Retorno al deporte luego de una cirugía de Latarjet: revisión sistemática de la bibliografía
Barra lateral del artículo
Publicado:
abr 14, 2021
Palabras clave:
Inestabilidad glenohumeral, retorno al deporte, Latarjet
Contenido principal del artículo
Resumen
Introducción: El objetivo de este estudio fue describir las tasas de retorno al deporte y el nivel alcanzado por los pacientes con inestabilidad de hombro luego del procedimiento abierto y artroscópico de Latarjet.
Materiales y Métodos: Seguimos un protocolo prespecificado y registrado en PROSPERO. Evaluamos la calidad de los estudios y utilizamos el sistema GRADE para evaluar la calidad general de la evidencia obtenida en los resultados. Incluimos estudios que evalúan el retorno al deporte de los pacientes luego de una cirugía de Latarjet con un seguimiento mínimo de 2 años.
Resultados: Se incluyeron 24 estudios, con 1436 atletas, todos con cirugía y un seguimiento promedio de 57 meses (rango 24-240). La tasa general de retorno al deporte varió del 65% al 100% de los pacientes, de ellos, el 23-100% retornó al mismo nivel. El tiempo promedio de retorno al deporte fue de 6 meses (rango 1-36). El nivel de evidencia fue bajo debido a las características de los estudios incluidos (nivel de evidencia IV), las limitaciones de los estudios y sus inconsistencias.
Conclusiones: La mayoría de los atletas con luxación recidivante de hombro sometidos a una cirugía de Latarjet retoman la práctica deportiva; sin embargo, el nivel alcanzado varía sustancialmente. El tiempo promedio de retorno al deporte fue de 6 meses, y no hubo diferencias significativas entre los deportistas competitivos y recreacionales.
Materiales y Métodos: Seguimos un protocolo prespecificado y registrado en PROSPERO. Evaluamos la calidad de los estudios y utilizamos el sistema GRADE para evaluar la calidad general de la evidencia obtenida en los resultados. Incluimos estudios que evalúan el retorno al deporte de los pacientes luego de una cirugía de Latarjet con un seguimiento mínimo de 2 años.
Resultados: Se incluyeron 24 estudios, con 1436 atletas, todos con cirugía y un seguimiento promedio de 57 meses (rango 24-240). La tasa general de retorno al deporte varió del 65% al 100% de los pacientes, de ellos, el 23-100% retornó al mismo nivel. El tiempo promedio de retorno al deporte fue de 6 meses (rango 1-36). El nivel de evidencia fue bajo debido a las características de los estudios incluidos (nivel de evidencia IV), las limitaciones de los estudios y sus inconsistencias.
Conclusiones: La mayoría de los atletas con luxación recidivante de hombro sometidos a una cirugía de Latarjet retoman la práctica deportiva; sin embargo, el nivel alcanzado varía sustancialmente. El tiempo promedio de retorno al deporte fue de 6 meses, y no hubo diferencias significativas entre los deportistas competitivos y recreacionales.
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Tanoira, I., Rossi, L., Franco, J. V. A., Escobar Liquitay, C. M., Pasqualini, I., & Ranalletta, M. (2021). Retorno al deporte luego de una cirugía de Latarjet: revisión sistemática de la bibliografía. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(2), 263-280. https://doi.org/10.15417/issn.1852-7434.2021.86.3.1068
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Derechos de autor 2021 Revista de la Asociación Argentina de Ortopedia y Traumatología
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Por la presente, acepta/n las modificaciones que sean necesarias, sugeridas en la revisión por los pares (referato), para adaptar el trabajo al estilo y modalidad de publicación de la Revista.
Citas
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recurrent anterior shoulder instability with bipolar bone loss: a systematic review to assess critical bone loss
amounts. Am J Sports Med 2018;27:363546518791555. https://doi.org/10.1177/0363546518791555
2. Willemot LB, Elhassan BT, Verborgt O. Bony reconstruction of the anterior glenoid rim. J Am Acad Orthop Surg 2018;26(10):e207-e218. https://doi.org/10.5435/JAAOS-D-16-00649
3. Degen RM, Camp CL, Werner BC, Dines DM, Dines JS. Trends in bone-block augmentation among recently
trained orthopaedic surgeons treating anterior shoulder instability. J Bone Joint Surg Am 2016;98(13):e56.
https://doi.org/10.2106/JBJS.15.01478
4. Rabinowitz J, Friedman R, Eichinger JK. Management of glenoid bone loss with anterior shoulder instability:
indications and outcomes. Curr Rev Musculoskelet Med 2017;10(4):452-62.
