Comparative Results After Latarjet Procedure for Shoulder Instability Management Between Primary and Revision Cases After Failed Arthroscopic Bankart Procedure: A Midterm Follow-up Study.

IF 2.4 3区 医学 Q2 ORTHOPEDICS
Orthopaedic Journal of Sports Medicine Pub Date : 2025-06-19 eCollection Date: 2025-06-01 DOI:10.1177/23259671251343807
Efstathios Konstantinou, Nikolaos Stefanou, Theodoros Mylonas, Alexandros Koskiniotis, Georgios Komnos, Socratis Varitimidis, Michael Hantes
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引用次数: 0

Abstract

Background: Anterior shoulder dislocation is often complicated by recurrent instability, with reported rates being as high as 70% in young patients. Bony lesions, young age, and contact sports have been correlated with higher rates of recurrent instability. The optimal surgical modality remains debatable, with the majority of surgeons preferring the arthroscopic Bankart procedure as the primary repair for recurrent instability.

Purpose: To compare the outcomes of the Latarjet procedure performed as a primary procedure versus the Latarjet procedure in the setting of a previously failed Bankart repair.

Study design: Cohort study; Level of evidence 3.

Methods: A retrospective comparative study was conducted of patients with traumatic anterior shoulder instability who underwent an open Latarjet as primary or revision surgery between 2012 and 2019. Outcomes were assessed using the Rowe score, Oxford Shoulder Instability (OSI) score, visual analog scale (VAS) score, and rate of recurrent instability. All patients had at least 4 years of follow-up. Radiographs were analyzed using the Samilson and Pietro classification.

Results: In total, 43 and 17 patients were included in the primary and revision groups, respectively. Mean follow-up was 7.7 years for the primary group and 7.9 years for the revision group. Postoperatively, Rowe and VAS scores were not significantly different between groups, but OSI scores were significantly worse for the revision group versus the primary group (40.6 ± 1.3 vs 42.1 ± 1.4, respectively). The difference in OSI scores was less than the minimal clinically important difference (8.6), indicating limited clinical relevance. Return to daily activities, including sports activities, was comparable between the 2 groups. One patient from each group had recurrent instability (P = .34). No major complication was recorded in either group during the follow-up. Seven (16%) patients from the primary group and 4 (23%) patients from the revision group showed preoperatively radiographic signs of mild (grade I) osteoarthritis.

Conclusion: The Latarjet procedure effectively prevented chronic anterior shoulder instability and was associated with high patient satisfaction as both a primary and a revision procedure. OSI scores were marginally lower in patients with previous failed Bankart repair compared with primary Latarjet. Similar outcomes were observed for shoulder stability and arthritis development, although these findings are limited to midterm follow-up. These findings support the use of primary arthroscopic Bankart repair with revision Latarjet as a realistic surgical option for previous surgical failure.

一项中期随访研究:肩关节镜Bankart手术失败后Latarjet手术与翻修手术治疗肩关节不稳定的比较结果。
背景:前肩脱位常并发复发性不稳定,据报道年轻患者的发生率高达70%。骨性损伤、年轻和接触性运动与复发性不稳定的高发生率相关。最佳的手术方式仍有争议,大多数外科医生更倾向于关节镜下Bankart手术作为复发性不稳定的主要修复方法。目的:比较Latarjet手术作为主要手术与Latarjet手术在先前Bankart修复失败的情况下的结果。研究设计:队列研究;证据等级3。方法:回顾性比较研究了2012年至2019年期间接受开放性Latarjet作为初次手术或翻修手术的外伤性肩关节前部不稳定患者。结果采用Rowe评分、牛津肩部不稳定性评分、视觉模拟评分(VAS)评分和复发不稳定性率进行评估。所有患者至少有4年的随访。x线片采用Samilson和Pietro分类进行分析。结果:初级组43例,改良组17例。初级组的平均随访时间为7.7年,修订组的平均随访时间为7.9年。术后,两组间Rowe评分和VAS评分无显著差异,但改良组的OSI评分明显低于初始组(分别为40.6±1.3比42.1±1.4)。OSI评分的差异小于最小临床重要差异(8.6),表明有限的临床相关性。恢复日常活动,包括体育活动,在两组之间具有可比性。两组均有1例复发性不稳定(P = 0.34)。随访期间,两组均无重大并发症发生。原发性组7例(16%)患者和翻修组4例(23%)患者术前影像学表现为轻度(I级)骨关节炎。结论:Latarjet手术有效地预防了慢性肩关节前路不稳,作为初级手术和翻修手术,患者满意度都很高。与初级Latarjet相比,先前Bankart修复失败的患者的OSI评分略低。在肩关节稳定性和关节炎发展方面也观察到类似的结果,尽管这些发现仅限于中期随访。这些发现支持使用初级关节镜Bankart修复和改良Latarjet作为先前手术失败的现实手术选择。
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来源期刊
Orthopaedic Journal of Sports Medicine
Orthopaedic Journal of Sports Medicine Medicine-Orthopedics and Sports Medicine
CiteScore
4.30
自引率
7.70%
发文量
876
审稿时长
12 weeks
期刊介绍: The Orthopaedic Journal of Sports Medicine (OJSM), developed by the American Orthopaedic Society for Sports Medicine (AOSSM), is a global, peer-reviewed, open access journal that combines the interests of researchers and clinical practitioners across orthopaedic sports medicine, arthroscopy, and knee arthroplasty. Topics include original research in the areas of: -Orthopaedic Sports Medicine, including surgical and nonsurgical treatment of orthopaedic sports injuries -Arthroscopic Surgery (Shoulder/Elbow/Wrist/Hip/Knee/Ankle/Foot) -Relevant translational research -Sports traumatology/epidemiology -Knee and shoulder arthroplasty The OJSM also publishes relevant systematic reviews and meta-analyses. This journal is a member of the Committee on Publication Ethics (COPE).
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