Shoulder
Surgical treatment of anterior instability in rugby union players: clinical and radiographic results of the Latarjet-Patte procedure with minimum 5-year follow-up

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Background

Anterior instability in rugby players is characterized by the common finding of a bony lesion, which has been identified as a potential cause of recurrence after soft-tissue reconstruction. The Latarjet-Patte procedure is effective in the treatment of recurrent anterior instability in collision sports such as rugby union.

Methods

We retrospectively assessed 34 rugby players (37 shoulders) stabilized with the Latarjet-Patte procedure. The mean follow-up was 12 years. All patients underwent clinical and radiographic assessment preoperatively and at final follow-up. Functional evaluation was performed with the Walch-Duplay and Rowe scores. A visual analog scale score for the evaluation of pain and the subjective shoulder value were recorded. In addition, all patients completed a questionnaire regarding the return to playing rugby.

Results

No recurrence of either dislocation or subluxation occurred. Persistent apprehension on clinical examination was present in 5 patients (14%). A bony lesion of the glenoid was present in 73% and a Hill-Sachs lesion in 68%. Sixty-five percent of the patients returned to playing rugby; only 1 patient did not return to playing rugby because of his shoulder. The mean Walch-Duplay and Rowe scores were 86 and 93 points, respectively. The mean subjective shoulder value was 90%. Radiographic healing of the bone block was observed in 89% of cases. At final follow-up, 11 patients (30%) had minor arthritic changes, with no cases of moderate or severe arthritis.

Conclusion

The Latarjet-Patte procedure provides a reliable method for stabilizing the shoulder, resulting in a return to playing rugby in a high number of cases without increasing the risk of long-term arthritic degradation.

Section snippets

Materials and methods

The study included rugby players who presented with recurrent anterior shoulder instability treated by a single surgeon with the Latarjet-Patte procedure. Each player included in the study agreed to undergo review by an independent observer and had a complete preoperative and final follow-up radiographic series.

We excluded patients who had undergone their first episode of anterior instability, who had other types of instability (eg, posterior or voluntary), who had undergone a revision

Radiographic results

The bone block was healed inferior relative to the equator of the glenoid in 33 cases (89%). In the horizontal plane, the bone block was flush with the glenoid joint line in 31 cases (84%), medial in 1 case, and overhanging in 1 case. In 4 cases (11%), the bone block had not healed: 3 fractures and 1 pseudarthrosis (Fig. 3). On the preoperative imaging studies, 3 shoulders (8%) had mild (stage 1) glenohumeral osteoarthritis. At final follow-up, 26 shoulders (70%) were free of arthritis (stage

Discussion

This study of coracoid bone block according to the Latarjet-Patte procedure in rugby players shows the absence of recurrence of anterior dislocation or subluxation with a mean follow-up of 12 years. Although the types of sports and length of follow-up are different, numerous series report low recurrence rates with a similar surgical technique.1, 6, 9, 10, 18 Moreover, our results for stability in the rugby player are better than those reported for an open capsuloplasty and labrum reinsertion

Conclusion

Our study shows the efficiency of the Latarjet-Patte procedure in the treatment of recurrent anterior instability in rugby players. The Latarjet-Patte procedure provides a stable shoulder joint without limitation in range of motion, a return to rugby participation in almost all cases if desired, and a high satisfaction rate in young patients with bony lesions on either the glenoid or humeral side. These results reinforce our current practice of systematically performing the Latarjet-Patte

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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  • Cited by (0)

    The Institutional Review Board of the ethical committee of Hopital Privé Jean Mermoz and Centre Orthopédique Santy allowed the authors to perform this study.

    This project does not infringe French ethical rules or infringe on the privacy of the patients.

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