. The complications when they happen can be serious and difficult to manage.
Paper #8 COMPARAISON OF THE ISOLATED LATISSIMUS DORSI TRANSFER AND THE LATISSIMUS DORSI TRANSFER COMBINED WITH A PARTIAL CUFF REPAIR IN MASSIVE POSTERO SUPERIOR CUFF TEAR
Philippe Valenti, MD, Felipe Reinares, MD, Marco Cartaya, MD, Jean-David Werthel, Shoulder Department, Institut de la Main, Paris, France Introduction: The surgical treatment of massive posterosuperior cuff tears remains controversial. The purpose of this study was to compare the clinical results of an isolated arthroscopic latissimus dorsi transfer with those of an arthroscopic latissimus dorsi transfer combined with a partial cuff repair. Materials and Methods: All patients who underwent an arthroscopic latissimus dorsi transfer either isolated or in combination with a partial cuff repair for a massive posterosuperior cuff tear between January 2011 and December 2013 at our institution were included prospectively. Massive posterosuperior cuff tear was defined as a tear of both the supraspinatus and infraspinatus retracted at the level of the glenoid with a fatty infiltration >2 in the Goutallier classification. The rupture was defined as irreparable because after complete release of the tendons, we were unable to reinsert them anatomically. Patients were excluded if subscapularis or the teres minor were involved. Thirty-five patients met the inclusion criteria. Twenty-one had had an isolated transfer (Group A) and 14 had had a transfer combined with a partial cuff repair (Group B). Rotator cuff lesions were not significantly different in both groups in terms of number of tendons involved, retraction, muscle atrophy and fatty infiltration. The transfer was fixed through a bony tunnel at the posterior insertion of the supraspinatus and the partial repair was done by advancing the supraspinatus and by side-toside sutures. Outcome measures included pain (VAS = visual analogue scale), range of motion, strength, Constant Scores and Subjective Shoulder Value (SSV). Results: The 35 patients were all significantly
J Shoulder Elbow Surg 2017
improved at a mean 16 months follow-up. The mean Constant Score was improved from 35 (+/− 15) to 60 (+/− 9, P < .001), mean pain scores (VAS) improved from 7 to 2 and the mean SSV improved from 32% to 66%. The results in the Group B were significantly better for the Constant Score (58 +/− 4 in Group A versus 64 + /− 8 in Group B, P < .03), the range of motion (29 + /− 5 points in Group A versus 33 +/− 5 points in Group B, P < .03) and strength in 90° of abduction (1.9 kg +/− 0.9 in Group A versus 2.5 kg +/− 1 in Group B, P < .029). Pain scores, SSVs and active external rotation were not significantly different in the two groups. Conclusion: This study confirms that the arthroscopic transfer of the latissimus dorsi improves the Constant Score, range of motion, strength, pain scores and SSVs in posterosuperior rotator cuff tears retracted to the glenoid with a fatty infiltration >2. Results were significantly better for range of motion and strenght when the transfer was combined with a partial repair of the cuff.
Paper #9 A RANDOMIZED CONTROLLED TRIAL COMPARING ARTHROGRAPHIC JOINT INJECTION WITH AND WITHOUT STEROIDS FOR THE TREATMENT OF ADHESIVE CAPSULITIS
Allison Tucker, MD, MSc a , Christina Hiscox, MD a , Ryan T. Bicknell, MD, MSc, FRCSCa,b, aDepartment of Mechanical and Materials Engineering, Human Mobility Research Centre, Queen’s University, Kingston, Ontario, Canada; bDepartment of Surgery, Human Mobility Research Centre, Queen’s University, Kingston, Ontario, Canada Introduction: Adhesive capsulitis is a common cause of shoulder pain and dysfunction, estimated to affect 2-5% of the population. Many forms of treatment have been advocated including physiotherapy, injection with steroid, distension arthrogram with steroid and/ or local anesthetic, manipulation under anesthetic and arthroscopic release. The objective of this study was to determine if arthrographic injection of the shoulder joint with steroid, local anesthetic and contrast is an effective treatment modality for adhesive capsulitis and whether it is superior to arthrographic injection with local anesthetic and contrast