Midterm Clinical Outcome of Minimally Invasive Latarjet Procedure for Recurrent Anterior Shoulder Instability- A Prospective Cohort Study

Abstract

Introduction: Latarjet coracoid bone block is an effective treatment for the management of recurrent anterior shoulder instability. Minimally invasive technique modified by Saragaglia helps in preservation of subscapularis, leaves a minimal scar and helps in early rehabilitation and recovery. Aim: To assess the midterm clinical outcome of minimally invasive Latarjet procedure for recurrent anterior shoulder instability. Materials and Methods: This was a prospective cohort study conducted from April 2013 to March 2019 at a tertiary care Orthopaedic and Trauma Hospital in patients above 20 years of age of either sex with instability severity score index of >6 were included. A detailed history and clinical examination was done with special reference to hand dominance and number of episodes. Special tests like shift and load test, sulcus test, anterior apprehension test shoulder anterior drawer test and Jobe’s relocation test were done and found to be positive. Preoperative Rowe score was assessed in all the patients. Mean follow-up in present study was 60±18 months. Quantitative variables were analysed using Student’s t-test and qualitative variables using Fisher’s-exact test or Chi-square test. A p-value of <0.05 was considered as significant. Results: There were 40 men and seven female patients (49 shoulders, two patients with bilateral pathology) with an average age of 33.5±9 years. No recurrent dislocation was reported in the study. None of the patients had a positive apprehension test at final follow-up. Rowe score at final follow-up was excellent in 39 (79.6%) patients, good in 7 (14.3%) patients, fair in 3 (6.1%) patients and no patient reported poor result (score below 50). All special tests like shift and load test, sulcus test, anterior apprehension test, shoulder anterior drawer test and Jobe’s relocation test became negative at final follow-up. Three patients developed superficial infection and one patient developed pseudoarthrosis of the graft. Conclusion: Minimally invasive Latarjet procedure is simple, easy and reproducible method of treating anterior shoulder instability. It provides good cosmesis and functional results with low recurrence rate at a midterm follow-up.

Keywords

• bony glenoid loss
• coracoid bone block
• recurrent dislocation