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Published on: January 23, 2018
High Rate of Return to Sport in Contact and Collision Athletes After Arthroscopic Latarjet With Cortical Button
Valentina Greco1, Jules Descamps1,2, Natalia-Martinez Catalan1,3
1ICR-Institut de Chirurgie Réparatrice Locomoteur & Sport-Groupe KANTYS, Nice, France.
Background:
Contact and collision athletes face a higher risk of recurrent anterior shoulder instability after surgical stabilization. The Latarjet procedure is often preferred given the high incidence of bony lesions. However, this stabilizing procedure, performed either open or arthroscopically, is met with concerns regarding complications and revision surgery rates.
Purpose:
To evaluate the return to sport (RTS) and assess complication and instability recurrence rates in contact/collision athletes undergoing the arthroscopic Latarjet procedure using a guided technique with suture buttons for coracoid fixations.
Study Design:
Case series; Level of evidence, 4.
Methods:
A retrospective analysis was conducted on contact/collision athletes who underwent the arthroscopic Latarjet procedure for recurrent anterior shoulder instability between January 2011 and March 2018. All patients were operated on arthroscopically using glenoid and coracoid guides and suture button fixation of the transferred coracoid. RTS was defined as the patient being able to participate in his or her activity without any restriction postoperatively. Two independent observers assessed patients using postoperative computed tomography (CT) scans to evaluate coracoid positioning and healing. A multivariate analysis was performed to identify predictive factors associated with persistent apprehension. A group comparison was performed to assess RTS failure risk factors.
Results:
In 136 contact/collision athletes (mean age, 25 ± 7 years), 93% were satisfied, and 98% achieved shoulder stability at a mean follow-up of 60 months (range, 24-117 months). No suture button-related complications or neurovascular issues were reported. Overall, 82% (112/136) returned to contact/collision sports. The mean time to RTS was 5.3 ± 1.2 months (range, 3-7.3 months). In a CT study performed 2 weeks after surgery, 87% (118/136) of bone grafts were positioned below the equator and 93% (126/136) were flush to the glenoid surface. At the 6-month postoperative CT examination, complete bone block healing was achieved in 84% (114/136). On clinical examination at the latest follow-up, 36 patients (26%) reported some anterior apprehension on testing. On multivariate analysis, patients with severe humeral bone defects (medium to large Hill-Sachs lesions, Calandra grade 2 or 3) had a higher risk of postoperative persistent apprehension. On group comparison, a visual analog scale score >3 and persistent anterior apprehension were found to be associated with failure of RTS.
Conclusion:
The arthroscopic Latarjet procedure with suture button fixation allowed 82% of athletes with recurrent anterior shoulder instability to return to contact or collision sports. Patients with severe humeral bone defects have a higher risk of persistent anterior apprehension and decreased RTS. The arthroscopic-guided procedure with suture button fixation is safe; accurate, with a high rate of anatomic graft positioning and healing; and reliable, with a low recurrence rate.
