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Presenter: Arthroscopic Latarjet technique has advantages, but steep learning curve
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Orthopaedic shoulder surgeons point to several theoretical advantages of arthroscopic Latarjet techniques for the shoulder, but according to recently presented study results, the gold standard is still the open Latarjet procedure since there is a steep learning curve for the arthroscopic technique.
Alexandre Lädermann, MD, of Geneva, Switzerland, and colleagues analyzed the learning curve for the arthroscopic shoulder Latarjet technique and found surgeons need to treat nearly twice as many patients to master it and obtain outcomes similar to those with an open Latarjet.
“It takes approximately 10 patients to overcome most of the arthroscopic learning curve, but 20 patients to achieve improvement in operative time. The overall patient satisfaction is the same in both techniques and quite high, however, there are more complications and true placement inaccuracy with the scope. The open Latarjet remains for us as the gold standard,” Lädermann said.
Learning curve analysis
“Outcome and patient satisfaction are similar in both open and arthroscopic techniques. However, complications, screw placement inaccuracy, persistent apprehension and recurrences still remained higher with the arthroscopic technique. Development of more specific arthroscopic instrumentation remain to be done,” Lädermann told Orthopaedics Today Europe.
Few studies have compared the learning curve of the two procedures, but there have been no studies comparing the outcomes of both techniques, according to Lädermann.
He and colleagues studied 57 patients in their comparative analysis of open and arthroscopic Latarjet procedures: 28 patients underwent an arthroscopic procedure and 29 patients underwent an open procedure. The outcomes they measured were the operative time, postoperative complications, graft and screw positioning and the preoperative and postoperative Walch-Duplay scores.
Lädermann reported the operative times and rates of postoperative complications were nearly double in the arthroscopic group compared with the open group. Screw positioning was also more accurate in the open group, however postoperative range of motion was similar in both groups.
Open Latarjet — the gold standard
The postoperative complications were mainly due to graft complications. Three patients in the arthroscopic group needed to be converted to an open procedure, according to Lädermann.
Postoperative Walch-Duplay scores were similar in the open and arthroscopic groups at 90.7 and 85.5, respectively, but there was greater improvement in the open scores compared to the arthroscopic scores. The mean gain in Walch-Duplay scores in the open group was 63 points vs. 41.5 points for the arthroscopic group.
In a subgroup analysis, the investigators divided the arthroscopic patients into subgroups of 10 patients, 10 patients and 8 patients each from the start to the end of the study. The average surgical time decreased for each subgroup, however most of the complications occurred in the first group, Lädermann noted.
By the time the last cases in this series were done, the operative time was almost the same between the open and arthroscopic groups, he said. – by Robert Linnehan
- Reference:
- Lädermann A, et al. Paper # SS-10. Presented at: Arthroscopy Association of North America Annual Meeting; April 23-25, 2015; Los Angeles.
- For more information:
- Alexandre Lädermann, MD, can be reached at Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Avenue J.-D.-Maillard 3, 1217 Meyrin, Switzerland; email: alexandre.laedermann@gmail.com.
Disclosure: Lädermann reports no relevant financial disclosures.