Travmatologiâ i Ortopediâ Rossii (Jan 2021)
Results of Modified Mini-Open Arthroscopically Assisted Bristow - Latarjet - Bankart Procedure
Abstract
The aim of the study — to evaluate clinical outcomes, complications, bone-block healing, positioning and subscapularis muscle insufficiency after modified mini-open arthroscopically assisted Bristow - Latarjet - Bankart procedure. Materials and Methods. The study included 133 patients who underwent modified mini-open arthroscopically assisted Bristow - Latarjet - Bankart procedure, assessed the functional outcome using the Rowe and Walch-Duplay scales, the range of motion and stability of the joint, and the function of the subscapularis muscle. All patients underwent CT, 82 patients were assessed for MR-signs of subscapularis muscle atrophy. Results. All patients were satisfied with the treatment results. The mean value on the Rowe scale increased from 35.7 [31,2; 41,0] to 91.3 [82,1; 96,8] (38 to 100 Me 90) (p0.001) and on the Walch-Duplay scale from 41.5 [34,2; 44,5] to 88.9 [80,4; 97,2] (32 to 100, Me 88) (p0.001). In 2 (1.5%) patients, shoulder dislocation recurred, in 9 (6.8%) patients, a positive test of premonition of dislocation or periodic feelings of instability were observed. There were no persistent contractures. In 6 (4.5%) cases, the graft was located medially and in 3 (2.3%) cases — laterally. The average α-angle was 14° [5°; 24°] (2° to 39°, Me 15). The proportion of the graft area lost due to resorbtion was 19% [9%; 30%] (from 6 to 58%, Me 20). Nonunion of the graft was observed in 4 (3.0%) patients, 2 (1.5%) of whom had a fracture and bone block migration. A significant (p = 0.021) decrease in the intensity of the MR-signal of the subscapularis muscle was observed, most pronounced in the lower portion. In 9 patients with a positive test of anticipation of dislocation or sensations of instability, the degree of bone block resorption (p = 0.038) and MR-signs of atrophy of the upper and lower portions of the subscapularis muscle were significantly higher (p = 0.031 and p0.001), and the results of stress testing significantly worse (p0.001) than in 122 patients without signs of instability. Conclusion. The results of this study show the efficacy of the modified arthroscopically-assisted Bristow - Latarjet - Bankart procedure in patients with large bone defects, when the soft tissue technique is not a reasonable option.
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