オープンLatarjet手術時の肩関節鏡視検査の有用性

Latarjet is a reliable surgery for shoulder instability, particularly in cases of glenoid bone loss. However, there is a paucity of literature regarding the utility of shoulder arthroscopy with open Latarjet. Prior to Latarjet, shoulder arthroscopy can evaluate the joint and assess for the need for concomitant procedures.

The purpose of this study was to determine if arthroscopy performed in conjunction with open Latarjet identifies pathology that alters surgical procedures performed. It was hypothesized that arthroscopy would effectively identify additional pathology not seen on magnetic resonance imaging (MRI) requiring surgical management.

Case series; Level of evidence, 4.

A retrospective review of open Latarjet procedures between 2010 and 2022 was performed. Patients who had a shoulder arthroscopy in conjunction with open Latarjet were identified. Electronic records were reviewed to gather patient and surgical data to determine what pathology was identified and what procedures were performed as part of arthroscopy.

In total, 307 Latarjet procedures were performed in 293 patients. Arthroscopy in conjunction with Latarjet was performed in 174 cases. Of these, 19 patients (10.9%) underwent diagnostic arthroscopy alone, 155 patients (89.1%) had at least an extensive debridement, and 16 patients (9.2%) had an additional arthroscopic procedure, including loose body removal, superior labrum anterior and posterior (SLAP) repair, biceps tenotomy, SLAP debridement, rotator cuff repair, and remplissage. Arthroscopic evaluation identified anterior glenoid bone loss (100%), torn or diminished anterior labrum (100%), Hill-Sachs lesion (87%), type I SLAP tear/fraying (11.5%), low-grade partial-thickness supraspinatus tear/fraying (9.2%), type II to IV SLAP tear (6.3%), biceps tendon tear (5.2%), and full-thickness supraspinatus tear (1.1%). Of the 16 cases with significant pathology identified that required additional treatment, there were 11 type II to IV SLAP tears requiring debridement, debridement and biceps tenodesis, or SLAP repair; 3 biceps tendon tears requiring biceps tenodesis; and 2 full-thickness supraspinatus tears requiring rotator cuff repair. For patients with a type II to IV SLAP or biceps tendon tear identified arthroscopically, preoperative MRI identified a tear in 10 cases, while 1 patient had a type III SLAP tear not identified on MRI. Both patients requiring a rotator cuff repair had a preoperative MRI that identified the tear.

Arthroscopy performed with open Latarjet effectively identifies additional pathology and may alter management. Ultimately, 89.1% of this population underwent arthroscopic debridement, while 9.2% had significant pathology identified that required additional procedures.