Comprehensive Overview of Latarjet Procedure and Comparison Studies
Understanding the Latarjet procedure, its benefits in cases of bone loss on the glenoid, comparison studies against arthroscopic Bankart repairs and DTA, and insights on open procedures versus arthroscopy. The discussion includes key concepts, outcomes, and considerations for surgical approaches in shoulder instability cases.
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Presentation Transcript
OPEN LATARGET Edwin E Spencer Jr MD Knoxville Orthopaedic Clinic
DISCLOSURES Consultant and receive royalties for DJO Consultant and receive royalties from Tornier/Wright
LATARJET CONCEPT Designed by Latarjet in 1954 and later modified to be performed through a subscap split Described by Patte as having a triple blocking effect Increases bony arc of glenoid Sling effect of conjoint under the inferior subscap in abduction Capsular tightening when the CA stump is sutured to the capsule
WHY DO A LATARJET? The coracoid can handle glenoid bone loss up to 25% when used in a modified position as shown with the inferior aspect down and can handle 20% defects when used with the medial side down Autogenous bone that incurs no risk of allograft use
BONE LOSS I agree that restoring the normal anatomy is best. Afterall who are we to think that we can improve upon God s design We will acquiesce that greater than 25% bone loss on the glenoid is going to require a structural allograft But what about those cases that are 15% to 20% borderline cases?
BORDERLINE CASE 118 arthroscopic Bankart repairs were compared with 31 Latarjet s for these borderline cases Jeon et al Am J Sports Med Jul 2018 Found that the recurrence rate was 23% for the Bankart s and 6.5% for the Latarjet s. That is a 4 fold difference in the recurrence rate! Lets agree that the Latarjet is superior to the arthroscopic Bankart in these cases.
WHAT ABOUT DTA VS LATARJET? Best study I know is a direct head to head analysis Romeo s group compared 50 Latarjet s and 50 DTA s with 2 year follow up with a minimum of 15% bone loss Each group had 32 revisions There was no difference in the VAS, ASES, SANE however the SST WAS SIGNIFICANTLY BETTER IN THE LATARJET! 5 complications in each These are equivalent procedures in skilled experienced hands
NOW THAT WE KNOW THAT THAT THE OPEN PROCEDURES ARE EQUAL DO WE STICK THE SCOPE IN? Its not all about the dislocation bro stay in your lane bro Systematic review was performed reviewing all stabilization surgeries that reported complications. Williams et al Am J Sports Med Dec 2018 4362 operation 1.6% Arthroscopic repair 6.2% Open soft tissue repair 7.2% Open bone block procedure 13.6% Arthroscopic bone block procedure ( 2 fold increase)
LETS SAY THAT YOU STILL WANT TO PROCEEDED WITH ARTHROSCOPIC BONE GRAFT PROCEDURE Wong et al evaluated arthroscopic Latarjet vs DTA Wong et al Am J Sports Med Sep 2018 Only 12 Latarjet (performed only until DTA was available therefore very early in the learning curve) and 36 DTA but had CT scans 2 years postop No clinical difference or difference in the dimensions of the reconstructed glenoid but there was a higher rate of graft resorption in the allograft group
LETS SAY THAT YOU STILL WANT TO PROCEEDED WITH ARTHROSCOPIC BONE GRAFT PROCEDURE Learning curve is greater for arthroscopic bony procedures and the complication rate is higher. Reported in Orthop J Sports Med Jul 2018 requires 20 open Latarjet s to be proficient while it takes double that (40) to perform arthroscopically. Ekhitari et al Orthop J Sports Med Jul 2018 Early outcomes for arthroscopic Latarjet in a systematic review reported a 23% complication rate Cerciello et al An J Sports Med Aug 2018
OVERVIEW Bone loss cases are better treated with bone replacement This has been accomplished very well with the Latarjet and DTA The interest in arthroscopic bone graft procedures is natural but we need to assess our risk benefit analysis what are we really gaining and at what cost? There is no gain in stability which is the primary goal! There is a a demonstrable increase in complications which is diametrically opposed to to our sacred oath of do no harm What do we truly gain?...a feather in our skill hat for us or a return of function to our patients? Whom do we truly serve?
