Analysis of the functional outcome in patients following mini-open latarjet procedure for the treatment of anterior instability of shoulder

Author(s): Dr. Ravi Kiran Kakumanu and Dr. Dinesh Golla

Abstract: More than 200 different operations have been described for the treatment of recurrent anterior dislocation of shoulder. The Latarjet procedure employs re-routing of the osteotomised coracoid process with its attached conjoined tendon through a split in the substance of sub scapularis and fixed to the antero inferior aspect of glenoid rim. The present study is done to analyse the functional outcome of Latarjet procedure by mini-open technique in recurrent anterior shoulder dislocations with or without bony Bankart lesion/ Hillsachs lesion. A total of 25 (23 men and 2 women). patients managed by mini open Latarjet technique with a 4-5 cms long incision(3cm in young females) and splitting the subscapularis tendon were followed up for a minimum of one year. Patients were evaluated using ROWE instability score, Oxford Shoulder Instability index Score at the last follow up. The mean external rotation achieved was 60 degrees (45-70 degrees). Mean abduction was 160 deg (150-180 deg).There was no single episode of recurrence of dislocation or subluxation, all the patients regained preoperative range of motion. Mean ROWE score is 90(excellent) & mean oxford shoulder instability index is 38.1(good). One patient has developed fibrous union (4%). None has developed osteoarthritic changes. The classic Open Latarjet procedure results in a large scar and decreased external rotation. Adequate exposure can be obtained by a mini open incision with splitting of the subscapularis. In our technique we split subscapularis at its distal edge in order to place the bone block in right position only splitting of the subscapularis tendon leads to better outcomes with a smaller scar. Latarjet procedure is an excellent surgical option for recurrent shoulder instability associated with glenoid bone deficiency with or without engaging hill Sachs lesion.

DOI: https://doi.org/10.22271/ortho.2019.v5.i1d.37