Objective To evaluate the short-term effectiveness of modified arthroscopic Latarjet procedure with double EndoButtons for recurrent anterior shoulder dislocation. Methods Between January 2019 and November 2020, 36 patients with recurrent anterior shoulder dislocation were treated by modified arthroscopic Latarjet procedure with double EndoButtons. There were 26 males and 10 females, with an average age of 27.8 years (range, 18-36 years). The number of shoulder dislocations ranged from 3 to 12 times, with an average of 6.5 times. The disease duration ranged from 5 to 36 months, with an average of 16.2 months. Preoperative shoulder fear test was positive, and the Beighton score of joint relaxation was 0-4, with an average of 1.3. Imaging examination showed that the defect width of the ipsilateral glenoid bone was 16%-28%, with an average of 21.5%. Postoperative complications, recurrent dislocation, subluxation, and instability of shoulder joint were recorded. Shoulder range of motion was examined, including forward flexion, external rotation at side, external rotation at 90° abduction, and internal rotation. Shoulder joint function was evaluated by Walch-Duplay score, American Association for Shoulder and Elbow Surgery Score (ASES), and ROWE score. X-ray film and CT images were taken to observe the shaping of coracoid process graft. Results All incisions healed by first intention, and no vascular or nerve injury occurred. All patients were followed up 12-28 months, with an average of 19.9 months. During follow-up, no shoulder dislocation recurred, and shoulder fear test was negative. At last follow-up, there was no significant difference in shoulder forward flexion, external rotation at side, external rotation at 90° abduction, and internal rotation when compared with preoperative values (P>0.05). The Walch-Duplay score, ASES score, and ROWE score of shoulder function significantly improved (P<0.05). Postoperative imaging examination showed that coracoid process graft was at the same level with the glenoid in 33 cases (91.7%), medial in 1 case (2.8%), and lateral in 2 cases (5.6%); the center of coracoid process graft was mainly located between 3 to 5 o’clock in 33 cases (91.7%), higher than 3 o’clock in 1 case (2.8%), and lower than 5 o’clock in 2 cases (5.6%). There was no obvious glenohumeral joint degeneration during follow-up, and the coracoid process graft gradually formed concentric circles with the humeral head. Conclusion The modified arthroscopic Latarjet procedure with double EndoButtons can effectively treat recurrent anterior shoulder dislocation, and the short-term effectiveness is satisfactory, and the position of coracoid process graft is accurate.
Objective To investigate the effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation in treatment of recurrent anterior shoulder dislocation combined with massive glenoid bone defects. Methods Between January 2018 and December 2021, 16 male patients with recurrent anterior shoulder dislocation combined with massive glenoid bone defects were treated with arthroscopic autogenous iliac bone grafting and double-row elastic fixation. The patients were 14-29 years old at the time of the first dislocation, with an average age of 18.4 years. The causes of the first dislocation included falling injury in 5 cases and sports injury in 11 cases. The shoulders dislocated 4-15 times, with an average of 8.3 times. The patients were 17-37 years old at the time of admission, with an average age of 25.1 years. There were 5 left shoulders and 11 right shoulders. The preoperative instability severity index (ISIS) score of the shoulder joint was 5.8±2.1, and the Beighton score was 4.3±2.6. The University of California Los Angeles (UCLA) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score were used to evaluate shoulder function, and the degree of the glenoid bone defect repair was observed based on CT after operation. Results All incisions healed by first intention, and no complication such as incision infection or neurovascular injury occurred. The patients were followed up 12 months. At 12 months after operation, UCLA score, Constant score, ASES score, and Rowe score all significantly improved when compared with the scores before operation (P<0.05). CT imaging showed the degree of glenoid bone defect was significantly smaller at immediate, 6 and 12 months after operation when compared with that before operation (P<0.05), and the bone blocks healed with the scapula, and bone fusion had occurred at 12 months. ConclusionArthroscopic autologous iliac bone grafting with double-row elastic fixation is a safe treatment for recurrent anterior shoulder dislocation combined with massive glenoid bone defects, with good short-term effectiveness.