Advertisement

Arthroscopic Latarjet Stabilization: Analysis of the Learning Curve in the First 90 Primary Cases: Early Clinical Results and Computed Tomography Evaluation

      Purpose

      To assess the learning curve of arthroscopic Latarjet, evaluating time of surgery, clinical outcomes, complications, revisions, and recurrence.

      Methods

      Arthroscopic Latarjet procedures performed from 2011 to 2016 were reviewed. Satisfaction rate, subjective shoulder value, Walch–Duplay, Rowe scores, range of motion, and stability were evaluated on clinical examination. Graft position and fusion were analyzed using computed tomography. All patients were divided into 3 chronological groups.

      Results

      Ninety patients (3 groups of 30) were available for clinical evaluation (96,8%). The mean follow-up was 23.7 months. Surgical time was significantly (P = .0028) longer in group I (mean 128 minutes, standard deviation [SD] 33.6) when compared with groups II (mean 102 minutes, SD 16.2) and III (mean 108 minutes, SD 21.8). A regression analysis and cumulative sum learning curve analysis showed the surgeon oscillated around mean operative time (112.7 minutes; SD 27.2) after 30 procedures. The number of intraoperative complications was significantly greater (P = .024) in Group I (5 cases; 17%) compared with zero in group II, and 3 (10%) in group III. All 3 cases (3.3%) of recurrence were reported in group I (P = .033). Significantly, 2 of 3 patients with recurrence had intraoperative graft complications (P = .0107). Overall patient satisfaction was evaluated as 92%, SSV 90%, Walch–Duplay and Rowe scores, respectively, 79 and 81 points. Nine revisions (10%) were reported. No significant differences were found between the results and revisions of the 3 chronological groups.

      Conclusions

      This study confirms that the arthroscopic Latarjet procedure provides good clinical and radiologic results at short-term follow-up. The surgical time, frequency of complications, and number of hardware problems significantly decreased after the first 30 cases. As such, surgeons should be aware of the elevated potential for complications and recurrence early in the learning curve—serious intraoperative complications are important risk factors for recurrence.

