MANAGEMENT OF THE FAILED LATARJET PROCEDURE

Delgado Cristina; Valencia Maria; Martínez-Catalán Natalia; Calvo Emilio

doi:10.1016/j.jse.2024.03.045

MANAGEMENT OF THE FAILED LATARJET PROCEDURE

J Shoulder Elbow Surg. 2024 May 10:S1058-2746(24)00325-2. doi: 10.1016/j.jse.2024.03.045. Online ahead of print.

Authors

Delgado Cristina¹, Valencia Maria¹, Martínez-Catalán Natalia¹, Calvo Emilio²

Affiliations

¹ Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
² Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain. Electronic address: ecalvo@fjd.es.

PMID: 38735635
DOI: 10.1016/j.jse.2024.03.045

Abstract

Aim: To analyze the causes of failure after a Latarjet procedure and to evaluate the results of revision surgery.

Methods: Single-cohort, retrospective, observational study. Fifteen patients, 13 males, mean age at revision failed Latarjet 38.9 years (range, 20-57), with anterior glenohumeral instability who underwent a revision surgery for a failed Latarjet procedure were reviewed. Failure was defined as subluxation or dislocation. Demographic features, the reason for failure, type of lesions observed, and postoperative clinical and functional status were recorded. Functional status was assessed with the Rowe score. Subjective clinical evaluation was performed using the WOSI Index and subjective shoulder value (SSV).

Results: Recurrence occurred in the first year following the Latarjet procedure in 11 (73.3%) patients. The causes of failure were graft avulsion in 3 cases, fracture in 1, coracoid misposition in 2 cases, graft non-union in 1, advanced osteolysis in 4 cases and persistence of an off-track Hill-Sachs lesion in one. In 3 cases no identifiable cause of failure, but patients generalized severe hyperlaxity was found. Regarding revision surgery after the Latarjet procedure, 8 patients underwent an arthroscopic Eden-Hybinette procedure and in 3 patients the graft was repositioned. In the remaining 4 patients an extraarticular capsular reinforcement was performed. Regarding the latter, one patient suffered new dislocations and required an additional revision surgery consisting of an Eden-Hybinette procedure. All patients remained stable after the revision surgery at the latest follow-up, except two who reported subluxations after an arthroscopic Eden-Hybinette and an extraarticular capsular reinforcement, but no additional surgical procedure was required. Functional status after revision surgery was satisfactory, with a Rowe mean score noted at 78 (10-100), WOSI score at 829 (225-1425) and a subjective shoulder value scale at 67 points (40-90).

Conclusion: The causes of failure after a Latarjet procedure were poor bone graft due to mispositioning, avulsion, fracture or resorption, generalized hyperlaxity, and incomplete restoration of the glenoid track. Our study demonstrates that when the cause of failure is identified and addressed, stability is restored, and clinical and functional scores improved.

Keywords: Latarjet; recurrence; shoulder instability.