alone. Methods: This was a double-blinded randomized control trial of patients with a diagnosis of adhesive capsulitis who were randomly assigned to receive an image-guided arthrographic glenohumeral joint injection with either triamcinalone (steroid), lidocaine (local anesthetic) and contrast or lidocaine and contrast alone. There were 37 shoulders with an average age of 54 years (range, 42-70 years). Twenty shoulders were randomized to receive local plus steroid and 17 received local anesthetic only. There were 21 females and 14 males. Outcome measures included active and passive shoulder range of motion (ROM) and functional outcomes assessed using the Shoulder Pain and Disability Index (SPADI), the Constant Score and a Visual Analog Scale (VAS) for pain. Postoperative evaluation occurred at 3, 6 and 12 weeks. Statistical analysis utilized a one-way ANOVA and the post-hoc Bonferroni correction multiple comparisons (P < .05). Results: VAS scores for both patient groups were significantly improved at all follow-up times (P < .05). Range-of-motion demonstrated significant improvement in abduction in the local plus steroid group at 3 and 6 weeks (P < .05). The Constant score showed no changes in for the local group (P = .08), however there were significant improvement for the local plus steroid group (P = .003) at all follow-up time points. The local group showed significant improvement in their SPADI pain scores at the 12 week follow-up only (P = .01) but no differences in their SPADI disability scores (P = .09). The local plus steroid group had significant improvement in SPADI pain and disability scores at all follow-up time points (P = .001). Discussion: This study demonstrated that patients receiving an arthrographic injection of either steroid and local anesthetic or local anesthetic alone had significantly improved postinjection pain scores. However, only the steroid and local anesthetic treatment group demonstrated improved SPADI disability and Constant scores. Therefore, we believe that while either treatment is a good
Paper #7 COMPLICATIONS OF ARTHROSCOPIC LATARJET: A MULTICENTER STUDY OF 1555 CASES
Laurent Lafosse, MDa, Jan Leuzingerb, Roman Brzoska, MD, PhDc, Pierre L. Métais, MD d , Philippe Clavert, MD, PhD e , Geoffroy Nourissat, MDf, Gilles Walch, MDg, French Arthroscopy Societyh, aAlps Surgery Institute, Annecy, France; bEtzel Clinic, Pfäffikon, Switzerland; c St Lukas Clinic, Bucurest, Romania; d Clinique La Chataigneraie, Beaumont, France; e Hopitaux Universitaires de Strasbourg, Strasbourg, France; fClinique des Maussins, Paris, France; g Centre Orthopedique Santy, Lyon, France; hFrench Arthroscopy Society, Rueil Malmaison, France Introduction: The open Latarjet procedure has a proven record of success in the treatment of shoulder instability. With the recent development of arthroscopic Latatjet techniques, it is important to evaluate complication rates from six arthroscopic Latarjet specialist surgeons. Material and Methods: This study is a multicenter retrospective review of complications of 1555 arthroscopic Latarjet procedures for the treatment of chronic shoulder instability. Each of the six centers included all patients undergoing arthroscopic Latarjet since the beginning of each surgeon’s arthroscopic Latarjet experience. The same fixation technique with two screws was used. The study reports on 1 to 10 years of experience. Results: Of the 1555 cases reviewed, there were 4 (0.2%) severe neurological complications, 10 (0.6%) infections, 7 (0.4%) hematomas, 14 (1%) fractures of the graft, and 30 (2%) cases of recurrent instability. 58 (3.7%) patients required an additional surgery due to these complications. Hardware removal was not included in these complications. Conclusion: This multicenter analysis of 6 arthroscopic Latarjet specialists shows a lower complication rate than previously reported in the literature. This retrospective analysis demonstrates that the arthroscopic Latarjet technique was reproducible among the six surgeons. While we report a low complication rate in this series of expert surgeons, the difficulty of this procedure should not be underestimated. The complications when they happen can be serious and difficult to manage.
