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Review
. 2018 Jul 26;6(7):2325967118786930.
doi: 10.1177/2325967118786930. eCollection 2018 Jul.

The Learning Curve for the Latarjet Procedure: A Systematic Review

Seper Ekhtiari  1 , Nolan S Horner  1 , Asheesh Bedi  2 , Olufemi R Ayeni  1 , Moin Khan  1
Affiliations
Review

The Learning Curve for the Latarjet Procedure: A Systematic Review

Seper Ekhtiari et al. Orthop J Sports Med. .

Abstract

Background: Anterior shoulder instability, including recurrent instability, is a common problem, particularly in young, active patients and contact athletes. The Latarjet procedure is a common procedure to treat recurrent shoulder instability.

Purpose: To identify the reported learning curves associated with the Latarjet procedure and to determine a point on the learning curve after which a surgeon can be considered to have achieved proficiency.

Study design: Systematic review; Level of evidence, 4.

Methods: Three online databases (Embase, MEDLINE, PubMed) were systematically searched and screened in duplicate by 2 independent reviewers. The search included results from the inception of each database to January 23, 2017. Data regarding study characteristics, patient demographics, learning curve analyses, and complications were collected. Study quality was assessed in duplicate.

Results: Two level 3 studies and 3 level 4 studies of fair methodological quality were included. Overall, 349 patients (350 shoulders) with a mean age of 25.1 years (range, 14-52 years) were included in the final data analysis. Patients were predominantly male (93.7%). After 22 open and 20 to 40 arthroscopic Latarjet procedures, surgeons achieved a level of proficiency as measured by decreased operative time. For open procedures, complication rates and lengths of hospital stay decreased significantly with increased experience (Spearman ρ = -0.3, P = .009 and Spearman ρ = -0.6, P < .0001, respectively).

Conclusion: With experience, surgeons achieved a level of proficiency in performing arthroscopic and open Latarjet procedures, as measured by decreased operative time, length of hospital stay, and complication rate. The most commonly reported difference was operative time, which was significant across all studies. Overall, the Latarjet procedure is a safe procedure with low complication rates, although further research is required to truly characterize this learning curve.

Keywords: Latarjet; coracoid process transfer; learning curve; surgeon experience.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: A.B. is a consultant for Smith & Nephew, A3 Surgical, Pivot Medical, Stryker, and CDC Medical; has stock/stock options in A3 Surgical; and has received educational support from Smith & Nephew. O.R.A. is a consultant for ConMed, Smith & Nephew, and DJO.

Figures

Figure 1.
Figure 1.
Hypothetical learning curve. As displayed, a skill with a steeper learning curve is one that is mastered more quickly. This principle also holds true for skills in which a lower numerical value is desirable (eg, blood loss).
Figure 2.
Figure 2.
Literature search and inclusion results.
See this image and copyright information in PMC

References

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