The Latarjet procedure is a successful primary and revision option for anterior shoulder instability; however recent reports have highlighted varying complication rates. Our aim was to prospectively study clinical, functional and radiological outcomes of patients undergoing this procedure. 50 consecutive patients underwent a Latarjet coracoid transfer between 2006 and 2012. Mean age was 27 years (17–63), 48 were male. Pre-/post-operative imaging, Oxford Shoulder Instability Score (OISS), American Shoulder & Elbow Surgeons score (ASES), Subjective Shoulder Value score (SSV) and clinical evaluation were documented. Mean follow up was 32 months (6–74). There were no dislocations or revision procedures. Subluxation occurred in one patient only. 95% of shoulders were subjectively graded “excellent” or “good;” 5% “fair;” and none as “poor”. The mean pre-op ASES was 58(50–66) and 95(92–98) post-operatively (p< 0.001). The mean pre-operative OISS was 19(18–22) and 43(41–45) post-operatively (p<0.001). The mean SSV increased from 46% to 89% (p < 0.001). 98% of patients considered their surgery to be “successful” and 95% would recommend the procedure to a friend. 82% returned to sport at their previous level. There were no infective or metalwork-related complications. Five experienced transient neurological symptoms all of which resolved within three months. These results suggest that the Latarjet procedure is safe and reliable with low complication rates.
The Latarjet procedure is a successful primary and revision option for anterior shoulder instability; however recent reports have highlighted varying complication rates. Our aim was to prospectively study clinical, functional and radiological outcomes of patients undergoing this procedure. 50 consecutive patients underwent a Latarjet coracoid transfer between 2006 and 2012. Mean age was 27 years (17–63), 48 were male. Pre-/post-operative imaging, Oxford Shoulder Instability Score (OISS), American Shoulder & Elbow Surgeons score (ASES), Subjective Shoulder Value score (SSV) and clinical evaluation were documented. Mean follow up was 32 months (6–74). There were no dislocations or revision procedures. Subluxation occurred in one patient only. 95% of shoulders were subjectively graded “excellent” or “good;” 5% “fair;” and none as “poor”. The mean pre-op ASES was 58(50–66) and 95(92–98) post-operatively(p<0.001). The mean pre-operative OISS was 19(18–22) and 43(41–45) post-operatively(p<0.001). The mean SSV increased from 46% to 89%(p < 0.001). 98% of patients considered their surgery to be “successful” and 95% would recommend the procedure to a friend. 82% returned to sport at their previous level. There were no infective or metalwork-related complications. 5 experienced transient neurological symptoms all of which resolved within 3 months. These results suggest that the Latarjet procedure is safe and reliable with low complication rates.
We evaluated the use of a cemented Constrained Acetabular Component to treat recurrent or potential instability after hip replacement. Over a seven year period, 109 patients who had undergone 110 operations were identified from hospital records. Patients were reviewed based on clinical and radiological follow-up. Post-operative mobility and quality of life was assessed using the Oxford Hip Score (OHS) and SF-12. From an original cohort of 109 patients, 9 patients were lost to follow up. Of the remaining 100 patients, the mean follow up was 2.9 years (SD+/−2 years). There were 4 failures, requiring 3 further revisions. The mean post-operative OHS was 33, SF-12 PCS 34 and SF12 MCS 52. 5-year survivorship was 90%. Cementing a Constrained Acetabular Component provides satisfactory mid term results in patients at high risk of hip dislocation.
To describe the treatment and morbidity of lower limb (LL) football fractures in regard to returning to football in a known UK population at all skill levels. All football fractures during 2007–2008 sustained by the Lothian population were prospectively collected with the diagnosis being confirmed by the senior author when patients attended the only adult orthopaedic service in Lothian. Patients living outside the region were excluded from the study. Patients were contacted in August 2010 to ascertain their progress in return to football. There were 424 fractures in 414 patients. 366 fractures (86%) in 357 patients (86%) were followed up with a mean interval of 30 months (range 24–36 months). Of these 32% were sustained in the LL. 88% of LL injuries returned to football compared to 85% of upper limb (UL) fractures (p=0.4). 60% of LL patients were treated as outpatients. 35% were operated on −26% had ORIF and 9% IM Nailing. The most common LL fractures were Ankle 38%, Tibial Diaphysis 14%, 5th Metatarsal 11%, Fibula 9% and Great Toe 7%. Only one of the fractures was an open injury - Gustillo Class 1 2nd Phallanx Foot. Three of the 12 patients who underwent IM nailing required fasciotomy. One patient in the operative cohort developed a significant infection. The mean time for return to football for conservative treatment was 17 weeks (range 3–104 weeks), and for operative treatment 41 weeks (range 10–104 weeks). 91% of patients treated conservatively returned to football, compared to 84% of the operative cohort (p=0.3). 43% of patients had ongoing symptoms from their injury. 9% of the operative cohort required removal of metal work or further operative intervention. 83% of patients returned to the same level of football or higher following injury. Patients under 30 were 1.4 times more likely to return to sport than those over 30 (p<0.05). We have previously demonstrated that football is the most common cause of sporting fracture(1), yet little is known about patient outcome following fractures. LL fractures are less common than UL fractures, and there is no difference in the proportion of patients returning to football following LL fractures and UL fractures. Over half of LL fractures are treated as outpatients and the incidence of open fractures is very low. There is no significant difference between the operative and conservative groups in their return to football. In the over 30 age group, sustaining a fracture may act as a catalyst to quit football. This may explain the higher non-return rate compared to the under 30 age group. 43% of patients perceive that they have ongoing problems with their fracture over 24 months post-injury reflecting the considerable morbidity of football-related fractures.
Previous Anterior Cruciate Ligament (ACL) reconstruction is currently a bar from entry to the Royal Marines and Royal Navy, whilst the British Army allows recruits to join if asymptomatic 18 months post ACL reconstruction. However current Royal Marines policy is to rehabilitate recruits who sustain an ACL disruption in training. We retrospectively analysed the rehabilitation times and pass out rate of Royal Marines who had an ACL disruption during recruit training over an 8 year period. 12 recruits sustained an ACL disruption during recruit training in the study period, giving an incidence of around 1.5/1000 recruits. 9 Patients underwent ACL repairs in training, with 1 patient leaving and rejoining post repair and later successfully passed out. 2 patients were treated conservatively. Of the 12 ACL sustained in training 8/12 (67%) passed out. None of the patients treated conservatively passed out. The mean time out of training for successful recruits was 51.6 weeks (95% CI 13.1) mean rehabilitation time post ACL reconstruction for successful recruits was 36.7 weeks (95% CI 12.5). Mean time to discharge for unsuccessful recruits 63.2 weeks (95% CI 42.4). In the operative group 1/10 left due to failure to return to training and 1/10 left through unrelated reasons. Current costing for recruit training is £1800 per week per recruit. ACL injuries are not common in Royal Marine Training, and reconstruction is not a bar to completing Royal Marine basic training. We estimate that it costs around £100,000 per-injured recruit, to maintain a policy of rehabilitating ACL injured recruits in Royal Marines training. Further research into the long-term employability or Royal Marines sustaining an ACL injury in training is required.
