Shoulder stabilization by modified Latarjet-Patte procedure: results at a minimum 10 years' follow-up, and role in the prevention of osteoarthritis.
BACKGROUND
In 1995, our team modified the Latarjet-Patte procedure by associating "south-north" capsule retention with reinsertion to the edge of the glenoid cavity to the coracoid bone-block.


OBJECTIVE
The present minimum 10-year follow-up study tested the hypothesis that the rate of osteoarthritis could be reduced by the strictly extra-articular position of the bone-block and stability be enhanced by the associated Bankart effect.


METHODS
Between January 1995 and December 2001, 78 shoulders were stabilized using the modified Latarjet-Patte procedure in 76 patients with a mean age at surgery of 26.7 years; 89.7% could be followed up, 82.8% of whom also had radiographic follow-up. Fifty-nine were sports players, including 25 at competition level. Stability was assessed on a questionnaire, any dislocation or subluxation being counted as recurrence.


RESULTS
At a mean 13 years' follow-up (range, 10-15 years), there had been no revision surgery. Mean Duplay score was 82.6, mean Subjective Shoulder Value 91.9% and the satisfaction rate 98.5%. The recurrence rate was 1.4% and 10 patients reported residual apprehension. The osteoarthritis rate was 8.5%. Seven bone-blocks projected, but only one was associated with osteoarthritis (stage 1) (non-significant). There were 4 non-unions and 9 lyses, without instability or pain.


CONCLUSIONS
The modified procedure provided a low rate of recurrence and an incidence of osteoarthritis (8.5%) much lower than in any other published series with a minimum 10 years' follow-up. The strictly extra-capsular situation of the bone-block appeared as an important factor in limiting long-term osteoarthritis. Capsule reinsertion also seemed to alleviate the radiologic complications.


METHODS
IV, retrospective study.
CHRU de Tours, Hôpital Trousseau, Service de Chirurgie Orthopédique et Traumatologique, 37044 Tours, France. Electronic address: yves.bouju@gmail.com.
Y
Y
Bouju
CHRU de Tours, Hôpital Trousseau, Service de Chirurgie Orthopédique et Traumatologique, 37044 Tours, France.
F
F
Gadéa
CHRU de Tours, Hôpital Trousseau, Service de Chirurgie Orthopédique et Traumatologique, 37044 Tours, France.
J
J
Stanovici
CHRU de Tours, Hôpital Trousseau, Service de Chirurgie Orthopédique et Traumatologique, 37044 Tours, France.
H
H
Moubarak
CHRU de Tours, Hôpital Trousseau, Service de Chirurgie Orthopédique et Traumatologique, 37044 Tours, France.
L
L
Favard
D000328:Adult; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D061165:Glenoid Cavity / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D010003:Osteoarthritis / Q000453:epidemiology / Q000517:prevention & control*; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000453:epidemiology; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
Coracoid bone-block; Extra-articular; Instability; Shoulder osteoarthritis