      Level of evidence

      III. Therapeutic study: case–control study.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Latarjet M.
        [Treatment of recurrent dislocation of the shoulder].
        Lyon Chir. 1954; 49: 994-997
        • Allain J.
        • Goutallier D.
        • Glorion C.
        • Surgery J.
        Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder.
        J Bone Jt Surg Am. 1998; 80: 841-852
        • Castricini R.
        • De Benedetto M.
        • Orlando N.
        • Rocchi M.
        • Zini R.
        • Pirani P.
        Arthroscopic Latarjet procedure: Analysis of the learning curve.
        Musculoskelet Surg. 2013; 97: 93-98
        • Boileau P.
        • Gendre P.
        • Baba M.
        • et al.
        A guided surgical approach and novel fixation method for arthroscopic Latarjet.
        J Shoulder Elbow Surg. 2016; 25: 78-89
        • Kany J.
        • Flamand O.
        • Grimberg J.
        • et al.
        Arthroscopic Latarjet procedure: Is optimal positioning of the bone block and screws possible? A prospective computed tomography scan analysis.
        J Shoulder Elbow Surg. 2016; 25: 69-77
        • Marion B.
        • Klouche S.
        • Deranlot J.
        • Bauer T.
        • Nourissat G.
        • Hardy P.
        A prospective comparative study of arthroscopic versus mini-open Latarjet procedure with a minimum 2-year follow-up.
        Arthroscopy. 2017; 33: 269-277
        • Zhu Y.-M.
        • Jiang C.
        • Song G.
        • Lu Y.
        • Li F.
        Arthroscopic Latarjet procedure with anterior capsular reconstruction: Clinical outcome and radiologic evaluation with a minimum 2-year follow-up.
        Arthroscopy. 2017; 33: 2128-2135
        • Valenti P.
        • Maroun C.
        • Wagner E.
        • Werthel J.-D.
        Arthroscopic Latarjet procedure combined with Bankart repair: A technique using 2 cortical buttons and specific glenoid and coracoid guides.
        Arthrosc Tech. 2018; 7: e313-e320
        • Edwards B.T.
        • Walch G.
        The Latarjet Procedure for recurrent anterior shoulder instability: Rationale and technique.
        Oper Tech Sports Med. 2012; 20: 57-64
        • Hovelius L.
        • Sandström B.
        • Sundgren K.
        • Saebö M.
        One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: Study I—Clinical results.
        J Shoulder Elbow Surg. 2004; 13: 509-516
        • Bhatia S.
        • Frank R.M.
        • Ghodadra N.S.
        • et al.
        The outcomes and surgical techniques of the latarjet procedure.
        Arthroscopy. 2014; 30: 227-235
        • Butt U.
        • Charalambous C.P.
        Complications associated with open coracoid transfer procedures for shoulder instability.
        J shoulder Elbow Surg. 2012; 21: 1110-1119
        • Lafosse L.
        • Lejeune E.
        • Bouchard A.
        • Kakuda C.
        • Gobezie R.
        • Kochhar T.
        The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability.
        Arthroscopy. 2007; 23: 1242.e1-1242.e5
        • Lafosse L.
        • Boyle S.
        Arthroscopic Latarjet procedure.
        J Shoulder Elbow Surg. 2010; 19: 2-12
        • Dumont G.D.
        • Fogerty S.
        • Rosso C.
        • Lafosse L.
        The arthroscopic Latarjet procedure for anterior shoulder instability: 5-year minimum follow-up.
        Am J Sports Med. 2014; 42: 2560-2566
        • Rosso C.
        • Bongiorno V.
        • Samitier G.
        • Dumont G.D.
        • Szollosy G.
        • Lafosse L.
        Technical guide and tips on the all-arthroscopic Latarjet procedure.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 564-572
        • Cunningham G.
        • Benchouk S.
        • Kherad O.
        • Lädermann A.
        Comparison of arthroscopic and open Latarjet with a learning curve analysis.
        Knee Surg Sport Traumatol Arthrosc. 2016; 24: 540-545
        • Cerciello S.
        • Corona K.
        • Morris B.J.
        • Santagada D.A.
        • Maccauro G.
        Early outcomes and perioperative complications of the arthroscopic Latarjet procedure: Systematic review and meta-analysis.
        Am J Sports Med. 2019; 47: 2232-2241
        • Yamamoto N.
        • Itoi E.
        • Abe H.
        • et al.
        Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: A new concept of glenoid track.
        J shoulder Elbow Surg. 2007; 16: 649-656
        • Di Giacomo G.
        • Itoi E.
        • Burkhart S.S.
        Evolving concept of bipolar bone loss and the Hill-Sachs lesion: From “engaging/non-engaging” lesion to “on-track/off-track” lesion.
        Arthroscopy. 2014; 30: 90-98
        • Walch G.
        Directions for the Use of the Quotation of Anterior Instabilities of the Shoulder.
        Abstracts of the First Open Congress of the European Society of Surgery of the Shoulder and Elbow, Paris, France1987
        • Rowe C.R.
        • Patel D.
        • Southmayd W.W.
        The Bankart procedure: A long-term end-result study.
        J Bone Joint Surg Am. 1978; 60: 1-16
        • Gilbart M.K.
        • Gerber C.
        Comparison of the subjective shoulder value and the Constant score.
        J Shoulder Elbow Surg. 2007; 16: 717-721
        • Wewers M.E.
        • Lowe N.K.
        A critical review of visual analogue scales in the measurement of clinical phenomena.
        Res Nurs Health. 1990; 13: 227-236
        • Kraus T.M.
        • Martetschläger F.
        • Graveleau N.
        • et al.
        CT-based quantitative assessment of the surface size and en-face position of the coracoid block post-Latarjet procedure.
        Arch Orthop Trauma Surg. 2013; 133: 1543-1548
        • Boileau P.
        • Mercier N.
        • Roussanne Y.
        • Thelu C.-E.
        • Old J.
        Arthroscopic Bankart-Bristow-Latarjet procedure: The development and early results of a safe and reproducible technique.
        Arthroscopy. 2010; 26: 1434-1450
        • Zumstein V.
        • Kraljevic M.
        • Conzen A.
        • Hoechel S.
        • Muller-Gerbl M.
        Thickness distribution of the glenohumeral joint cartilage: A quantitative study using computed tomography.
