Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2024 | Month : May | Volume : 18 | Issue : 5 | Page : RC13 - RC17 Full Version

Outcome of Modified Open Latarjet Operation in the Treatment of the Recurrent Anterior Shoulder Dislocation: A Cohort Study


Published: May 1, 2024 | DOI: https://doi.org/10.7860/JCDR/2024/68078.19431
Rajesh Jamoriya, Abhishek Pathak, Santosh Kumar Mishra

1. Resident, Department of Orthopaedics, Gandhi Medical College, Bhopal, Madhya Pradesh, India. 2. Associate Professor, Department of Orthopaedics, Gandhi Medical College, Bhopal, Madhya Pradesh, India. 3. Assistant Professor, Department of Orthopaedics, Gandhi Medical College, Bhopal, Madhya Pradesh, India.

Correspondence Address :
Dr. Santosh Kumar Mishra,
Assistant Professor, Department of Orthopaedics, Gandhi Medical College, Bhopal-462001, Madhya Pradesh, India.
E-mail: doctorskmishra@gmail.com

Abstract

Introduction: Shoulder instability is defined as a symptomatic translation of the humeral head about the glenoid fossa during active shoulder motion. Anteroinferior glenoid bone loss or labrum avulsion is most often a consistent finding in recurrent dislocation. The modified open Latarjet procedure is one of the most effective methods of treatment for patients with recurrent shoulder instability with glenoid bone loss.

Aim: To determine the functional outcome of the congruent arc modification of the open Latarjet procedure.

Materials and Methods: This prospective cohort study was conducted at a tertiary healthcare centre in Bhopal, Madhya Pradesh, India between January 2018 and December 2020. A total of 25 patients with recurrent anterior shoulder dislocation underwent treatment using the modified open Latarjet procedure. Two patients were lost to follow-up, resulting in the evaluation of 23 patients. All patients underwent a 3D Computed Tomography (CT) scan to document glenoid bone loss. The intensity of pain, activity level, strength of abduction, and Range of Motion (ROM) were assessed to calculate the Constant Shoulder Score for pre- and postoperative evaluation of functional outcomes. Follow-ups were conducted at 3 months, 6 months, 1 year, and 2 years after surgery. The data was analysed using the Wilcoxon’s signed-rank test, and Spearman’s correlation coefficient was used to identify associations between various variables.

Results: A total of 23 male patients aged between 18 and 63 years were included. The average age of patients was 30.35±11.27 years. Preoperatively, only 3 patients (13.04%) had good to excellent Constant Shoulder Scores. However, no statistically significant variation in Constant Score was observed three months after surgery. Six months post-surgery, 17 patients (73.92%) showed good to excellent scores. Nearly one year after surgery, 21 patients (91.3%) had good to excellent outcomes. At the final follow-up, 22 patients (95.65%) demonstrated good to excellent outcomes. A statistically significant improvement in good to excellent scores was noted six months postoperatively (p-value <0.001). A total of 20 patients (86.96%) achieved full ROM, with only 3 patients (13.04%) reporting mild to moderate limitations in shoulder ROM. None of the patients experienced redislocation, and the apprehension test was positive in only one patient.

Conclusion: The modified open Latarjet procedure is a reliable method for providing stability and Self confidence to patients with recurrent shoulder instability and glenoid bone loss.

Keywords

Congruent arc latarjet technique, Constant shoulder score, Coracoid bone block, Coracoid transfer, Recurrent glenohumeral instability

Shoulder instability is defined as a symptomatic translation of the humeral head around the glenoid fossa during active shoulder motion (1). By its anatomy and biomechanics, the shoulder is one of the most unstable and frequently dislocated joints in the body, accounting for nearly 50% of all dislocations with a 2% incidence in the general population (1),(2),(3). Previous studies have reported a very high recurrence within two years after the first episode of traumatic shoulder dislocation among males in younger age groups ranging from 15 to 35 years (72 to 90% for ages 13 to 20 years and 50% for ages 20 to 30 years) (4),(5).

Recurrent anterior shoulder dislocation is commonly associated with substantial bone loss at the anteroinferior aspect of the glenoid rim. Bone loss can manifest as a classic bony Bankart’s lesion (6) due to a traumatic event or attrition glenoid bone loss due to repetitive motion, as seen in overhead-throwing athletes. Traditionally, glenoid bone loss exceeding >20-25% is considered a “critical amount” and a contraindication for soft-tissue procedures alone due to the poor biomechanical environment and unsatisfactory clinical outcomes (7),(8). Similarly, cadaveric biomechanical studies have also indicated that a 19% to 21% loss of glenoid width significantly compromises the stability of soft-tissue repair alone (8). Previous studies have established that >20% bone loss in the anteroinferior glenoid is critically high, with reports suggesting that lower percentages of “subcritical” bone loss after arthroscopic soft-tissue stabilisation do not necessarily result in a recurrence of dislocation but can lead to a poor functional outcome compared to those treated with bone augmentation procedures (9). Some authors recommend treating shoulder instability with a primary Latarjet procedure regardless of glenoid bone loss (10).

