Original Article
Failed Latarjet Treated With Full Arthroscopic Eden–Hybinette Procedure Using Two Cortical Suture Buttons Leads to Satisfactory Clinical Outcomes and Low Recurrence Rate

https://doi.org/10.1016/j.arthro.2021.10.026Get rights and content

Purpose

To report clinical and radiologic outcomes of arthroscopic Eden–Hybinette using 2 cortical suture buttons in a series of patients with previous failed Latarjet and persistent glenoid bone loss.

Methods

Between 2015 and 2019, patients with recurrent anterior instability after failed Latarjet underwent arthroscopic Eden–Hybinette procedure using 2 cortical buttons for graft fixation. Exclusion criteria were open and primary Eden–Hybinette and less than one year follow-up. Functional assessment was performed using Rowe and Walch-Duplay scores, subjective shoulder value, visual analog scale, and degree of satisfaction. Iliac crest bone graft placement and healing were assessed postoperatively with computed tomography imaging.

Results

A total of 17 patients with a mean age of 28 years (range, 21-43 years) at time of revision were included. The mean glenoid bone loss was 23% (range, 18%-42%). Medium or deep Hill–Sachs lesion (Calandra 2 and 3) was present in 65% of cases. At a mean follow-up of 3 ± 1.6 years, all but 1 patient (94%) considered their shoulder stable, and 15 patients (88%) were satisfied or very satisfied. The subjective shoulder value increased from 51% to 87% (P < .05), the Walch–Duplay increased from 23 to 86 points (P < .05), and Rowe scores improved from 30 to 92 points (P < .05). Apprehension was still positive in 3 patients (17.6%), with this percentage being greater in the presence of Hill–Sachs Calandra 3 (P = .02). Postoperative computed tomography scans showed optimal bone autograft position in all patients (below the glenoid equator and flush to the glenoid rim). Iliac crest bone graft healed to the anterior glenoid neck in 16 shoulders (94%). The rate of recurrent instability was 11.7% but only 1 patient required revision surgery (5.8%).

Conclusions

Arthroscopic Eden–Hybinette using 2 cortical buttons leads to satisfactory clinical outcomes and a low recurrence rate after failed Latarjet, allowing successful reconstruction of the anterior glenoid rim and simultaneous treatment of capsular deficiency and humeral bone loss.

Level of Evidence

Therapeutic, level IV, retrospective case series.

Section snippets

Methods

Between June 2015 and December 2019, patients with recurrent anterior instability after failed Latarjet who underwent arthroscopic Eden–Hybinette procedure using 2 cortical buttons were included in this study. Surgeries were performed by 2 surgeons (P.V., J.D.W.) who specialized in shoulder surgery. Exclusion criteria were open and primary Eden–Hybinette and less than 1 year follow-up. All medical records were reviewed retrospectively. No patient was lost to follow-up.

Demographics

A total of 17 patients (16 males and 1 female) with recurrent shoulder instability after failed Latarjet were included. The average age was 25 ± 6 years (range 16-41 years) at the time of primary Latarjet procedure and 28 ± 5 years (range, 21-43 years) at the time of the revision Eden–Hybinette. Dominant side was affected in 12 patients (71%) and 13 patients (76%) were involved in sports. Two patients (12%) had epilepsy, and 7 patients (41%) had bilateral external rotation at the side of

Discussion

The results of this study show that arthroscopic Eden–Hybinette procedure using 2 cortical buttons leads to satisfactory clinical outcomes and low recurrence rates after failed Latarjet. The rate of recurrent anterior instability after revision was 11.7% at a mean follow-up of 3 years. This recurrence rate is similar to previous reports. Lunn et al.7 assessed the results of a modified open Eden–Hybinette, using metal screws, as a salvage procedure after failed Latarjet. Recurrent dislocation

Conclusions

Arthroscopic Eden–Hybinette using 2 cortical buttons leads to satisfactory clinical outcomes and a low recurrence rate after failed Latarjet, allowing successful reconstruction of the anterior glenoid rim and simultaneous treatment of capsular deficiency and humeral bone loss.

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The authors report the following potential conflicts of interest or sources of funding: P.V. is a consultant for VIMS and has developed the implants and the instruments used to perform the arthroscopic-guided Latarjet procedure with suture-button fixation. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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