title: The role of arthroscopy in the revision of failed Latarjet procedures.
abstract: Glenohumeral instability is an intrinsic pathological condition of the shoulder, owing to its ample range of mobility that predisposes this joint to a somewhat limited degree of stability. Several techniques have been employed for the treatment of instability. Among these, one is the Latarjet procedure, recommended for cases of substantial bone deficit on the humeral head or on the anterior region of the glenoid. Such technique gives generally good, long-term results, considering the low incidence of recurrence. However, potential complications such as glenohumeral arthrosis, absorption of the bone block, breakage, malpositioning or mobilization of the screws, infections, neurological or vascular complications can be serious. Moreover, as a result of further severe trauma, the shoulder can become again globally unstable. In such cases, the question arises of which technique to employ in surgical revision, since the Latarjet procedure determines substantial subversion of glenohumeral anatomy. The aim of the study was the analysis of arthroscopical treatment after failure of a Latarjet procedure and to describe the related definitive results. During the period between January 2000 and June 2007, we treated 17 patients (18 shoulders) using arthroscopy, following failure of an open Latarjet surgical procedure. One patient was operated bilaterally. Clinical revision according to the Constant Score, ROWE, ASES, UCLA and the VAS scale for pain evaluation was carried out during follow-up examination after an average period of 5 years and 9 months (min. 2 years-max. 9 years) from latest surgery. The system of evaluation according to the Constant Score indicated an average score of 78.4/100 at follow-up examination; UCLA indicated 27.2/35; ASES 99.6/120; ROWE 75.2/100. With regard to pain, the VAS Scale indicated an average score of 2.9/10. As criteria for relapse, we considered classic cases of dislocation and subluxations, or sprains with subluxation, and subjectively experienced apprehension and pain to a degree that seriously inhibited the patient's daily life. The incidence of relapse following the final surgical operation (taking into consideration both frank dislocations and subluxations) was 16.7%. At clinical revision, one patient showed dislocation due to relatively modest trauma approximately 1 year following the second surgery (5.6%). Episodes of subluxation or sprains continued in 2 shoulders (11.1% relapse). In 11 cases (61%), return to sports activities was achieved. Arthroscopy technique using anchors and sutures can, in selected cases, lead to satisfactory results, allowing, by means of minimal surgical invasion, identification and treatment also of intra-articular lesions, where associated.
authors.affiliation: IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Castagna
authors.forename: Raffaele
authors.initials: R
authors.lastname: Garofalo
authors.forename: Gianluca
authors.initials: G
authors.lastname: Melito
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Markopoulos
authors.forename: Silvana
authors.initials: S
authors.lastname: De Giorgi
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008875:Middle Aged; D012086:Reoperation; D012785:Shoulder Joint / Q000601:surgery*; D017211:Treatment Failure; D055815:Young Adult
references.citation: J Bone Joint Surg Br. 2007 Nov;89(11):1470-7
references.pmid: 17998184
references.citation: J Bone Joint Surg Am. 1998 Jun;80(6):841-52
references.pmid: 9655102
references.citation: Rev Chir Orthop Reparatrice Appar Mot. 2000 Sep;86 Suppl 1:111-4
references.pmid: 11084509
references.citation: J Bone Joint Surg Am. 2000 Aug;82(8):1108-14
references.pmid: 10954100
references.citation: Rev Chir Orthop Reparatrice Appar Mot. 2000 Sep;86 Suppl 1:114-21
references.pmid: 11084510
references.citation: J Bone Joint Surg Am. 1984 Feb;66(2):159-68
references.pmid: 6693441
references.citation: Rev Chir Orthop Reparatrice Appar Mot. 2008 Feb;94(1):12-8
references.pmid: 18342025
references.citation: Arthroscopy. 1993;9(2):190-4
references.pmid: 8461080
references.citation: Arthroscopy. 2008 May;24(5):514-9
references.pmid: 18442682
references.citation: Chir Organi Mov. 2005 Apr-Jun;90(2):145-52
references.pmid: 16422240
references.citation: J Bone Joint Surg Am. 1976 Mar;58(2):252-6
references.pmid: 1254632
references.citation: Arthroscopy. 1990;6(4):324-6
references.pmid: 2264902
references.citation: J Bone Joint Surg Br. 1985 Nov;67(5):709-14
references.pmid: 4055865
references.citation: Clin Sports Med. 1999 Oct;18(4):737-67
references.pmid: 10553234
references.citation: Chir Organi Mov. 2008 Feb;91(2):125-31
references.pmid: 18320386
references.citation: Am J Sports Med. 1995 May-Jun;23(3):276-81
references.pmid: 7661252
references.citation: Lyon Chir. 1954 Nov-Dec;49(8):994-7
references.pmid: 13234709
references.citation: Arthroscopy. 2002 May-Jun;18(5):469-82
references.pmid: 11987056
references.citation: Orthopedics. 1993 Sep;16(9):993-1002
references.pmid: 8234081
references.citation: Orthop Clin North Am. 1993 Jan;24(1):59-69
references.pmid: 8421618
references.citation: Arthroscopy. 2000 May-Jun;16(4):359-66
references.pmid: 10802472
references.citation: J Shoulder Elbow Surg. 2007 Jul-Aug;16(4):419-24
references.pmid: 17531511
references.citation: J Bone Joint Surg Am. 2006 Aug;88(8):1755-63
references.pmid: 16882898
references.citation: Surg Radiol Anat. 2009 Jan;31(1):49-53
references.pmid: 18936872
references.citation: Arch Orthop Trauma Surg. 1987;106(4):260-2
references.pmid: 3619608
references.citation: Arthroscopy. 2001 Feb;17(2):206-8
references.pmid: 11172253
references.citation: Acta Orthop Scand. 1983 Apr;54(2):284-90
references.pmid: 6846008
references.citation: Chir Organi Mov. 2008 Feb;91(2):79-83
references.pmid: 18320378
references.citation: J Bone Joint Surg Am. 2003 Aug;85(8):1511-8
references.pmid: 12925631
references.citation: Chir Organi Mov. 2005 Oct-Dec;90(4):353-64
references.pmid: 16878770
references.citation: Chir Organi Mov. 2005 Jan-Mar;90(1):1-10
references.pmid: 16422224
references.citation: Am J Sports Med. 1993 May-Jun;21(3):348-53
references.pmid: 8346746
references.citation: J Bone Joint Surg Am. 2002 May;84(5):711-5
references.pmid: 12004010
references.citation: Arthroscopy. 2000 Jul-Aug;16(5):451-6
references.pmid: 10882438
references.citation: Chir Organi Mov. 2005 Apr-Jun;90(2):201-7
references.pmid: 16422246
references.citation: Am J Sports Med. 2000 Nov-Dec;28(6):794-9
references.pmid: 11101100
references.citation: Chir Organi Mov. 2005 Apr-Jun;90(2):133-6
references.pmid: 16422238
references.citation: Chir Organi Mov. 2005 Apr-Jun;90(2):137-43
references.pmid: 16422239
references.citation: Am J Sports Med. 2000 Mar-Apr;28(2):156-60
references.pmid: 10750990
references.citation: Arthroscopy. 2002 Sep;18(7):755-63
references.pmid: 12209434
references.citation: J Shoulder Elbow Surg. 1999 Jan-Feb;8(1):58-65
references.pmid: 10077799