A very high recurrence rate ranging from 0 to 37.5% has been reported after an arthroscopic Bankart repair in the presence of significant glenoid bone loss or an inverted pear-shaped glenoid with or without an engaging Hill-Sachs lesion (11),(12). This unacceptably high recurrence rate has led surgeons to opt for non anatomic repairs with a coracoid bone block, such as the Latarjet procedure. In 1954, Michel Latarjet first introduced the coracoid-transferring bone block procedure to treat recurrent anterior shoulder dislocation (13). In 2009, De Beer J et al., described “The congruent arc modification” of the Latarjet procedure, involving a 90º rotation of the coracoid process (14). As a result, the curved undersurface of the coracoid lies congruent with the glenoid cavity (15). Rotation of the coracoid in such a manner has been shown to optimise glenohumeral contact forces in addition to the triple blocking effect of the traditional Latarjet procedure (14). The objective of the present study was to evaluate the outcome of the modified open Latarjet operation in the treatment of recurrent anterior shoulder dislocation.

Material and Methods

A prospective cohort study was conducted from January 2018 to December 2020 at the Department of Orthopaedics, Gandhi Medical College, Bhopal, Madhya Pradesh, India and the associated hospital in central India, after obtaining approval from the Institutional Ethical Committee (Letter No. 38062-08/MC//IEC/2018, Bhopal, Date: 30/01/2018). During the given study period, a total of 25 patients with recurrent anterior shoulder dislocation who consented to definitive treatment using the modified open Latarjet procedure were included. Two patients were later lost to follow-up, and the results of 23 patients were evaluated. A three-year study period was set between 2018 and 2020, ensuring a minimum follow-up of two years.

Sample size: For the present study, a purposive type of non probability sampling method was used.

Inclusion criteria:

• The consenting patient aged over 18 years with at least two episodes of recurrent anterior shoulder dislocation or subluxation episodes with or without hyperlaxity in the last two years.
• Clinically diagnosed recurrent anterior dislocation with a 3D CT scan documented Bankart’s lesion of the glenoid with or without an engaging Hill-Sachs lesion.
• Patients who completed a two-year follow-up.

Exclusion criteria:

• An acute first-time anterior shoulder dislocation.
• Multidirectional atraumatic shoulder instability or posterior instability.
• Patients lost to follow-up.

Study Procedure

In the present study, patients with any grade of glenoid bone loss (e.g., more or less than 20-25%) were subjected to the Latarjet operation. Those approaching 40% were excluded because larger glenoid defects are more appropriately treated by procedures that use larger autografts (16) or allografts (17). Before proceeding to operative intervention, all patients underwent a complete physical examination of the bilateral shoulders in a standard fashion. A generalised ligamentous laxity assessment was conducted using the Beighton score (18). A 3D CT scan of the shoulder joint was performed on all patients to evaluate the bony Bankart’s lesion and quantify the Hill-Sachs lesion of the humeral head.

The en face view of the glenoid fossa in the 3D CT image was used for the measurement of glenoid bone loss as described by Huysmans PE et al., and Vopat BG et al., (19),(20). The surface area method was used for the assessment of glenoid bone loss, as the inferior part of the glenoid has the shape of a true circle (21),(22).

Based on the quantity of glenoid bone loss, all the patients were categorised into three groups (Group A: <10%, Group B: 10%-20%, and Group C: >20% Glenoid bone loss).

Surgical technique: All surgeries were performed using a standard deltopectoral approach, and the coracoid graft transfer was done via a horizontal subscapularis split. The Latarjet procedure was performed following the Congruent Arc technique described by De Beer J et al., in 2009 (14). The coracoid graft was rotated approximately 90º along its axis before being placed over the anteroinferior glenoid defect and fixed with two 4 mm cannulated cancellous screws (Table/Fig 1). Two sutures were placed on the edge of the original glenoid around the screws and used to repair the capsule. The shoulder joint stability is provided by the triple blocking effect of the traditional Latarjet procedure. First, the coracoid bone block increases the inferior portion of the glenoid fossa’s Anterioposterior (AP) diameter, making it more challenging for the humeral head to subluxate or dislocate. Second, the conjoined tendon acts as a sling reinforcing the inferior capsular ligamentous complex and the inferior portion of the subscapularis. Finally, repairing the inferior capsular ligamentous complex to the coracoacromial ligament’s stump reconstructs the capsulolabral anatomy. Additionally, the Congruent Arc Latarjet is thought to improve glenoid reconstruction by providing better articular congruency, a larger surface to fill the glenoid defect, and a radius of curvature similar to that of the native glenoid, leading to increased anterior humeral head translation before reaching a non dislocated endpoint and decreased contact pressure across the glenohumeral joint.