        Surg Radiol Anat. 2014; 36: 327-331
        • Ladermann A.
        • Denard P.J.
        • Burkhart S.S.
        Injury of the suprascapular nerve during latarjet procedure: An anatomic study.
        Arthroscopy. 2012; 28: 316-321
        • Kordasiewicz B.
        • Malachowski K.
        • Kicinski M.
        • et al.
        Intraoperative graft-related complications are a risk factor for recurrence in arthroscopic Latarjet stabilisation.
        Knee Surg Sports Traumatol Arthrosc. 2019; 27: 3230-3239
        • Bonnevialle N.
        • Thelu C.E.
        • Bouju Y.
        • et al.
        Arthroscopic Latarjet procedure with double-button fixation: Short-term complications and learning curve analysis.
        J Shoulder Elbow Surg. 2018; 27: e189-e195
        • Metais P.
        • Clavert P.
        • Barth J.
        • et al.
        Preliminary clinical outcomes of Latarjet-Patte coracoid transfer by arthroscopy vs. open surgery: Prospective multicentre study of 390 cases.
        Orthop Traumatol Surg Res. 2016; 102: S271-S276
        • Gerometta A.
        • Klouche S.
        • Herman S.
        • Lefevre N.
        • Bohu Y.
        The Shoulder Instability-Return to Sport after Injury (SIRSI): A valid and reproducible scale to quantify psychological readiness to return to sport after traumatic shoulder instability.
        Knee Surg Sports Traumatol Arthrosc. 2018; 2: 203-211
        • Kordasiewicz B.
        • Malachowski K.
        • Kicinski M.
        • Chaberek S.
        • Pomianowski S.
        Comparative study of open and arthroscopic coracoid transfer for shoulder anterior instability (Latarjet)—clinical results at short term follow-up.
        Int Orthop. 2017; 41: 1023-1033
        • Kordasiewicz B.
        • Kicinski M.
        • Malachowski K.
        • Wieczorek J.
        • Chaberek S.
        • Pomianowski S.
        Comparative study of open and arthroscopic coracoid transfer for shoulder anterior instability (Latarjet)—computed tomography evaluation at a short term follow-up. Part II.
        Int Orthop. 2018; 42: 1119-1128
        • Ladermann A.
        • Denard P.J.
        • Arrigoni P.
        • Narbona P.
        • Burkhart S.S.
        • Barth J.
        Level of the subscapularis split during arthroscopic Latarjet.
        Arthroscopy. 2017; 33: 2120-2124
        • Hardy A.
        • Gerometta A.
        • Granger B.
        • et al.
        Preoperative CT planning of screw length in arthroscopic Latarjet.
        Knee Surg Sport Traumatol Arthrosc. 2018; 26: 24-30
        • Shah A.A.
        • Butler R.B.
        • Romanowski J.
        • Goel D.
        • Karadagli D.
        • Warner J.J.P.
        Short-term complications of the Latarjet procedure.
        J Bone Joint Surg Am. 2012; 94: 495-501
        • Willemot L.B.
        • Wodicka R.
        • Bosworth A.
        • Castagna A.
        • Burns J.
        • Verborgt O.
        Influence of screw type and length on fixation of anterior glenoid bone grafts.
        Shoulder Elbow. 2018; 10: 32-39
        • Schmiddem U.
        • Hawi N.
        • Liodakis E.
        • et al.
        Monocortical fixation of the coracoid in the Latarjet procedure is significantly weaker than bicortical fixation.
        Knee Surg Sports Traumatol Arthrosc. 2019; 27: 239-244
        • Moroder P.
        • Blocher M.
        • Auffarth A.
        • et al.
        Clinical and computed tomography—radiologic outcome after bony glenoid augmentation in recurrent anterior shoulder instability without significant glenoid bone loss.
        J Shoulder Elbow Surg. 2014; 23: 420-426
        • Kee Y.M.
        • Kim J.Y.
        • Kim H.J.
        • Sinha S.
        • Rhee Y.-G.
        Fate of coracoid grafts after the Latarjet procedure: will be analogous to the original glenoid by remodelling.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 926-932
        • Neyton L.
        • Barth J.
        • Nourissat G.
        • et al.
        Arthroscopic Latarjet Techniques: Graft and fixation positioning assessed with 2-dimensional computed tomography is not equivalent with standard open technique.
        Arthroscopy. 2018; 34: 2032-2040
        • Griesser M.J.
        • Harris J.D.
        • McCoy B.W.
        • et al.
        Complications and re-operations after Bristow-Latarjet shoulder stabilization: A systematic review.
        J Shoulder Elbow Surg. 2013; 22: 286-292
        • Di Giacomo G.
        • Costantini A.
        • De Gasperis N.
        • et al.
        Coracoid graft osteolysis after the Latarjet procedure for anteroinferior shoulder instability: A computed tomography scan study of twenty-six patients.
        J Shoulder Elbow Surg. 2011; 20: 989-995
        • Athwal G.S.
        • Meislin R.
        • Getz C.
        • Weinstein D.
        • Favorito P.
        Short-term complications of the arthroscopic Latarjet Procedure: A North American experience.
        Arthroscopy. 2016; 32: 1965-1970
        • Di Giacomo G.
        • de Gasperis N.
        • Costantini A.
        • De Vita A.
        • Beccaglia M.A.R.
        • Pouliart N.
        Does the presence of glenoid bone loss influence coracoid bone graft osteolysis after the Latarjet procedure? A computed tomography scan study in 2 groups of patients with and without glenoid bone loss.
        J Shoulder Elbow Surg. 2014; 23: 514-518

      Linked Article

      • Editorial Commentary: Arthroscopic Latarjet: An Analysis of Outcomes and Complications Through its Learning Curve
        ArthroscopyVol. 35Issue 12
        • Preview
          The arthroscopic Latarjet has been proposed in the past decade to reduce the rate of bone block malpositioning, decrease soft-tissue damage associated with open approach, and possibly decrease intraoperative complications. Several recent studies have reported similar or even superior results with arthroscopic Latarjet compared with those achieved with open technique. However, arthroscopic Latarjet is known to be more technically demanding and some feel that it should be performed by expert shoulder surgeons with advanced arthroscopic skills.
        • Full-Text
        • PDF