Background:

The Latarjet is a successful procedure but can be associated with significant complications, including failure. Iliac crest bone grafting (ICBG) is one of the salvage options for such failure.

Purpose:

To analyze factors associated with failure or success to restore shoulder stability with ICBG after Latarjet failure.

Study Design:

Case series; Level of evidence, 4.

Methods:

Twenty consecutive patients with recurrence of instability after a Latarjet procedure underwent revision using ICBG. Sixteen patients (80%) with a mean age of 35.0 years (range, 25-55) could be personally reexamined clinically and radiographically (including computed tomography scan) after a mean follow-up of 4.5 years (range, 2-8). Twelve patients had redislocation and 4 had recurrent subluxation after the Latarjet.

Results:

Salvage ICBG failed in 7 patients because of recurrent dislocations, with 5 necessitating reoperations: 2 arthrodeses, 1 reverse total shoulder arthroplasty, 1 repeat ICBG, and 1 Hill-Sachs allograft reconstruction and Bankart repair. Factors associated with ICBG failure were multidirectional instability (n = 2), subscapularis insufficiency (n = 1), uncontrolled seizures (n = 1), static inferior glenohumeral subluxation (n = 1), total graft resorption (n = 1), and voluntary dislocation attributed to schizoaffective disorder (n = 1). The initial Latarjet graft was malpositioned (too medial) in 3 of these patients. In patients without recurrent instability (n = 9), reasons for Latarjet failure were graft related: 6 graft avulsions, 2 graft resorptions, and 1 medial graft malpositioning. The mean absolute Constant score (62 to 87 points, P = .012) and relative Constant score (66% to 91%, P = .012), pain (10 to 15 points, P < .001), and Subjective Shoulder Value (31% to 85%, P = .011) in the group with a successful procedure were significantly improved over the preoperative state, and the total Western Ontario Shoulder Instability Index averaged 64% at final follow-up. Except in 1 case of major resorption, mild graft resorption or none was observed in successful procedures. Axial and sagittal graft positioning was good in all 9 patients.

Conclusions:

Salvage ICBG for failed Latarjet procedures failed in 7 of 16 patients. It was successful in patients with clearly graft-related factors of the initial Latarjet procedure. However, patients with unclear instability symptoms, subscapularis insufficiency, inferior subluxation, uncontrolled seizures, or psychological disorders were poor candidates for salvage ICBG, underlining the importance of careful patient selection for the initial Latarjet procedure and for salvage ICBG.

中文翻译：

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为失败的 Latarjet 手术挽救髂嵴骨移植：失败和成功手术的分析

背景：

Latarjet 是一项成功的手术，但可能会出现严重的并发症，包括失败。髂嵴骨移植 (ICBG) 是此类失败的补救选择之一。

目的：

分析与 Latarjet 故障后 ICBG 恢复肩部稳定性失败或成功相关的因素。

学习规划：

案例系列；证据等级，4。

方法：

连续 20 名在 Latarjet 手术后不稳定复发的患者接受了 ICBG 翻修。平均年龄为 35.0 岁（范围，25-55 岁）的 16 名患者（80%）可以在平均 4.5 年（范围，2-8 年）的平均随访后进行临床和影像学检查（包括计算机断层扫描）进行个人重新检查。Latarjet 术后 12 名患者发生再脱位，4 名患者发生复发性半脱位。

结果：

7 名患者因复发性脱位而挽救性 ICBG 失败，其中 5 例需要再次手术：2 例关节固定术、1 例反向全肩关节置换术、1 例重复 ICBG 和 1 例 Hill-Sachs 同种异体移植重建和 Bankart 修复。与 ICBG 失败相关的因素是多向不稳定性 (n = 2)、肩胛下肌功能不全 (n = 1)、不受控制的癫痫发作 (n = 1)、静态下盂肱半脱位 (n = 1)、总移植物吸收 (n = 1) 和归因于分裂情感障碍的自愿脱位（n = 1）。其中 3 名患者的初始 Latarjet 移植物位置不当（太内侧）。在没有复发性不稳定的患者 (n = 9) 中，Latarjet 失败的原因与移植物有关：6 次移植物撕脱、2 次移植物吸收和 1 次移植物内侧错位。平均绝对常数得分（62 到 87 分，P = .012）和相对恒定评分（66% 至 91%，P = .012）、疼痛（10 至 15 分，P < .001）和主观肩部值（31% 至 85%，P = .011 ) 手术成功组较术前状态有显着改善，最终随访时西安大略肩关节不稳指数平均为 64%。除了 1 例严重吸收外，在成功的手术中没有观察到轻微的移植物吸收或没有。所有 9 例患者的轴向和矢状移植物定位良好。

结论：

16 名患者中有 7 名对失败的 Latarjet 手术进行挽救性 ICBG 失败。它在初始 Latarjet 手术中有明显移植相关因素的患者中取得了成功。然而，不稳定症状不明确、肩胛下肌功能不全、下半脱位、癫痫不受控制或心理障碍的患者不适合挽救 ICBG，这强调了对初始 Latarjet 手术和挽救 ICBG 仔细选择患者的重要性。