This is report 2 of 2 for the same event.This report is being filed after the review of the following journal article: j.D.Agneskirchner, et al 2011, ¿arthroscopic coracoid transfer indication, technique, and initial results, the orthopedist, vol.40(1), pages 41-51 (germany).This article emphasizes on the indication, surgical technique and initial results from the arthroscopic execution of the latarjet operation.From 2003 to june 2010, a total of about 400 arthroscopic latarjet operations were performed using the method presented with the instruments described here.In a multicenter study conducted throughout europe, 52 cases from 9 participating shoulder centers were prospectively documented between october 2009 and april 2010 with respect to the feasibility of the technique, the operation time, and complications, whereby the technique and the instruments proved successful in all of the documented centers.In a prospective clinical study, 12 patients who had undergone an arthroscopic latarjet procedure between 2007 and 2008 in hanover were examined clinically and by x-ray after a follow-up period of at least one year.The average operation time was 100 min.11 of the 12 patients had been operated on previously (6 times with open and 5 times with arthroscopic bankart operations).Anterior shoulder instability is a frequent problem that is usually serious for those affected by it.In general, the surgical treatment is usually in the form of a bankart operation, i.E as a soft tissue intervention with reconstruction of the labrum, the capsule and the glenohumeral ligaments, which can be readily performed using arthroscopy.However, the bankart technique becomes problematic if there are significant osseous defects in the socket and/or humeral head- and if the structural quality of the capsular ligamentous structures is irreversibly impaired.An established method for treating these serious cases (latarjet operation) which particularly in france- is a standard method for treating anterior glenohumeral instability and is performed using an open technique.Indications for the 1st choice: patients with anterior relevant bone loss in the anteroinferior glenoid (more than 20%), shoulder instability and/or arthroscopically verified insufficient and irreparable capsular ligament damage (destruction of the labrum, frayed capsule with intraligamentous elongation of the ighl, chronic, relevant hagl lesion), failed previous operation on the labral ligamentous complex.Indications for the 2nd choice: patients with anterior pronounced hyperlaxity, shoulder instability and who are highly athletic (contact sport athlete) relative contraindications: significant anomalies, previous operations, or condition following fracture involving the coracoid or conjoint tendons.Patients who are growing (<16 years old), patients with subscapular tendon lesions, ighl glenohumeral ligament, hagl (humeral avulsion of glenohumeral ligaments).The article describes the following surgical technique: the intervention is carried out in a beach-chair position, with the arm supported by lightweight traction in a ventrocaudal orientation so that the arm is freely movable.An arm holder is helpful for this (e.G.Spider by smith & nephew).At least one assistant is needed - and preferably two, with one on the left side and one on the right side of the surgeon.The arthroscopy tower must be positioned on the opposite side of the patient, since the patient will not be standing behind the patient, but instead to one side, and will thus be afforded a direct view of the monitor.The covering must be positioned fairly medially, since both dorsal as well as ventral access points and skin incisions are used that are much more in a medial direction than what is otherwise customary for shoulder arthroscopy.The participation of a seasoned surgical nurse is absolutely essential - and also an experienced anesthesiologist who will maintain a low blood pressure and a low heart rate in the patient during surgery, since the main part of die operation is extraarticular, and thus it is not as easy to stop hemorrhaging by increasing the intraarticular pumping pressure as during as a bankart operation.The anatomical landmarks and portals should be labeled as reference points.However, the final position of the accesses is chosen based on the arthroscopic view from inside, as outer reference points become unreliable the greater the swelling in the soft tissues becomes.All soft tissue preparations should be carried out with a blunt instrument or with the vapr as much as possible, since shaving often leads to bleeding that impairs the view.The devices involved were: controlled shaver (depuy mitek) and radio frequency system (vapr by depuy mitek).At the time of the follow-up examination, the rowe score was 92 points for these patients.A side comparison showed a 6° loss of external rotation in 90° abduction.Reluxation occurred in one patient.Otherwise, no further complications occurred, and 11 of 12 patients were satisfied or very satisfied with the result.Latarjet technique is an excellent option for managing the recurrence of bankart operations, particularly those in patients who are engage in sports with shoulder movement, for whom a new bankart operation would usually be contraindicated.
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