Improvement in VAS and ASES Scores After Arthroscopic Latarjet
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Resident PGY 5
Henry Ford Macomb
Introduction: Shoulder dislocations are the most common dislocation among the major joints. Instability due to a dislocation can be a difficult problem causing significant morbidity among sufferers. Soft-tissue procedures while successful for labral pathology have shown high failure rates in cases of bony deficiency, humeral avulsion of the glenohumeral ligaments, contact sports, and revision of previous soft tissue reconstructions. Coracoid transfer to address anterior shoulder instability, first proposed by Michel Latarjet in 1954, is increasingly used in cases of glenoid deficiency and in revision anterior stabilization. With the move towards more minimally invasive, pain-reducing procedures, the arthroscopic latarjet was developed. While many studies detail the potential complications, when done by skilled surgeons, successful outcomes can be achieved. Although technically challenging, the arthroscopic latarjet can lead to improvement in pain and functional scores while also achieving enhanced stability.
Study: Using data collected from a single surgeon, improvement was noted in both visual analog scale (VAS) pain scores as well as ASES (American Shoulder and Elbow Surgeon) shoulder scores after arthroscopic latarjet was performed. It was also noted that none of the patients have had further instability events to date following the procedure. Data was collected from December 2014 through May 2018. All patients had instability events with glenoid and/or humeral bone loss leading to off-track lesions as interpreted on CT and MRI by the operative surgeon. Each patient had failed conservative treatment with oral anti-inflammatories, ice, activity modification, and physical therapy. A total of 25 patients met criteria and were used in the analysis.Results:The average pre-operative VAS and ASES scores for the included patients were 5.92 and 53.77, respectively. The 6-week, 3 month, and 6 month VAS scores were 2.5, 2.06, and 2.34 respectively. The VAS scores decreased on average 3.58 points at 6 months compared to pre-op. The ASES scores at 6-weeks, 3 months, and 6 months were 54.40, 71.53, and 81.25, respectively. The ASES scores improved on average 26.85 points at the 6 month mark. Most importantly, no patients have had further instability events to date.Conclusion:We believe that the arthroscopic latarjet is a safe and reliable procedure. As the general public pushes for improved cosmesis and pain control after surgery, the arthroscopic latarjet should be an option. There is a steep learning curve but when surgeons use appropriate indications, stability can be restored with improved function and pain control. This retrospective study from a single surgeon performing the arthroscopic latarjet demonstrates improvement in VAS and ASES scores by 6 months post-op.
Rodenhouse, Paul and Bishai, Shariff, "Improvement in VAS and ASES Scores After Arthroscopic Latarjet" (2019). Clinical Research. 35.