The Value of Arthroscopy Before an Open Modified Latarjet Reconstruction
Authors: Paolo Arrigoni, David Huberty, Paul C. Brady, Ian C. Weber, Stephen S. Burkhart
References: Arthroscopy: The Journal of Arthroscopic and Related Surgery - May 2008 (Vol. 24, Issue 5, Pages 514-519
Purpose: The purpose of this study was to identify the presence of intra-articular pathology in patients undergoing shoulder arthroscopy immediately before modified Latarjet reconstruction for recurrent anterior instability with bone deficiency.
Methods: The records of 33 consecutive patients who underwent shoulder arthroscopy immediately before the modified Latarjet reconstruction were analyzed. Arthroscopy was performed just before the open procedure to identify and treat intra-articular pathology that would otherwise have been missed or not well treated during the routine open anterior approach to the shoulder.
Results: In 24 of 33 cases (73%) associated pathologic lesions were identified and addressed arthroscopically (lesions not likely to have been discovered and treated optimally during the open deltopectoral approach). We identified and addressed 21 type 2 SLAP lesions (64%) as well as 1 posterior Bankart lesion, 2 loose bodies, 2 rotator cuff tears, and 2 localized areas of grade 4 chondromalacia.
Conclusions: Arthroscopic examination before modified Latarjet reconstruction is recommended because it allows the surgeon to identify and arthroscopically address associated pathologic entities that are present in over two thirds of the cases.
Level of Evidence: Level IV, therapeutic case series.
"The presence of multiple intra-articular lesions has previously been shown in patients who underwent an arthroscopic anterior stabilization procedure for dislocation. A recent series of 53 patients found that "most patients had more than a single lesion," with 6 partial-thickness rotator cuff tears (11%); 1 full-thickness rotator cuff tear; 31 SLAP lesions (55%), with 28 being classified as type II; 13 Hill-Sachs lesions (25%); and 9 loose bodies (17%). The authors concluded that the success rate of arthroscopic procedures for shoulder instability is optimized by treating all of the associated lesions seen at the time of the Bankart repair.
Another work similarly reported finding multiple intra-articular lesions among 212 patients who had at least 1 documented shoulder dislocation without any prior surgical intervention. Of the patients, 14% were noted to have complete rotator cuff tendon tears, 12% had posterior glenoid labral tears, and 7% had SLAP lesions."