Modified Arthroscopic Latarjet Procedure: Button Fixation Without Splitting of the Subscapularis.
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SUBMITTER: Yan H
PROVIDER: S-EPMC8556670 | biostudies-literature | 2021 Oct
REPOSITORIES: biostudies-literature
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Modified Arthroscopic Latarjet Procedure: Button Fixation Without Splitting of the Subscapularis.
Yan Hui H Dai Linghui L Wang Jianquan J
Arthroscopy techniques 20210921 10
The Latarjet procedure is used for the treatment of anterior glenohumeral instability in the presence of bone loss. One decade after a fully arthroscopic Latarjet procedure was described, this technique has been modified to reduce the risk of complications and improve the fixation method. We aimed to simplify the components of this surgical procedure. ...[more]
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Project description:In the presence of bone loss, the Bristow or Latarjet procedure is used to alleviate anterior glenohumeral instability. The techniques have gradually improved under arthroscopy. However, such an arthroscopic procedure has a steep learning curve, lengthy operation time, and considerable risk of complications, inhibiting its rapid development. The current method of modified arthroscopic Bristow procedure with screw fixation without subscapularis split reduces surgical time, reduces the risk of nerve damage consequences, and is simple to apply. Technique Video Video 1 We present our modified arthroscopic Bristow procedure: screw fixation without subscapularis split. The patient is placed in the beach-chair position, and 5 portals are created. After performing a diagnostic arthroscopy examination, the coracoid process lower surface, tip, and base, and the conjoined tendon are identified. The soft tissue lateral to the conjoined tendon is released to a sufficient length to allow transferring the coracoid process. The coracoacromial ligament is excised at its coracoid insertion to expose its lateral and upper surfaces. Subsequently, the pectoralis minor muscle is released from the coracoid to ∼5 cm below the junctions between the pectoralis minor muscle and the conjoined tendon to ensure the transfer of the coracoid process will not be affected. A 1.2-mm K-wire is drilled into the coracoid under the guidance of a thin cannula. A PDS line is passed through the bone tunnel for traction and guidance. After ensuring an adequate length of the coracoid bone, it is osteotomized with a willow saw. Subsequently, the labrum and capsule are detached completely from the glenoid to the 6-o’clock position. The glenoid is refreshed by a burr. The upper edge of the subscapularis is pressed downwards by a switching stick until the 4-o’clock position of the anterior glenoid is exposed. A marking point is placed to assist in creating a tunnel at the 4-o’clock position. After drilling and measuring, a 1.2-mm K-wire is inserted into the tunnel to guide the screw. The coracoid is pulled out through portal D, its length is measured, and its osteotomy surface is trimmed to match the anterior glenoid surface. A hole is drilled from the center of the osteotomy surface to the tip of the coracoid with a 1.2-mm K-wire. The hole created by the 1.2-mm K-wire is drilled through with a 2.7-mm hollow drill. A cannulated screw with a diameter of 4 mm is implanted into the coracoid graft along the 1.2-mm K-wire, leaving 2 mm of the screw head above the osteotomy surface for the coracoid's final fixation. The lateral edge of the conjoined tendon is sutured with No. 2 ETHIBOND suture near the coracoid and kept sufficiently taut to prevent twisting during coracoid fixation. The coracoid with partial screw fixation is then inserted for the final fixation. The tip of the screw is positioned against the K-wire introduced through the glenoid tunnel in the previous phase. The K-wire is threaded through the screw, and the coracoid and screw are secured with a screwdriver. The final placement of the transferred coracoid is arthroscopically assessed through portal B. The postoperative anteroposterior radiograph shows that a single screw maintains the coracoid in place. The 3-dimensional computed tomography scan depicts the locations of the graft and screw. The transferred coracoid is seen at the 4-o’clock position, and the glenoid surface is well integrated with the coracoid graft’s surface. The scan also shows that the transferred coracoid is standing on the glenoid surface with a 90° rotation. (PDS, polydioxanone.).
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Project description:Shoulder instability is a commonly seen pathology. The Latarjet procedure was first described in 1954 to address recurrent instability or patients with glenoid bone loss. Since its introduction, the procedure has been widely adopted and modified, including being performed all-arthroscopically. Various arthroscopic techniques have been described, but we present a technique performed in the lateral decubitus position that takes advantage of a pneumatic arm holder. After arthroscopic diagnosis, multiple accessory portals are established and used to accomplish the technique. Next, the coracoid is prepared and cut using a cannulated drill guide, followed by arthroscopic glenoid preparation using a cannulated drill system to ensure appropriate position of the coracoid. The subscapularis split is performed arthroscopically, and finally the coracoid is fixed with use of the EndoButton device.
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Project description:Bristow-Latarjet procedure has been widely regarded as a reliable and satisfactory operation for recurrent anterior glenohumeral instability, especially for patients with significant glenoid bone loss or high sports demand. Once failed, however, the subsequent revision surgery could be challenging. Eden-Hybinette procedure is the most common operation for revision of failed Bristow-Latarjet. It can perfectly restore the bone defect of the failed Bristow-Latarjet by harvesting a proper size of iliac bone block. Furthermore, several studies have shown the advantages of using suture button fixation in the revision surgery for failed Bristow-Latarjet procedure. However, the potential inferior biomechanical strength of suture button fixation is still a concern. This Technical Note introduced an arthroscopic "double-inlay" Eden-Hybinette procedure with modified suture button fixation for the revision of failed Bristow-Latarjet. With its "quadruple" reinforcement effect, this procedure can achieve an excellent biomechanical strength of fixation.
