Editorial Commentary: Healthy Skepticism: An Invaluable Trait
| Autor: | Richard L. Angelo |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Joint Instability
medicine.medical_specialty Coracoid Arthroscopy Rotator Cuff 03 medical and health sciences 0302 clinical medicine Scapula Humans Medicine Orthopedics and Sports Medicine Rotator cuff 030222 orthopedics medicine.diagnostic_test Shoulder Joint business.industry 030229 sport sciences Latarjet procedure Surgery medicine.anatomical_structure Learning curve Shoulder joint business Cadaveric spasm |
| Zdroj: | Arthroscopy: The Journal of Arthroscopic & Related Surgery. 33:2125-2127 |
| ISSN: | 0749-8063 |
| DOI: | 10.1016/j.arthro.2017.09.006 |
| Popis: | Using a switching stick from the posterior portal is a frequently employed method of identifying the location for the subscapularis split for a shoulder arthroscopic Latarjet. However, in a recent cadaveric study, in none of the 20 specimens studied did this technique result in the split being placed in the preferred position-the junction of the superior two-thirds and the inferior one-third of the subscapularis. As a result, if the position of the coracoid graft is too superior, the anteroinferior extension of the glenoid arc and the vector of the conjoined sling may be suboptimal and fail to restrain humeral head translation. There is thus a need for a more reliable method for establishing the subscapularis split in patients with shoulder instability and significant glenoid bone loss. Moreover, in comparison to the open Latarjet surgical technique, an arthroscopic Latarjet procedure is notably more complex, technically challenging, and involves a demanding learning curve. For any procedure, the morbidity curve is inversely related to the learning curve-the lower one is on the learning curve, the greater the expected complications. The area beneath the morbidity curve is related to increased costs to manage complications and suboptimal outcomes. Study, practice, acquisition, and refinement of the necessary skills needed to perform a complex procedure should be done primarily in the cadaver lab. It is imperative that each of us critically evaluate our own experience and clinical practice to determine if we have or expect to generate the critical volume necessary to successfully master the arthroscopic Latarjet techniques and to retain the expertise needed for optimal patient outcomes. |
| Databáze: | OpenAIRE |
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