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Journal of Shoulder and Elbow Surgery

Capsular repair is not an important part of the Latarjet-Walch procedure

  • Dipit Sahu
    Correspondence
    Corresponding author: Dipit Sahu M.S. Sir H.N. Reliance foundation hospital, Mumbai, & Mumbai Shoulder institute, Mumbai, India
    Affiliations
    Sir H.N. Reliance Foundation Hospital, Mumbai, India

    Jupiter Hospital Thane, Maharashtra, India

    Dr RN Cooper Hospital & HBT Medical College, Juhu, Mumbai, India

    Mumbai Shoulder institute, Mumbai, INdia
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Published:November 19, 2021DOI:https://doi.org/10.1016/j.jse.2021.10.030
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      Abstract

      Background

      Patte et al noted that the Latarjet procedure works by a triple blocking effect of: (1) the conjoint tendon sling effect, (2) the bone block effect, and (3) the capsular repair. However, no clinical study has specifically investigated the role of capsular repair in the Latarjet procedure.

      Aims

      The primary aim was to compare:(1) the external rotation range of motion (ROM) achieved after the Latarjet procedure with and without the capsule to coracoacromial (CA-CAL) repair. The secondary aims were to compare: the functional outcomes, forward elevation ROM and internal rotation ROM after the Latarjet procedure with and without the CA-CAL repair

      Methods

      A prospective cohort of 30 patients who underwent the Latarjet-Walch procedure with a CA-CAL repair between October 2018 and February 2020 was compared with the preceding group of 31 patients who underwent the Latarjet-Walch procedure without any capsular repair between October 2016 and September 2018, at a minimum of 1-year of follow-up.

      Results

      ER2 (External rotation with elbow abducted @ 90°) deficit (compared to normal opposite side) was significantly larger after the CA-CAL repair augmentation of the Latarjet procedure (mean difference=6°, p=0.03) as compared to that after no repair. ER1 (external rotation with the elbow adducted) deficit after the CA-CAL repair augmentation was not significantly different compared to that after no repair. ER2 deficit of more than 15° [minimum clinical important difference (MCID)] was observed in 11 patients (38%) in the CA-CAL repair group and 3 patients (10%, p=0.015) in the no repair group. Walch-Duplay score, Rowe score, and subjective shoulder value were not significantly different between the CA-CAL repair group and the no repair group. Covariates of hand dominance, overhead sports, and glenoid defect size did not significantly affect the ER2 deficit and ER1 deficit outcomes.

      Conclusions

      This study disproved the long-held belief that capsular repair is an essential step of the Latarjet-Walch procedure. Capsular repair to the coracoacromial ligament in the Latarjet procedure leads to a clinically insignificant restriction of external rotation (with the arm abducted), no restriction of external rotation (with the arm adducted), but similar functional outcomes compared to Latarjet without a capsular repair in a non-overhead athlete.

      Keywords

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