Tekrarlayan anterior omuz instabilitesinde uygulanan latarjet ameliyatında korakoid greftinin yerleşimi ve osteolizisinin fonksiyonel ve radyolojik sonuçlara etkisi / Relation of graft positioning with the functional and radiological outcomes, and graft osteolysis analysis for arthroscopic and open latarjet procedures

Abstract

Assessment of the relation between the medio-lateral and supero-inferior graft positioning and functional outcomes and graft osteolysis after open and arthroscopic Latarjet procedures. In the surgical treatment of shoulder instability, good functional results are obtained after both open and arthroscopic Latarjet surgery for glenohumeral bone loss. However, graft positioning and its osteolysis are still at issue. Forty-eight patients (mean age 29.5 years) who underwent open (n=15; group A) or arthroscopic (n=33; group B) Latarjet procedures, between 2009-2015, were retrospectively evaluated. At the final follow-ups, the ranges of shoulder flexions (F), external rotations (ER) and internal rotations (IR), Rowe, The Western Ontario Shoulder Instability Index (WOSI) and Visual Analogue Scale (VAS) scores were evaluated, bilaterally. Computerized tomography (CT) scans assessed for bone loss size, preoperatively, and graft positioning, screw orientations, and graft lysis, postoperatively. The mean follow-up was 30.5 (range, 12-62) months. Mean superio-inferior position of the coracoid bone graft, using a validated method, was found between 1:55:00 and 04:49:00 o'clock (02:05:00-04:55:00 for group A; 01:51:00-04:47:00 for group B) in en-face views. The grafts were placed laterally in 13.3%(group A) and 9.1%(group B) of patients. The mean α angles of the screws were 19.2° and 11°, respectively (p=0.004). The mean osteolysis rates were 21.3% and 34.3% (p=0.087), respectively and were found to be correlated with the Gerber index (rs=0.336, p=0.019) and defect percentage (rs=0.297, p=0.041). There were significant differences in the mean IR loss (p=0.017) and WOSI (p=0.017) scores although no significant differences were observed in the mean ranges of F(p=0.918) and ER(p=0.883), and Rowe(p=0.429) and VAS(p=0.208) scores. Medio-lateral and superio-inferior positioning of the graft did not affect the functional outcomes. Although the amount of graft lysis was not related to the functional outcome and recurrence development, it was found to be associated with persistance apprehension after Latarjet procedures.

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