Summary

Functional and subjective clinical outcomes of epileptic patients with anterior shoulder instability after arthroscopic Latarjet stabilization were comparable with those of non-epileptic patients

Abstract

Background

Outcomes following Latarjet for anterior shoulder instability in epileptic patients are still a matter of debate. Unacceptably high rates of re-dislocations after surgery, reoperation and coracoid nonunion were reported in patients with a seizure disorder after Latarjet repair.

Objectives
The main goal of this study was to evaluated functional and radiographic results, recurrence and coracoid nonunion rates of the arthroscopic Latarjet procedure for anterior shoulder instability in patients with epilepsy and comparing with the results of patients without epilepsy.

Study Design & Methods
A comparative case-control analysis was conducted including nineteen patients (twenty-one unstable shoulders) with a seizure disorder and who underwent arthroscopic Latarjet procedure (epileptic-group) by the same senior surgeon, were matched with twenty-one patients without a history of seizure (non-epileptic group) who also underwent arthroscopic Latarjet repair.

Clinical outcomes at a minimum of 3 years (range, 3-9 years) postoperatively included Rowe score, Western Ontario Shoulder Instability Index, Constant-Murley Shoulder Outcome score and Single Assessment Numeric Evaluation. Demographics, surgical indications and imaging data were collected. The incidence of complications, recurrent instability, re-dislocation, revision surgery, repeat seizure(s) and presence of coracoid nonunion were also examined.

Results

After a mean follow-up of 5.8 years, no significant differences for functional results were found between epileptic and non-epileptic patients on the average ROWE; WOSI; Constant and SANE scores (P=0.500; 0.173; 0.193; 0.859; respectively).
A total of five patients (seven shoulders) continued to have seizures post-operatively but no glenohumeral instability was documented. Osteo-arthritic changes of the glenohumeral joint were observed in five shoulders (26.3%) in the epileptic patient group and in three shoulder (15.0%) in the non-epileptic group (p=0.451). No case of coracoid nonunion or ostelysis were recorded in any of the two groups investigated
There was no statistically significant difference in postoperative athletic activity( p=0.660). However, epileptic patient revelead significantly descreased postoperative sports participation (p=<0.001).

Conclusions

The functional and subjective clinical outcomes of epileptic patients with anterior shoulder instability after arthroscopic Latarjet stabilization were comparable with those of non-epileptic patients with no significant difference of coracoid nonunion and re-dislocation rate. However, decreased postoperative sports participation is expected in patient with a seizure disorder.