Paper #8 COMPARAISON OF THE ISOLATED LATISSIMUS DORSI TRANSFER AND THE LATISSIMUS DORSI TRANSFER COMBINED WITH A PARTIAL CUFF REPAIR IN MASSIVE POSTERO SUPERIOR CUFF TEAR
Philippe Valenti, MD, Felipe Reinares, MD, Marco Cartaya, MD, Jean-David Werthel, Shoulder Department, Institut de la Main, Paris, France Introduction: The surgical treatment of massive posterosuperior cuff tears remains controversial. The purpose of this study was to compare the clinical results of an isolated arthroscopic latissimus dorsi transfer with those of an arthroscopic latissimus dorsi transfer combined with a partial cuff repair. Materials and Methods: All patients who underwent an arthroscopic latissimus dorsi transfer either isolated or in combination with a partial cuff repair for a massive posterosuperior cuff tear between January 2011 and December 2013 at our institution were included prospectively. Massive posterosuperior cuff tear was defined as a tear of both the supraspinatus and infraspinatus retracted at the level of the glenoid with a fatty infiltration >2 in the Goutallier classification. The rupture was defined as irreparable because after complete release of the tendons, we were unable to reinsert them anatomically. Patients were excluded if subscapularis or the teres minor were involved. Thirty-five patients met the inclusion criteria. Twenty-one had had an isolated transfer (Group A) and 14 had had a transfer combined with a partial cuff repair (Group B). Rotator cuff lesions were not significantly different in both groups in terms of number of tendons involved, retraction, muscle atrophy and fatty infiltration. The transfer was fixed through a bony tunnel at the posterior insertion of the supraspinatus and the partial repair was done by advancing the supraspinatus and by side-toside sutures. Outcome measures included pain (VAS = visual analogue scale), range of motion, strength, Constant Scores and Subjective Shoulder Value (SSV). Results: The 35 patients were all significantly
J Shoulder Elbow Surg 2017
improved at a mean 16 months follow-up. The mean Constant Score was improved from 35 (+/− 15) to 60 (+/− 9, P < .001), mean pain scores (VAS) improved from 7 to 2 and the mean SSV improved from 32% to 66%. The results in the Group B were significantly better for the Constant Score (58 +/− 4 in Group A versus 64 + /− 8 in Group B, P < .03), the range of motion (29 + /− 5 points in Group A versus 33 +/− 5 points in Group B, P < .03) and strength in 90° of abduction (1.9 kg +/− 0.9 in Group A versus 2.5 kg +/− 1 in Group B, P < .029). Pain scores, SSVs and active external rotation were not significantly different in the two groups. Conclusion: This study confirms that the arthroscopic transfer of the latissimus dorsi improves the Constant Score, range of motion, strength, pain scores and SSVs in posterosuperior rotator cuff tears retracted to the glenoid with a fatty infiltration >2. Results were significantly better for range of motion and strenght when the transfer was combined with a partial repair of the cuff.
Paper #9 A RANDOMIZED CONTROLLED TRIAL COMPARING ARTHROGRAPHIC JOINT INJECTION WITH AND WITHOUT STEROIDS FOR THE TREATMENT OF ADHESIVE CAPSULITIS
Allison Tucker, MD, MSc a , Christina Hiscox, MD a , Ryan T. Bicknell, MD, MSc, FRCSCa,b, aDepartment of Mechanical and Materials Engineering, Human Mobility Research Centre, Queen’s University, Kingston, Ontario, Canada; bDepartment of Surgery, Human Mobility Research Centre, Queen’s University, Kingston, Ontario, Canada Introduction: Adhesive capsulitis is a common cause of shoulder pain and dysfunction, estimated to affect 2-5% of the population. Many forms of treatment have been advocated including physiotherapy, injection with steroid, distension arthrogram with steroid and/ or local anesthetic, manipulation under anesthetic and arthroscopic release. The objective of this study was to determine if arthrographic injection of the shoulder joint with steroid, local anesthetic and contrast is an effective treatment modality for adhesive capsulitis and whether it is superior to arthrographic injection with local anesthetic and contrast alone. Methods: This was a double-blinded randomized control trial of patients with a diagnosis of adhesive capsulitis who were randomly assigned to receive an image-guided arthrographic glenohumeral joint injection with either triamcinalone (steroid), lidocaine (local anesthetic) and contrast or lidocaine and contrast alone. There were 37 shoulders with an average age of 54 years (range, 42-70 years). Twenty shoulders were randomized to receive local plus steroid and 17 received local anesthetic only. There were 21 females and 14 males. Outcome measures included active and passive shoulder range of motion (ROM) and functional outcomes assessed using the Shoulder Pain and Disability Index (SPADI), the Constant Score and a Visual Analog Scale (VAS) for pain. Postoperative evaluation occurred at 3, 6 and 12 weeks. Statistical analysis utilized a one-way ANOVA and the post-hoc Bonferroni correction multiple comparisons (P < .05). Results: VAS scores for both patient groups were significantly improved at all follow-up times (P < .05). Range-of-motion demonstrated significant improvement in abduction in the local plus steroid group at 3 and 6 weeks (P < .05). The Constant score showed no changes in for the local group (P = .08), however there were significant improvement for the local plus steroid group (P = .003) at all follow-up time points. The local group showed significant improvement in their SPADI pain scores at the 12 week follow-up only (P = .01) but no differences in their SPADI disability scores (P = .09). The local plus steroid group had significant improvement in SPADI pain and disability scores at all follow-up time points (P = .001). Discussion: This study demonstrated that patients receiving an arthrographic injection of either steroid and local anesthetic or local anesthetic alone had significantly improved postinjection pain scores. However, only the steroid and local anesthetic treatment group demonstrated improved SPADI disability and Constant scores. Therefore, we believe that while either treatment is a good