Background:Despite improved visualization, the use of arthroscopic surgery to perform the Latarjet procedure has not decreased the rates of complications and glenohumeral osteoarthritis (OA) in the long term. Many of the reported complications are related to the use of screws for bone block fixation with freehand drilling.Purpose:To evaluate the long-term (at a minimum 10-year follow-up) clinical and radiological outcomes of the arthroscopic Bristow-Latarjet procedure using a posterior guided drilling technique and suture button for coracoid bone graft fixation.Study Design:Case series; Level of evidence, 4.Methods:Consecutive patients who underwent the arthroscopic Bristow-Latarjet procedure with suture button fixation between 2011 and 2013 were reviewed by 2 independent evaluators. Complications and revision surgery were recorded, and we evaluated patient-reported outcomes including subjective scores, recurrence of shoulder instability (dislocation or subluxation), range of motion limitations, and return to sports. Patients had radiographs taken at least 10 years after surgery to assess glenohumeral OA according to the Samilson-Prieto classification system and computed tomography scans to assess bone block positioning and healing.Results:A total of 65 consecutive patients (68 shoulders) with a mean follow-up of 135 months (range, 120-156 months) were included. The mean age at the time of surgery was 25 ± 8 years; 7 patients had previous failed Bankart repair. At follow-up, 94% (64/68) of the shoulders had no recurrence of instability. The 4 cases of instability recurrence were traumatic and occurred at 3 weeks (a fall), 4 months, 2 years, and 7 years after surgery. No hardware failures, coracoid fractures, or neurological complications were observed. Overall, 61 patients (94%) were still participating in sports, with 44 (68%) at the same or higher level. Range of motion showed nonsignificant restrictions in external rotation with the arm at the side (7° ± 9°) and with the arm at 90° of abduction (9° ± 10°) compared with the contralateral side. Additionally, 11 shoulders (16%) had some residual anterior apprehension on clinical examination. At last follow-up, 77% (47/61) of the shoulders had no OA development or progression. Previous failed Bankart repair was a risk factor for the development of OA. Patients with OA had significantly lower Subjective Shoulder Value scores (79% vs 91%, respectively; P = .01) and decreased external rotation with the arm at the side (40° vs 65°, respectively; P = .001) compared with patients with no or little OA.Conclusion:The arthroscopically guided Bristow-Latarjet procedure with suture button fixation is a safe and durable surgical treatment method for recurrent anterior shoulder instability, allowing a high rate of return to sports without significant motion restrictions and no or little OA in the long term.

中文翻译：

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关节镜引导下皮质纽扣固定的 Bristow-Latarjet 手术：至少 10 年随访


背景：尽管可视化效果有所改善，但从长远来看，使用关节镜手术进行 Latarjet 手术并没有降低并发症和盂肱骨关节炎 (OA) 的发生率。许多报告的并发症与徒手钻孔使用螺钉进行骨块固定有关。目的：评估关节镜 Bristow-Latarjet 手术的长期（至少 10 年随访）临床和放射学结果使用后路引导钻孔技术和缝合纽扣进行喙突骨移植固定。研究设计：病例系列；证据级别，4。方法：2011 年至 2013 年间连续接受缝纽固定的关节镜 Bristow-Latarjet 手术的患者由 2 名独立评估员进行评估。记录并发症和翻修手术，并评估患者报告的结果，包括主观评分、肩部不稳定（脱位或半脱位）的复发、运动范围限制和恢复运动。患者在手术后至少 10 年拍摄 X 光片，根据 Samilson-Prieto 分类系统评估盂肱骨关节炎，并进行计算机断层扫描以评估骨块定位和愈合。 结果：总共 65 名连续患者（68 肩）的平均随访时间- 包括 135 个月（范围：120-156 个月）。手术时的平均年龄为 25 ± 8 岁； 7 名患者之前曾接受过 Bankart 修复失败。随访时，94% (64/68) 的肩部没有复发不稳定。 4例不稳定复发为创伤性，分别发生在术后3周（跌倒）、4个月、2年、7年。没有观察到硬件故障、喙骨骨折或神经系统并发症。 总体而言，61 名患者（94%）仍在参加运动，其中 44 名患者（68%）处于相同或更高水平。与对侧相比，手臂位于一侧 (7° ± 9°) 和手臂外展 90° (9° ± 10°) 时，运动范围显示出不显着的外旋限制。此外，在临床检查中，11 个肩膀（16%）有一些残留的前部恐惧。在最后一次随访中，77% (47/61) 的肩部没有出现 OA 或进展。先前失败的 Bankart 修复是 OA 发展的风险因素。与 OA 患者相比，OA 患者的主观肩部评分显着较低（分别为 79% vs 91%；P = .01），且手臂位于一侧时的外旋能力显着降低（分别为 40° vs 65°；P = .001）。结论：关节镜引导下纽扣固定的 Bristow-Latarjet 手术是治疗复发性肩关节前不稳定的一种安全且持久的手术治疗方法，可实现较高的运动恢复率，且没有明显的运动限制，并且没有或很少有运动限制。从长远来看，OA。