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Project description:BackgroundAs several neurologic and hardware complications have been reported with screw fixation. Suture buttons are used to serve as an alternative to screw fixation to obtain better outcome and to reduce the complication. The purpose of this study was to observe the clinical outcomes and make the radiologic assessment of a modified suture button (MSB) arthroscopic Latarjet procedure.MethodsA total of ninty-one patients with recurrent shoulder joint dislocation who underwent MSB arthroscopic Latarjet procedure was retrospectively reviewed. Fifty cases identified from the chart review met the inclusion criteria. The clinical outcomes and position of the grafts, glenohumeral degeneration, and graft healing condition were assessed postoperatively in a follow-up with at least one and half of a year.ResultsAll the fifty patients were satisfied with their clinical outcome. The overall complication rate was 4% in this study. The mean visual analog scale score, the affected shoulder active mobility in Ers(external rotation at the side), Era(external rotation in abduction) decreased significantly; the ASES score, Rowe score, Walch-Duplay score improved significantly. CT scans in the sagittal view showed that grafts in 88% of cases were in good position, grafts in 12% of cases were fixed too superiorly and inferiorly. In the axial view grafts in forty cases were flush with the glenoid rim, ten were considered as too lateral. The ten grafts became remodeled and were more flush with the glenoid rim in the follow-up.ConclusionsThe MSB arthroscopic Latarjet procedure provides excellent outcome with few complications, and no degenerative changes were observed in the follow-up. Moreover, the graft fixed too laterally presented a phenomenon of remodeling and became flush with the glenoid rim over time.
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Project description:Arthroscopic Latarjet procedure is an efficient and reliable approach for the treatment of shoulder instability. Nevertheless, the screws fixing the bone block may sometimes be responsible for pain and uncomfortable snapping in the shoulder that is triggered during active external rotation. We propose an all-arthroscopic technique for screw removal in cases of complications involving the screws from a Latarjet procedure. The all-arthroscopic screw removal is reliable and efficient. This procedure is indicated in more cases than thought because of the bone block resorption. It permits a revision of the glenohumeral joint in case of persisting pain.
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Project description:The Latarjet procedure for treating anterior glenohumeral instability includes transfer of the coracoid and biceps tendon to the anterior glenoid. A modified method for the arthroscopic procedure was developed to facilitate the procedure and minimize the risk of injury to the brachial plexus. The detached coracoid was exteriorized through the anteroinferior portal for drilling and shaping. A Coracoid Drill Guide (Arthrex, Naples, FL) was used to help cut the coracoid to the desired size and make 2 drill holes in the coracoid for fixation to the glenoid. The Coracoid Transfer Instrument (Acierart, Masku, Finland) was designed to facilitate coracoid transfer and serve as a pin guide for fixation. Ten patients with severe anterior glenohumeral instability were treated with this technique. They had only mild to moderate postoperative pain. There were no postoperative infections or recurrent dislocations. The safety of this operation was similar to that of other operations on the coracoid process in the proximity of the brachial plexus. The modified arthroscopic Latarjet procedure may be applied successfully to the treatment of anterior glenohumeral instability, with good patient satisfaction and functional outcome.
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Project description:The optimal management of recurrent anterior shoulder instability with significant glenoid bone loss continues to be a challenge. The high recurrence rates seen in arthroscopic Bankart repair in the presence of significant glenoid bone loss have led many surgeons to choose bony reconstructions to manage these injuries. The Latarjet procedure acts through the combination of 3 different mechanisms: the coracoid bone graft restores and extends the glenoid articular arc, the conjoint tendon acts as a dynamic sling on the inferior subscapularis and anteroinferior capsule when the arm is abducted and externally rotated, and the effect of repairing the capsule to the stump of the coracoacromial ligament. However, in patients with multiple recurrences and previous surgeries, the anteroinferior labrum and capsule are often very deficient or practically destroyed. This Technical Note provides a detailed description of the modified Latarjet procedure without capsulolabral repair for patients with failed previous operative stabilizations.
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Project description: Not available
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Project description:The Bristow-Latarjet procedure has been one of the most recognized procedures for the treatment of recurrent shoulder dislocation with anterior glenoid bone loss, revision surgery after failed Bankart repair, contact and collision sport injuries, and patients with a high risk of recurrence. Open and arthroscopic approaches have recently shown similar outcomes by several authors. However, complications related to metal implants, despite being low, are still a matter of concern. We describe an all-arthroscopic Latarjet technique with a metal-free fixation method using 2 ultra-high-strength sutures, creating a cerclage construct through 2.4mm glenoid and coracoid tunnels with a final capsulolabral complex reconstruction.
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Project description:The Latarjet procedure is very popular and is the method of choice in cases of glenoid bone loss and anterior-inferior instability or revision procedures. However, recurrence is common after this procedure. One of the methods of revision after the Latarjet procedure is the Eden-Hybinette technique. However, recurrence occurs after this bone grafting procedure as well. The primary reasons for recurrence are graft resorption and capsular deficiency. To improve these outcomes, transfer of the long head of the biceps for capsular reinforcement has been recommended by several authors. We describe an all-arthroscopic procedure, performed after the Latarjet technique, that combines bone block transfer, trans-subscapular transposition of the long head of the biceps, and anterior labroplasty. This technique can significantly reinforce the deficient capsule through the sling effect and cover the graft for prophylaxis against bone resorption.
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