Summary

Evaluation of the learning curve after 103 cases of arthroscopic Latarjet resulted in the recognition that the procedure was technically demanding but safe, with good outcomes and low recurrence rates.

Abstract

Purpose

When changing from a standard open procedure to a novel technique, evaluating the effect of a learning curve is important. The aim of this study was to evaluate two experienced surgeons learning curve of the arthroscopic Latarjet procedure by comparing the outcomes and complications of the first 25 patients with the latter 25 patients.
Material: A consecutive cohort of 103 patients operated with arthroscopic Latarjet procedure were prospectively registered from December 2014 until November 2019. Patients in this cohort represent the first cases for the two shoulder surgeons. No conversion to open surgery and no standard open Latarjet procedures were done in this period. All patients had a double screw fixation technique. We prospectively recorded WOSI score preoperatively and at 1 year follow up (FU), and 3D-CT preoperatively, post operatively and at 1 year FU. Patient demographics, intraoperative data, complications, WOSI scores, radiology scores,satisfactgion rate and reoperations were all recorded. Complications were graded according to severity. Two groups; the first and last 25 patients, a total of 50, with complete data sets were compared.

Results

86 of 103 (83%) patients had complete sets of data available for analysis, 12 had incomplete WOSI scores, 5 were lost to FU due to drug abuse(3), death(1) and emigration (1).The patients undergoing arthroscopic Latarjet were predominantly male (90%), and the median age at surgery was 26 years in the first group and 32 years in the latter group. The median number of dislocations before surgery was 10 in both groups, 19 of 50 were reoperations after former instability surgery and we found no significant differences in patient demographics between the groups.
Surgery time improved from 130 minutes to 105 minutes. There was no difference in patient postoperative satisfaction (84%), preoperative WOSI (45% in both groups) and postoperative WOSI scores (75% versus 80%). Graft placement and union rates on 3-D CT was better in the latter group than the first group (p<0.05). There were relatively high rates of graft resorption in both groups, 48% and 44% in group 1 and group 2 respectively. There were higher complication rates with a total of 23 minor complications that resolved without a need for intervention in the first group versus 14 in the latter. There were 5 major complications that needed reoperations, 4 in group 1 and 1 in group 2. No cases of recurrent dislocation were recorded and 3 subluxations were recorded in group 1.

Discussion

We found an obvious learning curve when it comes to operating time and complications that lead to reoperations when introducing arthroscopic Latarjet. The outcomes in both groups were satisfactory and comparable to previous studies on the Latarjet procedure. There was a relatively high number of resorption of the coracoid graft after one year in both groups, and this finding explains the high number of minor complications. Bone resorption did not seem to influence the clinical result and did not cause any reoperations. These are challenging cases with many previous dislocations, high percentage of bipolar bone loss and previous surgery.

Conclusion

Arthroscopic Latarjet is a technically demanding but safe procedure with good outcomes and low recurrence rates. Minor complications that resolve without a need for intervention are common in the beginning and major complications reduced from 4 (20%) to 1 (4%).