Arthoscopic Bankart-latarjet in a Peripheral Hospital Center? Feasibility and Reproducibility: A Study of 40 Cases
2Service d’orthopédie, Centre hospitalier de l’Ardenne, Belgium
3OrthoVar, Pôle médical Epsilon 3, France
4Orthopedic department, Assuta Samsom University Hospital, Israel
Aim:
The purpose of this study is to evaluate the feasibility and reproducibility of a Bankart-Latarjet under arthroscopy fixed by cortical buttons, in a peripheral hospital center (10-15 operations by year) by a surgeon experienced in shoulder arthroscopy.
Background:
The arthroscopic Latarjet-Bankart technique is still reserved for high-volume referral centers. Its realization in a peripheral hospital with a lower volume of activity may therefore give rise to some reservations.
Methods and Materials:
This is a retrospective study of patients treated for recurrent anterior instability of the shoulder, primary or secondary after previous arthroscopic Bankart repair, with loss of glenoid bone stock ≥ 40% by the Gerber index. All patients were operated on by the same surgeon using the technique described by Boileau. The duration of surgery, intra and post-operative complications (at 2, 6 and 12 weeks, 6 and 12 months minimum) were recorded. The clinical scores (Walch-duplay, Rowe and WOSI (Western Ontario Shoulder Instability Index)) were measured preoperatively and at 12 months post operatively. The consolidation and position of the bone block were evaluated at 6 months (at 12 months if necessary) by CT scan.
Results:
Between September of 2016 and February of 2020, 40 operations (mean age of 28.5 years [16-46] were performed with a mean operative time of 176 minutes [120-285] without transferring to an open approach. In a mean follow-up of 29.5 months [12-59] we noted one case of fracture of the callus of a consolidated bone block (2.5%) following trauma, but no other complication. No recurrence of instability was recorded. The clinical scores improved significantly during post-operative consultations and at 12 months post-op. The Walch-Duplay score increased from 17.8 to 94.6, Rowe from 24.9 to 96,8 and WOSI from 52.1% to 6.9%. The bone block was consolidated in 35 patients (87.5%), a sub-equator position was noted in 28 patients (70%) and a flush position with the anterior edge of the glenoid was noted in 40 patients (100%).
Conclusion:
The arthroscopic Bankart-Latarjet technique with the use of guided instrumentation and cortical suture-button fixation of the bone block is a difficult but reliable and reproducible procedure in the hands of surgeons experienced in shoulder surgery, in a peripheral hospital center.