Background:Contact and collision athletes face a higher risk of recurrent anterior shoulder instability after surgical stabilization. The Latarjet procedure is often preferred given the high incidence of bony lesions. However, this stabilizing procedure, performed either open or arthroscopically, is met with concerns regarding complications and revision surgery rates.Purpose:To evaluate the return to sport (RTS) and assess complication and instability recurrence rates in contact/collision athletes undergoing the arthroscopic Latarjet procedure using a guided technique with suture buttons for coracoid fixations.Study Design:Case series; Level of evidence, 4.Methods:A retrospective analysis was conducted on contact/collision athletes who underwent the arthroscopic Latarjet procedure for recurrent anterior shoulder instability between January 2011 and March 2018. All patients were operated on arthroscopically using glenoid and coracoid guides and suture button fixation of the transferred coracoid. RTS was defined as the patient being able to participate in his or her activity without any restriction postoperatively. Two independent observers assessed patients using postoperative computed tomography (CT) scans to evaluate coracoid positioning and healing. A multivariate analysis was performed to identify predictive factors associated with persistent apprehension. A group comparison was performed to assess RTS failure risk factors.Results:In 136 contact/collision athletes (mean age, 25 ± 7 years), 93% were satisfied, and 98% achieved shoulder stability at a mean follow-up of 60 months (range, 24-117 months). No suture button–related complications or neurovascular issues were reported. Overall, 82% (112/136) returned to contact/collision sports. The mean time to RTS was 5.3 ± 1.2 months (range, 3-7.3 months). In a CT study performed 2 weeks after surgery, 87% (118/136) of bone grafts were positioned below the equator and 93% (126/136) were flush to the glenoid surface. At the 6-month postoperative CT examination, complete bone block healing was achieved in 84% (114/136). On clinical examination at the latest follow-up, 36 patients (26%) reported some anterior apprehension on testing. On multivariate analysis, patients with severe humeral bone defects (medium to large Hill-Sachs lesions, Calandra grade 2 or 3) had a higher risk of postoperative persistent apprehension. On group comparison, a visual analog scale score >3 and persistent anterior apprehension were found to be associated with failure of RTS.Conclusion:The arthroscopic Latarjet procedure with suture button fixation allowed 82% of athletes with recurrent anterior shoulder instability to return to contact or collision sports. Patients with severe humeral bone defects have a higher risk of persistent anterior apprehension and decreased RTS. The arthroscopic-guided procedure with suture button fixation is safe; accurate, with a high rate of anatomic graft positioning and healing; and reliable, with a low recurrence rate.

中文翻译：

---

关节镜 Latarjet 联合皮质纽扣固定术后接触和碰撞运动员重返运动的高比率


背景： 接触和碰撞运动员在手术稳定后面临更高的复发性肩前部不稳定风险。鉴于骨病变的高发生率，Latarjet 手术通常是首选。然而，这种稳定手术，无论是开腹还是关节镜，都遇到了对并发症和翻修手术率的担忧。目的： 评估重返运动 （RTS） 并评估接受关节镜 Latarjet 手术的接触/碰撞运动员的并发症和不稳定复发率，使用带有缝合纽扣的引导技术进行喙突固定。研究设计： 病例系列;证据水平， 4.方法： 对 2011年1月至 2018年3月期间因复发性肩关节不稳定而接受关节镜 Latarjet 手术的接触/碰撞运动员进行回顾性分析。所有患者均使用关节盂和喙突导板进行关节镜手术，并缝合固定转移的喙突。RTS 被定义为患者术后能够不受任何限制地参与他或她的活动。两名独立观察者使用术后计算机断层扫描 （CT） 扫描评估患者，以评估喙突定位和愈合情况。进行多变量分析以确定与持续忧虑相关的预测因素。进行组比较以评估 RTS 失败的危险因素。结果： 在 136 例接触/碰撞运动员 （平均年龄 25 ± 7 岁） 中，93% 的患者满意，98% 的患者在平均随访 60 个月 （范围，24-117 个月） 时达到肩部稳定性。未报告缝合扣相关并发症或神经血管问题。总体而言，82% （112/136） 重返接触/碰撞运动。RTS 的平均时间为 5 秒。3 ± 1.2 个月（范围，3-7.3 个月）。在手术后 2 周进行的一项 CT 研究中，87% （118/136） 的骨移植物位于赤道以下，93% （126/136） 与关节盂表面齐平。术后 6 个月 CT 检查时，84% （114/136） 实现骨阻滞完全愈合。在最近一次随访的临床检查中，36 例患者 （26%） 报告在测试时有一些前部恐惧。在多变量分析中，患有严重肱骨缺损 （中到大 Hill-Sachs 病变，Calandra 2 级或 3 级） 的患者术后持续忧虑的风险更高。在组比较中，发现视觉模拟量表评分 >3 和持续的前部恐惧与 RTS 失败相关。结论： 关节镜下 Latarjet 手术联合缝合扣固定使 82% 的复发性前肩关节不稳定运动员能够恢复接触或碰撞运动。严重肱骨缺损患者持续前部恐惧和 RTS 降低的风险更高。关节镜引导下缝合扣固定术是安全的;准确，解剖移植物定位和愈合率高;可靠，复发率低。