Diagnosis and treatment of anteroinferior capsular redundancy associated with anterior shoulder instability using an open Latarjet procedure and capsulorrhaphy

Abstract : Methods Seventy-seven patients who had a Latarjet procedure were followed for a 55-month period. Per-operative ACR was assessed during surgery. ACR was considered present if the inferior capsular flap of a Neer T-shaft capsulorrhaphy was able to cover the superior capsular flap with the arm in the neutral position. Patients with ACR(+) received an additional Neer capsulorrhaphy, while patients with ACR(−) did not. This per-operative finding was correlated with demographics, clinical, radiological pre-operative data and surgical outcome. Results Patients presenting with a per-operative ACR(+) were significantly associated with a sulcus sign (P < 0.001), a Beighton score >4 (P < 0.01), a low-energy instability history (P < 0.05), a predominant history of subluxations (P < 0.05), fewer Hill–Sachs lesion (P < 0.05) and a female gender (P < 0.05), but not significantly with external rotation >85°. Open standard Latarjet procedures with Neer capsulorrhaphy in ACR(+) patients showed excellent or good results and stability rate of 95 %. All patients except four who presented with a new dislocation after surgery were satisfied with their outcome. Thirteen patients (16 %) had a persistent apprehension sign at the last follow-up. ACR(+) and ACR(−) groups did not show significant difference in the mean values of Rowe, Walch–Duplay and Constant–Murley scores. Conclusion ACR correlated with a sulcus sign, Beighton score and instability history. In anterior shoulder instability associated with ACR, the Latarjet procedure with a Neer capsulorrhaphy appears a satisfactory treatment alternative to arthroscopic or open capsular shift. It decreased apprehension in comparison with Latarjet procedures without capsular repair. Level of evidence Cases series, treatment study, Level IV.
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Article dans une revue
Knee Surgery, Sports Traumatology, Arthroscopy, Springer Verlag, 2016, 24 (12), pp.3756-3764. 〈10.1007/s00167-015-3621-9〉
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Contributeur : Armel Crétual <>
Soumis le : mardi 8 décembre 2015 - 11:00:01
Dernière modification le : mercredi 16 mai 2018 - 11:23:34

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Mickael Ropars, Armel Crétual, Rajiv Kaila, Isabelle Bonan, Hervé Anthony, et al.. Diagnosis and treatment of anteroinferior capsular redundancy associated with anterior shoulder instability using an open Latarjet procedure and capsulorrhaphy. Knee Surgery, Sports Traumatology, Arthroscopy, Springer Verlag, 2016, 24 (12), pp.3756-3764. 〈10.1007/s00167-015-3621-9〉. 〈hal-01239752〉

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