Poster 189: The Latarjet Procedure: 6-Year Outcomes in Female Patients
Authors: Dib Aseel , Meade Joshua , Rao Allison , Fleischli James , Hamid Nady , Saltzman Bryan , Berk Alexander 
Published: August 2023

Objectives:

Despite nearly 30% of first-time anterior shoulder dislocations occurring in females, little has been reported on the outcomes of female patients with recurrent instability and bone loss. Stabilization surgery via the Latarjet procedure can reduce the risk of recurrent dislocation and improve patient quality of life. Prior studies have focused on high-risk subgroups, such as young males who play contact sports, and there thus remains a paucity of data regarding female-specific outcomes. The limited data on shoulder stabilization surgery in female patients has demonstrated low post-operative return to sport and shoulder scores, suggesting that current strategies are not adequately meeting the demands of this demographic. The objective of this study was to investigate and retrospectively report on the outcomes of female patients undergoing the Latarjet procedure.

Methods:

A query of the administrative database at a single surgical center based on the CPT code 23462 was used to identify all patients from January 2010 to October 2021 who underwent the Latarjet procedure. All female patients undergoing the Latarjet procedure with minimum 24-month follow-up were considered for inclusion in the study. We retrospectively reviewed clinical and operative notes of all eligible patients. Patients were contacted via telephone or email and interviewed to obtain Numeric Pain Rating Scale (NPRS), Single Assessment Numeric Evaluation (SANE), and Return to Sport (RTS) data.

Results:

After applying inclusion and exclusion criteria, a total of 30 patients were eligible for participation in the study. Of these, one (3.3%) declined to participate and 10 (33.3%) were unable to be contacted, leaving 19 (63.3%) patients available for analysis. The median age at the time of surgery was 29.0 years (IQR, 23.5-41.0), median BMI 24.5 kg/m2 (IQR, 21.8-30.6), and average follow up 76.5 months (range, 24.6-144.3). Eleven patients (57.9%) had undergone prior arthroscopic soft-tissue stabilization. Concomitant procedures occurred in 10 (52.6%) patients including open capsular shift in seven (36.8%), arthroscopic plication in three (15.8%), and arthroscopic debridement in three (15.8%). All surgical procedures were performed using an open approach. The subscapularis was managed with tenotomy in 6 patients (31.6%) and a split in 12 (63.2%). The approach was not detailed in one patient (5.3%) (Table 1). Median post-operative NPRS and SANE scores were 1 (IQR, 0-4) and 70 (IQR, 63-85), respectively. Patient reported sporting activities included: cheerleading (1), softball (2), yoga (1), track and field (2), and soccer (1) (Table 2). Twelve patients (63.2%) denied involvement in athletic activity prior to surgery. Of the seven patients who reported playing a sport in the three years prior to surgery, 3 (42.9%) had a successful RTS at a median of 12.0 months (range, 8.0-36.0). Among these three patients, the level of play upon return was variable (1 worse, 1 same, 1 better). In the four patients who did not RTS, two (50%) cited a shoulder specific reason (Table 3). Four patients (21.1%) required reoperation at a median of 15.3 months (IQR, 11.3-43.0) (Table 4). The indication for all reoperations included persistent pain and lack of range of motion. One patient (5.3%) went on to require reverse total shoulder arthroplasty due to persistent pain and poor function, and one (5.3%) required total shoulder arthroplasty due to recurrent instability after involvement in a motor vehicle accident.

Conclusions:

At mid-term follow-up female patients reported acceptable pain levels despite overall low shoulder function and RTS in comparison to published data. The role of patient sex should be explored further as a variable to be taken into consideration when determining appropriate treatment options for shoulder instability. [Table: see text][Table: see text][Table: see text][Table: see text]