Nicolas Bonnevialle

Arthroscopic Latarjet procedure with double-button fixation: short-term complications and learning curve analysis

BACKGROUND The arthroscopic Latarjet with double-button fixation is a guided procedure recently proposed to treat anterior shoulder instability with glenoid bone loss. The goal of this study was to report intraoperative and early postoperative complications and to analyze the learning curve. METHODS This was a prospective, nonrandomized study that included 88 patients. Intraoperative or postoperative complications as well as adverse events and operative time were recorded. Clinical outcomes were evaluated at 2 weeks, 1.5 months, and at the last follow-up. Radiologic analysis was based on an immediate postoperative computed tomography scan. RESULTS The intraoperative complications or adverse events rate was 3.3%: 1 conversion to open surgery, 1 bone block fracture, and 1 instrumentation problem. The postoperative complication rate was 6.8%: 4 coracoid migrations, and 2 subluxations. None of these complications occurred beyond the 10th case performed. The average operative time significantly decreased with surgical experience (r = -0.8426; 95% confidence interval, -0.9074 to -0.7384; P < .0001) to reach 76 ± 12 minutes (range, 62-95 minutes) at 30 cases. Radiologically, 90% of the bone blocks were flush and subequatorial beyond the 30th case. At a mean follow-up of 12.6 months (range, 6-24 months), Walch-Duplay and Rowe scores were 80 and 81 points, respectively. CONCLUSIONS At short-term follow-up, the arthroscopic Latarjet procedure with double-button fixation exhibited a low complication rate. Operative time significantly improved with surgical experience and was optimized after 30 cases. Early clinical results confirmed that this procedure can be safe and reliable.

Periprosthetic shoulder infection: an overview

Periprosthetic shoulder infection (PSI) is rare but potentially devastating. The rate of PSI is increased in cases of revision procedures, reverse shoulder implants and co-morbidities. One specific type of PSI is the occurrence of low-grade infections caused by non-suppurative bacteria such as Propionibacterium acnes or Staphylococcus epidemermidis. Success of treatment depends on micro-organism identification, appropriate surgical procedures and antibiotic administration efficiency. Post-operative early PSI can be treated with simple debridement, while chronic PSI requires a one- or two-stage revision procedure. Indication for one-time exchange is based on pre-operative identification of a causative agent. Resection arthroplasty remains an option for low-demand patients or recalcitrant infection. Cite this article: EFORT Open Rev 2017;2:104-109. DOI: 10.1302/2058-5241.2.160023

Contribution of arthroscopy in the treatment of anterior glenoid rim fractures: a comparison with open surgery

BACKGROUND This study assessed the clinical and radiologic outcomes of Ideberg type IA glenoid fractures treated using conventional open surgery compared with those treated with arthroscopic surgery. MATERIALS AND METHODS This was a retrospective, multicenter study of anterior glenoid rim fractures (Ideberg IA) treated with conventional open surgery (group O) or arthroscopic surgery (group A). Included were 56 patients: 10 in group O and 46 in group A. The patients were reviewed after a minimum of 12 months of follow-up. The Constant score was used as an objective clinical outcome. Radiographs were reviewed to assess the quality of the postoperative reduction, fracture healing, complications, and whether osteoarthritis was present at the last follow-up. RESULTS At a mean follow-up of 30 months (range, 12-115 months), there was no significant difference between the groups based on the Constant Score (group O: 74 points; group A: 84 points, P = .07). None of the shoulders showed signs of instability. Conversely, the rate of postoperative complications was higher in group O than in group A (30% vs. 4%; P = .03). Glenohumeral osteoarthritis was found in 10% of group O patients and 18% of group A patients (P = .65). CONCLUSIONS This study shows that anterior glenoid rim fractures have similar functional outcomes, whether treated using conventional open surgery or arthroscopic surgery. Arthroscopic surgery appears to reduce the complication and reoperation rate.

Reconstruction Techniques for Acute and Chronic Distal Biceps Tears

Distal biceps tears are more prevalent among male manual workers. When they present acutely they should be probably treated by surgical reattachment to the radial tuberosity. Neglected distal biceps avulsions may cause weakness in supination and muscle cramps. Surgical techniques vary both in fixation method and approach. Outcomes of the different techniques for surgical reconstruction of the distal biceps are predictably good, and they mainly differ in the type and rate of complications. Chronic distal biceps tears rarely require surgery and when they do, a tendon graft is usually required. Complications in the chronic setting are more common as a more extensive approach is required but patients may greatly benefit from this reconstructive procedure.