latarjet with comparison -姜春岩教授 1_肩关节培训班.pptxVIP

Arthroscopic vs. Open Latarjet: Who’s the Champion ? ， • 4% recurrent rate (7/173) in patients without significant bone defects vs. 67% (14/21) in patients with significant bone defects • Contact athlete with significant bone defects: 89% recurrent rate Glenoid bone defect in anterior instability • • Latarjet Procedure – “triple blocking” • Dynamic reinforcement by the conjoined tendon • Inferior capsular ligamentous complex reinforcement by the stump of the coracoacromial ligament • Increase glenoid width • Laurent Lafosse: capsule sacrifice massive ablation in subscap Antero-inferior capsule prep Coracoid graft prep Nerve identification Glenoid prep Subscap split Graft fixation + capsule repair Antero-inferior capsule prep Coracoid graft prep Nerve identification Glenoid prep Subscap split Graft fixation + capsule repair Antero-inferior Capsule Debridement - coracoid“circumcision” Nerve identification Latarjet Procedure： @ vs open ? Purpose To evaluate compare the clinical and radiographic outcomes of anterior shoulder instability patients treated with arthroscopic Latarjet vs open Latarjet regarding graft position, screw orientation, graft resorption clinical function Traumatic anterior instability Glenoid defect 20% 40% on preop CT en face view Treated by open or @ Latarjet Patients’ agreements Complete radiological evaluation (CT-3d at preop, immediate postop postop 1-y) Exclusion criteria MDI Concomitant RCT Degenerative evidence in G-H Neurological deficit Incomplete radiological evaluation Patients and Methods Study design: Prospective Comparative study Inclusion criteria The open Latarjet group initial 47 patients in the series The arthroscopic Latarjet the subsequent 51 patients Patients and Methods group General + inter-scalene block Beach-chair position: Open: Walch technique,axillary crease approach @: Modified Lafosse technique Two 4.0mm AO cannulated screws Concomitant Bankart repair Surgical te