• Orthopaedics Clinical Trials
• Shoulder & Elbow Conditions
• Orthopaedic Pain Management
• Orthopaedic Procedures

• Orthopaedics Clinical Trials
• Orthopaedics
• Shoulder & Elbow Conditions
• Orthopaedic Pain Management
• Orthopaedic Procedures

Patients with chronic anterior instability of the shoulder that required bone grafting had significantly less pain and better bone block and equatorial positioning with an arthroscopic rather than a minimally invasive mini-open surgical approach for the Latarjet procedure in a prospective, nonrandomized, comparative study presented by Julien Deranlot, MD, Hôpitaux Universitaires Paris Ile-de-France Ouest, Paris, France.

The average Instability Severity Index Score (ISIS) was 4.4 at inclusion; an ISIS >3 was an inclusion criterion. The 36 patients in the arthroscopic and 22 patients in the mini-open groups had an average age of 26.9 years and 13 were women. Most (84.5%) of the patients were active in sports (67.2% recreationally). The treatment groups were comparable.

The primary outcome of patient-reported postoperative pain during Week 1 using the Visual Analog Score (VAS) of 0 to 10 was a mean 1.2±1.2 with arthroscopy compared with 2.5±1.4 with mini-open (p=0.0026). Further, the mean VAS pain scores were significantly lower for Day 1 (2.1±1.3 vs 4.3±1.7; p=0.0001) through Day 4 (1±1.6 vs 2.3±1.8; p=0.001). Postoperative use of analgesics, by a standardized protocol that included paracetamol, tramadol, and naproxen, was similar (Table 1).

The arthroscopic approach took significantly more time (76.8±14 vs 61.6±13.2 minutes; p=0.0001). No perioperative complications occurred in either group, and the postoperative side effects of nausea, vomiting, anxiety, and vertigo were similar.

Radiography revealed significantly better bone block positioning at the anterior aspect of the glenoid with arthroscopy compared with the mini-open procedure, but no significant difference was seen with computed tomography (CT). On antero-posterior and lateral x-ray, the medio-lateral bone block positioning was 3.7±3.3 mm with arthroscopy versus 6.6±5.5 mm with mini-open (p=0.036), and the equatorial bone block positioning was better at 94.1% compared with 44.4%, respectively (p=0.002). On CT scan assessment, equatorial bone positioning was 40.9% with arthroscopy and 50% with the mini-open procedure at 4 hours, and bone block length was 20.6±2.8 and 21.4±2.1 mm, respectively.

The arthroscopic approach to the Latarjet procedure is more technically demanding, stated Prof. Deranlot, and to date there have been few comparisons between this approach and the mini-open surgical approach. This study shows that the arthroscopic procedure is reliable and reproducible and provides good bone positioning.

• © 2014 MD Conference Express®