Effect Of Lateral Graft Placement On Dislocation Arthropathy:Radiological Study Of The Modified Latarjet Procedure With Suture-Button Fixation At 5-Year Follow-Up

PURPOSETo investigate the effect of lateral graft placement on dislocation arthropathy after the modified Latarjet procedure with suture-button fixation for recurrent anterior shoulder dislocation in patients with glenoid bone defect at a minimum 5-year follow-up.METHODSA total of 20 patients who underwent the modified Latarjet procedure with suture-button fixation in the Sports Medicine Department of Shenzhen Second People’s Hospital between January 2015 and November2016 and met the inclusion criteria were enrolled in this study.The radiological evaluation was performed using the radiography(true anteroposterior view)to determine the grade of dislocation arthropathy,according to the classification of Samilson and Prieto,as well as the computed tomography(CT)to verify the positioning and remodeling of the bone graft.Pre-and postoperative clinical results were also assessed by using the visual analogue scale(VAS)score,American Shoulder and Elbow Surgeons’ Form(ASES),Walch-Duplay score,Rowe score,and range of motion(ROM).RESULTSThe mean follow-up time was 61.7±1.4 months.Before operation,20 cases did not present arthropathy according to the Samilson and Prieto classification.All cases showed no progression of dislocation arthropathy at 36,48 months and final follow-up after operation.Immediately postoperative CT showed that centers of all grafts were between 3: 30 and4: 30(right shoulder)or between 7: 40 and 8: 20(left shoulder)and no grafts were positioned superiorly or inferiorly in the glenoid En-face view.All grafts were positioned laterally to the glenoid with the mean distance of 3.4±0.7 mm in the axial view.During follow-up observations,grafts remodeled to a steady state within 24 months after the operation.The graft and glenoid finally remodeled analogous to the pear shape of the intact glenoid in the En-face view and became flush to the glenoid rim,remodeling to a curved shape congruent to the humeral head in the axial view.The shape of the remodeled glenoid at final follow-up was not significantly different from that at 24 months after operation.There was no neurovascular injuries,infections,fixation-related and graft-related complications.No re-dislocation and revision occurred.All patients returned to normal life,18 of whom returned to sport.The VAS score was significantly decreased and ASES,Walch-Duplay and Rowe scores were significantly improved at final follow-up(P<0.05).No significant difference was found in range of motion(ROM)of shoulder between preand postoperation(P>0.05).CONCLUSIONPatients with lateral graft placement in the modified Latarjet procedure with suture-button fixation showed no radiological signs of progression of dislocation arthropathy at a minimum 5-year follow-up.