title: Latarjet procedure using subscapularis split approach offers better rotational endurance than partial tenotomy for anterior shoulder instability.
abstract: OBJECTIVE
  Latarjet, which is a coracoid bone block procedure, is an effective treatment for anterior shoulder instability with glenoid bone loss. During this reconstructive procedure the subscapularis may be tenotomized or be split to expose the glenoid neck. The aim of this study was to assess the effect of subscapularis management on functional outcomes and internal and external rotation durability and strength. Hypothesis is that the subscapularis split approach will result in better functional results and superior internal rotation strength and endurance.
  
  
  METHODS
  The study included 48 patients [median age 30 (range 16-69); 42 males, 6 females], who underwent a modified Latarjet procedure for anterior shoulder instability. There were 20 patients in the subscapularis tenotomy group and 28 patients in the subscapularis split group. The groups were compared isokinetically using a computerized dynamometer for internal and external rotation durability and strength. At the latest follow-up, the patients were evaluated with the American Shoulder and Elbow Surgeons (ASES) and ROWE scores for functional outcomes.
  
  
  RESULTS
  At a median follow-up period of 25 (range 12-73) months after the Latarjet procedure, the internal rotation durability was significantly higher in the split group (p = 0.045). However, a statistically significant difference could not be found for internal and external rotational strengths (n.s.). There was also no significant difference between the final ASES and ROWE scores (n.s.).
  
  
  CONCLUSIONS
  Although both approaches offer promising results, the subscapularis split approach appears to provide better internal rotation durability compared to subscapularis tenotomy. Therefore, the subscapularis split approach may be more preferable for the management of the subscapularis muscle during Latarjet procedure.
  
  
  METHODS
  Retrospective cohort study, Level III.
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey. ali_ersen@hotmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Ersen
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey.
authors.forename: Fevzi
authors.initials: F
authors.lastname: Birisik
authors.affiliation: Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Ozben
authors.affiliation: Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey.
authors.forename: Ata Can
authors.initials: AC
authors.lastname: Atalar
authors.affiliation: Department of Sports Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Turker
authors.initials: T
authors.lastname: Sahinkaya
authors.affiliation: Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey.
authors.forename: Aksel
authors.initials: A
authors.lastname: Seyahi
authors.affiliation: Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Demirhan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D000070597:Coracoid Process / Q000601:surgery*; D004210:Dissection; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D053581:Muscle Strength Dynamometer; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D012189:Retrospective Studies; D012399:Rotation; D017006:Rotator Cuff / Q000601:surgery*; D012782:Shoulder / Q000503:physiopathology / Q000601:surgery; D012783:Shoulder Dislocation / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D058971:Tenotomy; D016896:Treatment Outcome; D055815:Young Adult
keywords: Latarjet procedure; Strength; Subscapularis split; Subscapularis tenotomy