https://doi.org/10.1007/s12178-017-9439-y
5. Riff AJ, Frank RM, Sumner S, Friel N, Bach BR Jr, Verma NN, Romeo AA. Trends in shoulder stabilization
techniques used in the United States based on a large private-payer database. Orthop J Sports Med
2017;5(12):2325967117745511. https://doi.org/10.1177/2325967117745511
6. Ekhtiari S, Horner NS, Bedi A, Ayeni OR, Khan M. The learning curve for the Latarjet procedure: a
systematic review. Orthop J Sports Med 2018;6(7):2325967118786930. https://doi.org/10.1177/2325967118786930
7. Dines JS, Dodson CC, McGarry MH, Oh JH, Altchek DW, Lee TQ. Contribution of osseous and
muscular stabilizing effects with the Latarjet procedure for anterior instability without glenoid bone loss. J Shoulder Elbow Surg 2013;22(12):1689-94. https://doi.org/10.1016/j.jse.2013.02.014
8. Yamamoto N, Muraki T, An KN, Sperling JW, Cofield RH, Itoi E, et al. The stabilizing mechanism of
the Latarjet procedure: a cadaveric study. J Bone Joint Surg Am 2013;95(15):1390-7. https://doi.org/10.2106/JBJS.L.00777
9. An VV, Sivakumar BS, Phan K, Trantalis J. A systematic review and meta-analysis of clinical and patient-reported
outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair. J Shoulder Elbow Surg 2016;25(5):853-63. https://doi.org/10.1016/j.jse.2015.11.001
10. Lädermann A, Böhm E, Tay E, Scheibel M. Bone-mediated anteroinferior glenohumeral instability : Current
concepts. Orthopade 2018;47(2):129-38. https://doi.org/10.1007/s00132-017-3511-6
11. Porter DA, Birns M, Hobart SJ, Kowalsky M, Galano GJ. Arthroscopic treatment of osseous instability of the
shoulder. HSS J 2017;13(3):292-301. https://doi.org/10.1007/s11420-017-9553-9
12. Tjong VK, Devitt BM, Murnaghan ML, Ogilvie-Harris DJ, Theodoropoulos JS. A qualitative investigation of return to sport after arthroscopic Bankart repair: beyond stability. Am J Sports Med 2015;43(8):2005-11.
https://doi.org/10.1177/0363546515590222
13. Higgins JPT, Lasserson T, Chandler J, Tovey D, Churchill R. Methodological Expectations of Cochrane Intervention [Internet]. London: Cochrane; Version July 2019. Standards for the conduct of new Cochrane Intervention (C1-75). [cited 2019 sept 03]. Disponible en:
https://community.cochrane.org/mecir-manual/standards-conduct-new-cochrane-intervention-reviews-c1-75
14. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Disponible en: www.handbook.cochrane.org
15. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement. Int J Surg 2010;8:336-41. https://doi.org/10.1016/j.ijsu.2010.02.007
16. Moga C, Guo B, Schopflocher D, Harstall C. Development of a quality appraisal tool for case series studies using a modified Delphi technique [Internet]. Edmonton AB: Institute of Health Economics; 2012:71 [cited 2019 sept 03]. Disponible en: https://www.ihe.ca/advanced-search/development-of-a-quality-appraisal-tool-for-case-series-studies-using-a-modified-delphi-technique
17. Schünemann H, Brożek J, Guyatt G, Oxman A (eds). Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. Updated October 2013 [Internet]. The GRADE Working Group; 2013 [cited 2019 sept 03]. Disponible en: https://gdt.gradepro.org/app/handbook/handbook.html#h.hnedbo8gqjqk
18. El Andaloussi Y, Arssi M, Zaouari T, Benhima MA, Cohen D, Trafeh M, et al. Instabilité antérieure de l’épaule chez les sportifs À propos de 36 cas. J Traumatol Sport 2006;23:148-52. https://doi.org/10.1016/S0762-915X(06)71431-0
19. Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health 2014;72(1):39. https://doi.org/10.1186/2049-3258-72-39
20. Baverel L, Colle PE, Saffarini M, Anthony Odri G, Barth J. Open Latarjet procedures produce better outcomes in competitive athletes compared with recreational athletes: a clinical comparative study of 106 athletes aged under 30 years. Am J Sports Med 2018;46(6):1408-15. https://doi.org/10.1177/0363546518759730
21. Higgins JPT, Green S (eds). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011][Internet]. The Cochrane Collaboration; 2011. Chapter 9, Analysing data and undertaking metaanalyses. [cited 2019 sept 03]. Disponible en: www.handbook.cochrane.org
22. Cote MP, Lubowitz JH, Rossi MJ, Brand JC. Reviews pooling heterogeneous, low-evidence, high-bias data result in incorrect conclusions: but heterogeneity is an opportunity to explore. Arthroscopy 2018;34(12):3126-8.
https://doi.org/10.1016/j.arthro.2018.10.005
23. Harris JD, Brand JC, Cote MP, Faucett SC, Dhawan A. Research pearls: the significance of statistics and perils of
pooling. Part 1: Clinical versus statistical significance. Arthroscopy 2017;33(6):1102-12. https://doi.org/10.1016/j.arthro.2017.01.053
24. Hunter JP, Saratzis A, Sutton AJ, Boucher RH, Sayers RD, Bown MJ. In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias. J Clin Epidemiol 2014;67(8):897-903. https://doi.org/10.1016/j.jclinepi.2014.03.003
25. GRADEpro GDT [Software]. McMaster University and Evidence Prime; c2015 [cited 2019 Sep 03]. Disponible
en: gradepro.org
26. Burkhart SS, De Beer JF, Barth JR, Cresswell T, Roberts C, Richards DP. Results of modified Latarjet
reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy 2007;23:1033-41.
https://doi.org/10.1016/j.arthro.2007.08.009
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