Postoperative rehabilitation: Immediately postoperatively, patients were made to wear a shoulder arm pouch for support, and passive shoulder ROM only to the tolerance level was allowed with pendulum exercises until postoperative day 4. From postoperative day 5 to 2 weeks, gentle passive and active-assisted shoulder ROM in the scapular plane up to the tolerance level was permitted, e.g., door handle exercises. No resisted shoulder and elbow exercises were allowed for the first six weeks. Starting from seven weeks onwards, ROM gradually progressed to normal limits, optimum strength was gained by 5-6 months, and patients returned to their normal activities.

Postoperative functional outcome was assessed using the Constant shoulder score, which includes parameters like pain, activity level, arm positioning strength of abduction, and motion range (23). All patients were followed-up at three months, six months, one year, and two years postoperatively, and the outcome was graded based on the scores obtained preoperatively and postoperatively at follow-ups as excellent (<11), good (11-20), fair (21-30), and poor (>30).

Statistical Analysis

The statistical analysis was performed using Epi Info 7.0 and Microsoft excel 2020 for tabulation and graphical data presentation. The data distribution was skewed, so non parametric tests, i.e., Wilcoxon’s signed-rank test (for inter follow-up association) and Spearman’s correlation coefficient (for statistical correlation between affected and unaffected Constant shoulder scores), were applied. The Friedman test for Chi-square value was performed to signify the mean and standard deviation values of the Constant shoulder score at each preoperative and postoperative follow-up assessment.

Results

In the present study, the average age of patients was 30.35±11.27 years, ranging from 18 to 63 years. All the patients undergoing the operation were males. The right shoulder was affected in 16 cases (69.56%). None of the patients had ligamentous hyperlaxity. A total of 21 patients (91.3%) had bony Bankart’s lesions, while 2 cases (8.7%) had soft Bankart’s lesions. Concomitant Bankart’s lesion and Hill-Sachs lesion were observed in 16 cases (69.56%). Glenoid bone loss was <10% in 4 cases (17.4%), 10-20% in 10 cases (43.5%), and more than 20% in 9 (39.1%) cases.

In the present study, 20 shoulders (86.96%) achieved full ROM in an average follow-up period of 677 days (1.86 years). When the patients were assessed for internal rotation, 16 patients (69.57%) could bring their hands up to the interscapular area. A total of 5 patients (21.74%) could bring their hand up to the T12 vertebrae level. A total of 2 patients (8.69%) reported moderately limited internal rotation up to the waist. External rotation was fully achieved in 20 cases (86.96%), and mild limitation was reported in 3 patients (13.04%). It was found that the mean lateral and forward elevation of 172.91±24.10 degrees and 172.74±24.12 degrees was achieved (Table/Fig 2),(Table/Fig 3)a-g.

Constant shoulder score: The mean Constant shoulder scores significantly increased from 51.17±12.283 to 84.565±10.43 (p=0.001) from preoperative to final follow-up. The Constant shoulder score observed at the first follow-up was 58.31±12.89, in the second follow-up 78.12±11.56, and in the third follow-up 83.43±10.53. Preoperatively, there was a non significant (p=0.118) weak association (rs=0.335) between the affected and normal shoulder. At the final follow-up, a highly significant (p=0.01) extraordinarily strong correlation (rs=0.813) between the affected (84.565±10.43) and normal side (89.26±2.73) was found. It was observed that Group A patients with glenoid bone loss of <10% had a mean Constant score of 87.75±2.06, Group B patients with glenoid bone loss of 10-20% had a mean Constant score of 82.30±15.24, whereas Group C patients (with glenoid bone loss of >20%) had a mean score of 84.44±4.67.

Moreover, when a comparative analysis of Constant scores (mean and median) of the three groups categorised based on the percentage of glenoid bone loss was performed, no statistically significant difference was found by Analysis of Variance (F value=0.381, p-value=0.688) and Kruskal-Wallis test (Chi-square value=1.538, p-value=0.463) (Table/Fig 4). Preoperatively, 16 patients (69.6%) had a poor grading of the constant score, and none of the patients achieved excellent grades. Postoperatively, at each follow-up, there was an improvement in the grading of the constant score, as shown in (Table/Fig 5). At the final follow-up, 22 patients (95.65%) scored excellently, and only 1 patient (4.35%) reported a poor grade. Wilcoxon’s signed-rank test was applied to calculate the paired difference of mean constant scores between preoperative versus postoperative scores. Initially, at the first follow-up, the paired difference was significantly less (p=0.876). Still, with successive follow-up evaluations, a statistically significant difference was found due to improvements in shoulder function and the constant score (p=0.001). The maximum paired difference was recorded between preoperative and final follow-up constant scores, which is highly significant (p=0.001) (Table/Fig 6). No significant intraoperative or perioperative complications occurred. There were no surgical site infections, and no complications related to the use of screws. The apprehension test was positive in 1 patient (4.35%), mild pain was reported in 3 patients (43.04%) at the final follow-up of two years, but none of the patients had redislocation.

