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Subscapularis management during open Latarjet procedure: does subscapularis split versus tenotomy matter? A
Martin S Davey1, Matthew G Davey1, Eoghan T Hurley1
1Department of Orthopaedics, Sports Surgery Clinic, Dublin, Ireland.
Background:
The purpose of this study was to systematically review the literature to ascertain the clinical outcomes of the open Latarjet (OL) procedure using either a subscapularis-split (SS) or subscapularis tenotomy (ST) via a deltopectoral (DP) approach.
Methods:
Two independent reviewers performed a literature search using the PubMed, Embase, and Scopus databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Only studies reporting on outcomes of the OL procedure via a DP approach comparing both SS and ST were considered for inclusion. Meta-analysis to compare clinical outcomes was performed using RevMan software.
Results:
Our search found 5 studies that met our inclusion criteria, including 615 shoulders (80.8% male patients), with an average age of 27.8 ± 12.6 years (range, 15-79 years) and mean follow-up period of 50.1 ± 29.4 months (range, 12-180 months). A total of 410 shoulders and 205 shoulders underwent the OL procedure via a DP approach using the ST technique and the SS technique, respectively, with both techniques resulting in significant increases in the Rowe score postoperatively (P < .0001 for both). Additionally, significantly higher postoperative Constant scores were observed in patients who underwent the OL procedure via an SS technique vs. those in the ST group (91.8 ± 7.2 vs. 79.6 ± 16.1, P < .0001). However, meta-analysis showed nonsignificantly higher postoperative Rowe and American Shoulder and Elbow Surgeons scores in patients who underwent the OL procedure via an SS technique vs. those in the ST group (96.1 ± 2.6 vs. 86.4 ± 7.6 [P = .57] and 91.6 ± 1.3 vs. 80.6 ± 25.5 [P = .47], respectively). Furthermore, meta-analysis showed that significantly more patients in the ST group had positive lift-off test results (10.0%) when compared with the SS group at final follow-up (2.7%, P = .01). However, meta-analysis indicated that the rate of recurrent instability was trending toward significance in favor of the SS group (0% vs. 11.7%, P = .07).
Conclusion:
Our systematic review established that in cases of OL procedures being carried out via a DP approach, the SS technique results in significantly better functional outcome measures and significantly lower rates of subscapularis insufficiency when compared with an L-shaped ST technique at medium-term follow-up. Furthermore, there were lower rates of recurrent instability that were trending toward significance in favor of the SS technique.
