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Surgical Treatment of Anterior Shoulder Instability by Latarjet-Patte Procedure

March 01, 2017

Contributors: Raffaele Borghi, MD; Salvatore Calderone, MD; Mohammadreza Chehrassan, MD; Daniele Fabbri, MD; Cesare Faldini, MD; Fabrizio Perna; Federico Pilla, MD; Niccolò Stefanini, MD; Francesco Traina, MD, PhD; Francesco Traina, MD, PhD

2017 AWARD WINNER Introduction: Anterior shoulder instability is a common clinical entity with an incidence as high as 2% in the general population. Shoulder instability most commonly occurs in young, active patients who are involved in heavy work or contact sports. Shoulder stabilization is the treatment of choice for these patients because of the high rate of recurrent instability (60% to 90%) reported in patients with anterior shoulder instability that is not managed before the patient is aged 25 years. The preferred treatment option is arthroscopic Bankart repair, which is associated with success rates ranging from 85% to 90%. The main cause of arthroscopic Bankart repair failure is related to osseous defects of the glenoid rim or the humeral head that are not managed. Cadaver model studies have shown that bone loss of 20% of overall glenoid width is the threshold beyond which arthroscopic Bankart repair is insufficient for safe shoulder stabilization. The Latarjet-Patte procedure with coracoid transfer is the treatment of choice for the management of defects that involve 20% of glenoid width and patients in whom arthroscopic Bankart repair fails. Materials and Method: A retrospective review of 36 patients was performed. Patient age at first dislocation, mechanism of injury, and number of preoperative dislocations were recorded. Using the Rowe shoulder score, function and stability of the shoulder were evaluated preoperatively and at the latest follow-up. Results: Mean follow-up was 2 years (range, 1 to 4 years). The study included 34 men and 2 women. All 36 patients experienced instability after trauma. Mean patient age at the time of the first shoulder dislocation was 20 years (range, 16 to 29 years). The mean number of recurrent dislocations was seven (range, 5 to 11 dislocations). The dominant limb was involved in 22 of the patients. The mean preoperative Rowe shoulder score was 38 (range, 15 to 70). At the latest follow-up, no patient had experienced a dislocation. The mean postoperative Rowe shoulder score was 91 (range, 80 to 100). No screw loosening was reported. Complete bone union was achieved in all the patients. A slight decrease in mean external rotation was reported on the surgical side (30° [range, 20° to 45°]) compared with the nonsurgical side (45° [range, 35° to 55°]); however, the difference was not clinically relevant. Conclusion: The Latarjet-Patte procedure may be a valuable surgical option for the management of recurrent anterior shoulder instability in patients with bone defects that involve 20% of glenoid width, resulting in good clinical outcomes and a low rate of complications.