Discussion

The congruent Arc Latarjet technique restores a greater anterior-posterior diameter of the glenoid bone without compromising the congruency of the articular surface of the shoulder joint. This may potentially decrease contact pressure across the glenohumeral joint and avoid degenerative changes in the long term (24). As far as the outcome of the congruent arc Latarjet operation is concerned, the authors assessed the patients for pain, sleep disturbance, activity level, arm position, strength of abduction, and ROM in the form of a Constant shoulder score. With a strict rehabilitation protocol, the recovery of flexion, abduction, external rotation, and internal rotation in all planes was within normal limits in the majority of the patients. In the present study, the mean Constant score of the affected shoulders at the final follow-up was significantly comparable to the Constant scores of the normal shoulder of the same individual at the final follow-up. In a series by Bauer S et al., on more than 80 cases with a minimum 1-year follow-up (range: 1-5 years), demonstrated outcomes were good to excellent (subjective shoulder value >80% in 95% of cases; Constant score >90% and Rowe score >90%) (25).

The complication rate was low, with one early coracoid fracture (1.3%), no recurrent dislocation or neurological complications, and no new arthritis of the shoulder joint observed. A similar observation was found in a study by Mizuno N et al., on 68 patients (26). The mean Rowe score increased from 37.9 preoperatively to 89.6 at the final follow-up (p<0.001). The mean subjective shoulder value was 90.9% at the final follow-up. The postoperative rate of recurrence of dislocation was 5.9%. In a study by Hurley ET et al., including 822 patients (845 shoulders), where 82% of patients were men with an average age of 27.4 years, and the mean follow-up was 199.2 months (16.6 years) (27), the rate of good/excellent outcomes was 86.1%. The recurrent instability rate was 8.5%, with 3.2% of patients having recurrent dislocations and arthritic changes seen in 38.2% of patients, and residual shoulder pain in 35.7% of patients. They concluded that the Latarjet procedure for anterior shoulder instability results in excellent functional outcomes in the long term and a high rate of return to sport among athletes.

Willemot L et al., concluded that the underlying failure mechanism of the Latarjet procedure was associated with non union in 42.3%, graft resorption in 23.1%, graft malpositioning in 15.4%, and trauma or graft fracture in 19.2% of cases (28). They reported none of the recurrent dislocations after this procedure. A similar observation was found in a study by Bohu Y et al., on 217 patients, aged 26.8±7.3 years aimed to report the rate and time of Return To Play (RTP) during the first eight months following the Latarjet procedure (29). They concluded that 158 patients (73%) resumed their main sports, at a mean of 5.1±1.5 months by eight-month follow-up. In a study by Menon A et al., a total of 280 patients were analysed in which 92.1% were athletes (30). The recurrence of instability after the Latarjet procedure was observed only in 7 patients (2.5%), and radiological signs of the development of shoulder osteoarthritis were observed in 25.8% of the patients. The overhanging position of the bone graft resulted in a statistically significant onset or worsening of osteoarthritis. However, it was observed that the age of the patient at the time of surgery, the number of dislocations before surgery, and the presence of a Hill-Sachs lesion were not significantly associated with joint degeneration. The strength of the present study was that it was a prospective study and was performed at a single centre.

Limitation(s)

The main limitations of the present study were the small sample size and short follow-up period. Therefore, it is recommended that prolonged follow-up of all cases be conducted to evaluate long-term complications of the Latarjet operation, such as arthrosis of the shoulder joint and effects caused by graft resorption.

Conclusion

The congruent arc modification of the Latarjet procedure is a reliable method for treating recurrent anterior shoulder dislocation in patients with minimal to more than 20% glenoid bone loss. The Latarjet procedure facilitates early recovery with regular compliance with the rehabilitation protocol. The present study established that this procedure ensures no further dislocation, early recovery, and adequate rehabilitation. Therefore, the Latarjet procedure is an excellent surgical intervention with satisfactory results for recurrent anterior shoulder instability.

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DOI and Others

DOI: 10.7860/JCDR/2024/68078.19431

Date of Submission: Oct 15, 2023
Date of Peer Review: Jan 18, 2024
Date of Acceptance: Apr 02, 2024
Date of Publishing: May 01, 2024

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 16, 2023
• Manual Googling: Mar 27, 2024
• iThenticate Software: Mar 29, 2024 (23%)

ETYMOLOGY: Author Origin

EMENDATIONS: 7

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