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Results of Mini-Open Latarjet Procedure in Failed in Arthroscopic Bankart Repair-Dr. Rahul Kumar

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Results of Mini-Open Latarjet Procedure in Failed in Arthroscopic Bankart Repair-Dr. Rahul Kumar

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Results of Mini-Open Latarjet Procedure in Failed in Arthroscopic Bankart Repair-Dr. Rahul Kumar

  1. 1. Results Of Mini-Open Latarjet Procedure In Failed Arthroscopic Bankart repair – A Retrospective analysis Dr Rahul Kumar Sports Injury centre, Safdarjung Hospital
  2. 2. DISCLOSURE The authors have no financial conflicts to disclose
  3. 3. INTRODUCTION Anterior shoulder instability is most common type of shoulder instability. Arthroscopic bankart repair has become the procedure of choice of primary recurrent anterior shoulder instability However, failures of stabilization can and do occur.
  4. 4. INTRODUCTION Recurrent instability after Bankart repair is a difficult problem for both the patient and treating physician. • Open procedure: 10% • Arthroscopic procedure: 0-43%. Recurrence rates
  5. 5. CAUSES OF FAILURES GLENOID BONE LOSS • Re-Dislocation - no bone loss 4% recurrence - inverted pear 61% recurrence (>25% Glenoid Bone loss) Burkhart SS, De Beer JF. Traumatic Glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeralengaging Hill-Sachs lesion. Arthroscopy 2000;16:677-694.)
  6. 6. Humeral head bone defects Engaging Hill sach’s lesion
  7. 7. Glenoid Tracking Yamamoto at al. JSES 2007 mapped track of glenoid on humeral head through simulated motion started in max ER Varied Abduction from 0 degree to 60 degree.
  8. 8. Humeral head defect - outside the glenoid track - high risk for engaging (OUT-E). Humeral head defect – inside the track – Non engaging ( IN-NE)
  9. 9. ORIGINAL LATARJET Developed and reported in 1954 using Standard delto-pectoral approach Transfers a large segment of the coracoid (2.5 to 3 cm in length) as bone graft to the anterior inferior glenoid rim. Latarjet M. Traitement de la luxation récidivante de l’épaule. Treatment of recurrent dislocation of the shoulder. Lyon Chirurgical. 1954; 49:994–997.
  10. 10. Mini open Latarjet Limited delto-pectoral approach Skin incision: 1 cm above the tip of the coracoid extending 4-5 cm toward the axillary fold. Slightly medial to coracoid, so that anterior inferior glenoid neck is exposed easily.
  11. 11. Materials and Methods Study design: Retrospective study Sample size : 24 Study period: June 2010 – May 2012 Inclusion criteria: Patients who had undergone arthroscopic Bankart repair for recurrent anterior shoulder instability who presented with persistent instability after surgery with positive apprehension test. Exclusion Criteria: Primary latarjet procedures were excluded from the study.
  12. 12. Pre-op workup Clinical and radiological evaluation done. • Size of Hill sach’s lesion • Glenoid Bone Loss 3D CT was performed
  13. 13. Surgical Technique
  14. 14. Surgical Technique
  15. 15. Post op Rehabilitation Shoulder immobiliser upto 2 weeks Shoulder pendulum exercises are started from day 1. Passive abduction & forward elevation upto 900 and External rotation upto 300 is initiated from 3rd week after suture removal.
  16. 16. Follow Up Minimum Follow up: 2 years Radiographic assessment • AP view • scapular Y view Functional results • American shoulder and elbow score(ASES) • Western Ontario shoulder instability score(WOSI). Range of motion • Loss of mean forward elevation • Loss of external rotation
  17. 17. Follow Up Data Analysis •Range •Mean •Student’s T-test with statistical significance set at p value < .05
  18. 18. RESULTS All patients were Male. Mean age of patients was 31.8 years (range: 21-37 years). The right shoulder was involved in 13 cases (54.17 %), and the dominant arm was affected in 11 patients (45.83 %). Average glenoid bone loss was 21% as assessed by three dimensional computed tomography (range ; 15- 29%).
  19. 19. CAUSE OF FAILURE GLENOID BONE LOSS HUMERAL HEAD DEFECT TRAUMATIC 8 9 7
  20. 20. RESULTS RANGE OF MOTION 180 160 140 120 100 80 60 40 20 0 mean forward elevation mean external rotation preop postop Loss of 3.1 degree Loss of 6.4 degree
  21. 21. FUNCTIONAL RESULTS 100 90 80 70 60 50 40 30 20 10 0 ASES WOSI PREOP POSTOP 92.5 76.84% 52 34.76%
  22. 22. COMPLICATIONS Shoulder pain was found in 6 patients (32%) (4 with mild pain and 2 with moderate pain) One patient had hardware complication in terms of screw backing out from the plate. The implant was removed after 15 months of surgery. One patient had superficial wound infection which responded to irrigation and oral antibiotics.
  23. 23. LITERATURE REVIEW POST OP ROM Our study • Flexion: 164.8 degree + 2.0 degree • External rotation: 45.6 degree + 3.0 degree Burkhart and De beer • Flexion:179.6± 2.0° • external rotation: 50.2±12.6° Allain et al • Abduction: 42±17° • external rotation: 48±18° Burkhart S, De Beer J, Barth J, et al. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. . Arthroscopy.2007; 23(10):1033–1041. doi: 10.1016/j.arthro.2007.08.009. Allain J, Goutallier D, Glorion C. Long-term results of the latarjet procedure for the treatment of anterior instability of the shoulder. Journal of Bone and Joint Surgery A. 1998; 80(6):841–852.
  24. 24. LITERATURE REVIEW Redislocation & Subluxation 10 9 8 7 6 5 4 3 2 1 0 Our study Hill et al Allain et al Hovelius et al Redislocation Subluxation 26 mths 58 mths 14.3 yrs 15 yrs
  25. 25. Literature review Arthroscopic vs open Latarjet There is superior stabilization effect of the open Latarjet technique in the ABD position(Abduction with neutral rotation) - anterior capsular repair In the ABER position, no difference Johanna Schulze-Borges, Dr.Eng: Arthroscopy: Vol 29, No 4 (April), 2013: pp 630-637 Biomechanical Comparison of Open and Arthroscopic Latarjet Procedures:
  26. 26. LIMITATIONS Small sample size Short follow up – effect of bone graft on gleno-humeral degenerative arthritis could not be assessed.
  27. 27. CONCLUSION The mini-open Latarjet procedure provides satisfactory outcome and stabilization in this extremely challenging category of patients who present with dramatic bone loss and failed soft tissue reconstruction. We recommend this procedure for young active patients with recurrent anterior inferior shoulder instability even after Arthroscopic Bankart repair.
  28. 28. CASE 1: 21yrs/Male Preop Radiographs and CT
  29. 29. Post op Radiographs AP view Scapular Y view Scapular Y view at 6 months

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