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

Arthroscopic vs. Open Latarjet: Who’s the Champion ? 姜春岩 朱以明 Chunyan Jiang MD Ph.D ， Yiming Zhu MD Professor, Shoulder Service Beijing Ji Shui Tan Hospital School of Medicine, Peking University Glenoid bone defect in anterior instability • High failure rate if treated only by soft tissue recon • 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 • “Kissing lesion”: Bony defect + huge Hill-Sach’s the Inverted-Pear Glenoid and the Humeral Engaging Hill-Sachs Lesion. Arthroscopy, Vol 16, No 7 (October), 2000: pp 677–694 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 Arthroscopic Latarjet • Laurent Lafosse: capsule sacrifice massive ablation in subscap Major steps Antero-inferior capsule prep Coracoid graft prep Nerve identification Glenoid prep Subscap split Graft fixation + capsule repair Major steps Antero-inferior capsule prep Coracoid graft prep Nerve identification Glenoid prep Subscap split Graft fixation + capsule repair Antero-inferior Capsule Debridement - Lafosse’s technique Antero-inferior Capsule Release Coracoid Harvest - coracoid “circumcision” Nerve identification Coracoid Harvest - Graft prep Glenoid Preparation Subscap split - Lafosse’s technique with massive ablation Subscap split - tendon-muscle junction Bankart repair - make graft extra-articular Latarjet Procedure： @