Surgical treatment of post-traumatic instability of the shoulder joint in athletes

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Abstract

BACKGROUND: Surgical treatment of post-traumatic instability of the shoulder jointinvolves the use of various surgical techniques: open Latarjet procedure, Bristow–Latarjet operation, which was first performed in Russia at CITO named after N.N. Priorov, the founder of the clinic for sports and ballet trauma, Professor Zoya S. Mironova, also use soft tissue stabilization with anchors, etc. However, in recent years, the Latarjet arthroscopic operation has become a priority choice in the treatment of post-traumatic instability of the shoulder joint.

AIM: To improve the results and reduce the frequency of postoperative complications, reduce the time of surgical intervention, as well as evaluate the technical difficulties, nuances and improve the surgical technique when performing the arthroscopic Latarjet procedure in professional athletes and amateurs with post-traumatic defects of the shoulder joint.

MATERIALS AND METHODS: During the period from 2015 to 2021, 50 Latarjet arthroscopic procedure were performed in athletes with post-traumatic defects of the glenoid cavity of the scapula.

RESULTS: To improve postoperative results, during the Latarjet arthroscopic operation, when positioning the bone autograft, we focused on the 5 o’clock in the anterior inferior section of the glenoid cavity of the scapula, which allowed us to maintain the range of motion, namely abduction, flexion and external rotation and bring it almost to the previous level in 96% of patients, the pain syndrome also regressed to 0.8±0.21 points. Fixation of the capsular-ligamentary apparatus exarticularly allowed to reduce the likelihood of relapse, fracture of the bone autograft, and the development of deforming osteoarthritis of the shoulder joint in the near future.

CONCLUSIONS: The arthroscopic Latarjet procedure in the treatment of post-traumatic injuries of the shoulder joint is gaining popularity due to the fact that, using low-traumatic approaches, it is possible to correctly position the bone autograft on the anterior-inferior region of the articular surface of the scapula, without subsequent restrictions on the functional component of the shoulder joint.

About the authors

Anatoliy K. Orletskiy

N.N. Priorov National Medical Research Center

Email: nova495@mail.ru

MD, Dr. Sci. (Med.), traumatologist-orthopedist

Russian Federation, Moscow

Dmitriy O. Timchenko

N.N. Priorov National Medical Research Center

Author for correspondence.
Email: d.o.Timchenko@mail.ru
SPIN-code: 6626-2823

MD, Cand. Sci. (Med.), traumatologist-orthopedist

Russian Federation, Moscow

Nikolay A. Gordeev

N.N. Priorov National Medical Research Center

Email: nikolas095@mail.ru

traumatologist-orthopedist

Russian Federation, Moscow

Vladislav A. Zharikov

N.N. Priorov National Medical Research Center

Email: vladislav.zharikov1996@yandex.ru

resident

Russian Federation, Moscow

Elena S. Kozlova

N.N. Priorov National Medical Research Center

Email: elenako352@gmail.com

physiotherapist

Russian Federation, Moscow

Sergey V. Krylov

N.N. Priorov National Medical Research Center

Email: doc087@inbox.ru

MD, Cand. Sci. (Med.), anesthesiologist

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. Magnetic resonance imaging of the shoulder joint with glenoid deficiency.

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3. Fig. 2. 3D reconstruction of Bankart lesion with a defect of the articular surface of the scapula in the anterior inferior section.

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4. Fig. 3. X-ray of the shoulder joint before arthroscopic Latarjet procedure.

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5. Fig. 4. Determining the access point for installing the front port using a needle.

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6. Fig. 5. Processing of a safe rotator interval with the help of a shaver and a coblator: a — access; b — capsule mobilization and expansion of the rotator interval.

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7. Fig. 6. Axillary nerve isolation (n. axillaris).

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8. Fig. 7. Treatment of the processus coracoideus with a drill.

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9. Fig. 8. Treatment of the articular surface of the scapula: a — treatment of the anterior inferior section with a coblator; b — use of a rasp in the anterior inferior section of the glenoid.

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10. Fig. 9. Carrying the pins into the processus coracoideus: a — installation of the spicer; b — carrying out the guide pins.

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11. Fig. 10. Preparation of channels for guide sleeves in the processus coracoideus: a — formation of channel No. 1 using a guide pin; b — drilling of channel No. 2 for the guide sleeve.

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12. Fig. 11. Installation of sleeves in the processus coracoideus.

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13. Fig. 12. Osteotomy with a curved chisel.

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14. Fig. 13. Bone autograft transposition: a — the moment of positioning; b — the final fixation of the bone block.

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15. Fig. 14. X-ray control 4 weeks after arthroscopic Latarjet procedure.

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16. Fig. 15. Functional state of the shoulder joint after arthroscopic Latarget prosedure.

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Copyright (c) 2022 Orletskiy A.K., Timchenko D.O., Gordeev N.A., Zharikov V.A., Kozlova E.S., Krylov S.V.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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