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Is the learning curve for arthroscopic Latarjet procedure facilitated by a specific step-by-step guiding system for the surgical technique?

OBJECTIVES: Treating anterior shoulder instability with the arthroscopic Latarjet procedure is a complex, operator-dependent technique that requires a learning curve. The objective of the study is to compare a guided technique with cortical button fixation and a non-guided technique with screw fixat...

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Autores principales: Belas, Maxime, Gaujac, Nicolas, Bouche, Pierre Alban, Charousset,MD, Christophe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917945/
http://dx.doi.org/10.1177/2325967121S00003
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author Belas, Maxime
Gaujac, Nicolas
Bouche, Pierre Alban
Charousset,MD, Christophe
author_facet Belas, Maxime
Gaujac, Nicolas
Bouche, Pierre Alban
Charousset,MD, Christophe
author_sort Belas, Maxime
collection PubMed
description OBJECTIVES: Treating anterior shoulder instability with the arthroscopic Latarjet procedure is a complex, operator-dependent technique that requires a learning curve. The objective of the study is to compare a guided technique with cortical button fixation and a non-guided technique with screw fixation. METHODS: This is a retrospective study including 72 consecutive patients who underwent surgery for recurrent anterior shoulder instability by the arthroscopic Latarjet procedure, with a mean age of 26 years and minimum clinical follow-up of 6 months. The same surgeon performed all the surgeries. The procedure was performed either with an instrument set and dedicated instrumentation that guides the different surgical steps and fixed by two cortical buttons connected by loops of a continuous thread (Group A) or with a specific instrument set and fixed by two cortical screws (Group B). We compared the difficulty of the different surgical steps, each rated from 1 to 5 (1 being the simplest and 5 the most difficult), the number of procedures required to attain a level of difficulty, the operating time and the intraoperative or postoperative complications. RESULTS: Coracoid preparation had a score of 1.3 in group A versus 2.9 in group B (p<0.001) with a difficulty level of 1 as of 19 procedures. The Subscapularis split had a score of 1.9 in group A versus 3.2 in group B (p<0.001) with a level as of 15 procedures. Horizontal positioning of the bone block scored 1.4 in group A versus 1.8 in group B (p=0.019) with a level as of 15 procedures. The mean operating time was 95 minutes in group A and 123 minutes in group B (p<0.0001). There was one coracoid fracture in group A, one case of sepsis and 2 repeat procedures for screw removal in group B, and 2 reversible neurological complications in each group. CONCLUSION: The Latarjet procedure performed under arthroscopy remains a difficult procedure. An instrument set and dedicated instrumentation with reciprocating rasp and saw, posterior glenoid drill guide and subscapularis retractors allow faster and more reproducible learning.
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spelling pubmed-79179452021-03-11 Is the learning curve for arthroscopic Latarjet procedure facilitated by a specific step-by-step guiding system for the surgical technique? Belas, Maxime Gaujac, Nicolas Bouche, Pierre Alban Charousset,MD, Christophe Orthop J Sports Med Article OBJECTIVES: Treating anterior shoulder instability with the arthroscopic Latarjet procedure is a complex, operator-dependent technique that requires a learning curve. The objective of the study is to compare a guided technique with cortical button fixation and a non-guided technique with screw fixation. METHODS: This is a retrospective study including 72 consecutive patients who underwent surgery for recurrent anterior shoulder instability by the arthroscopic Latarjet procedure, with a mean age of 26 years and minimum clinical follow-up of 6 months. The same surgeon performed all the surgeries. The procedure was performed either with an instrument set and dedicated instrumentation that guides the different surgical steps and fixed by two cortical buttons connected by loops of a continuous thread (Group A) or with a specific instrument set and fixed by two cortical screws (Group B). We compared the difficulty of the different surgical steps, each rated from 1 to 5 (1 being the simplest and 5 the most difficult), the number of procedures required to attain a level of difficulty, the operating time and the intraoperative or postoperative complications. RESULTS: Coracoid preparation had a score of 1.3 in group A versus 2.9 in group B (p<0.001) with a difficulty level of 1 as of 19 procedures. The Subscapularis split had a score of 1.9 in group A versus 3.2 in group B (p<0.001) with a level as of 15 procedures. Horizontal positioning of the bone block scored 1.4 in group A versus 1.8 in group B (p=0.019) with a level as of 15 procedures. The mean operating time was 95 minutes in group A and 123 minutes in group B (p<0.0001). There was one coracoid fracture in group A, one case of sepsis and 2 repeat procedures for screw removal in group B, and 2 reversible neurological complications in each group. CONCLUSION: The Latarjet procedure performed under arthroscopy remains a difficult procedure. An instrument set and dedicated instrumentation with reciprocating rasp and saw, posterior glenoid drill guide and subscapularis retractors allow faster and more reproducible learning. SAGE Publications 2021-02-26 /pmc/articles/PMC7917945/ http://dx.doi.org/10.1177/2325967121S00003 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc-nd/4.0/ This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at http://www.sagepub.com/journals-permissions.
spellingShingle Article
Belas, Maxime
Gaujac, Nicolas
Bouche, Pierre Alban
Charousset,MD, Christophe
Is the learning curve for arthroscopic Latarjet procedure facilitated by a specific step-by-step guiding system for the surgical technique?
title Is the learning curve for arthroscopic Latarjet procedure facilitated by a specific step-by-step guiding system for the surgical technique?
title_full Is the learning curve for arthroscopic Latarjet procedure facilitated by a specific step-by-step guiding system for the surgical technique?
title_fullStr Is the learning curve for arthroscopic Latarjet procedure facilitated by a specific step-by-step guiding system for the surgical technique?
title_full_unstemmed Is the learning curve for arthroscopic Latarjet procedure facilitated by a specific step-by-step guiding system for the surgical technique?
title_short Is the learning curve for arthroscopic Latarjet procedure facilitated by a specific step-by-step guiding system for the surgical technique?
title_sort is the learning curve for arthroscopic latarjet procedure facilitated by a specific step-by-step guiding system for the surgical technique?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917945/
http://dx.doi.org/10.1177/2325967121S00003
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