113. LONG-TERM OUTCOME OF PATTE’S OPEN TRIPLE LOCK PROCEDURE FOR ANTERIOR SHOULDER INSTABILITY

Abstract

Purpose of the study: The purpose of this retrospective clinical and radiographic study was to analyse the long-term results obtained after Patte’s triple locking procedure for the treatment of anterior instability of the shoulder joint.

Material and methods: A questionnaire was sent to 574 patients who underwent the procedure performed by the same senior operator from 1986 to 2006. Variables studied wer the Walch-Duplay score (with pain score), patient satisfaction, postoperative complications and radiographic aspect.

Results: One hundred fifty patients (26%) responded and sent three radiographs. There were 107 men and 43 women, mean age 28.6±8.7 years (range 16–57). Mean follow-up was 14.6 years (range 2.8–22.6). One hundred seventeen patients (78%) were reviewed with follow-up greater than 10 years. Two patients (1.3%) experienced recurrent anterior instability; no revision was required. The Walch-Duplay scores were excellent or good in 146 patients (97.3%); 53% of patients were pain free; 34% had episodic pain, 9% moderate to mild pain and 4% severe pain. Resumption of sports activity was noted by 85% of patients. Overall, 79% of patients were very satisfied, 18% satisfied, and 3% not satisfied. Postoperative complications (2%) were one case each of infection, transient paresis of the musculocutaeous nerve, and superficial venous thrombosis. There were radiographic signs of an anomaly of the coracoids block in 13 patients (8%); non-union (n=3), lysis (n=4) fracture (n=2), migration (n=1), fracture of the ceramic washer (n=3). The block or washer overhang was noted in 19 patients (12.7%). Centred osteoarthritis was noted in 31% of patients (25% Samilson 1, 4% Samilson 2, 2% Samilson 3). There were two factors associated with long-term degenerative disease: age > 40 at surgery (p=0.02 and block overhang (p< 0.01).

Discussion: Patte’s triple locking procedure is an open procedure for the treatment of anterior shoulder instability. The technique is very minute and specific postoperative rehabilitation is needed. In these conditions, the operation is effective, providing good control of shoulder stability and allowing resumption of sports activities with a low complication rate. This study shows that long-term degenerative disease can be decreased if the patient undergoes surgery before the age of 40 years and if the coracoids block does not overhang.