Advances in Human Biology

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 11  |  Issue : 4  |  Page : 22--26

Midterm clinical results of bankart repair, bankart remplissage, and latarjet procedures for treating recurrent anterior shoulder dislocation


Hossein Saremi1, Ali Saneii2, Bijan Goodarzi3,  
1 Department of Orthopedics, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
2 Department of Physical Education and Sport Science, Islamic Azad University, Borujerd Branch, Borujerd, Iran
3 Department of Physical Education and Sports Sciences, Islamic Azad University, Borujerd Branch, Borujerd, Iran

Correspondence Address:
Hossein Saremi
No. 11, Shokufeh St, Milad Ave, Ostadan Blv, Hamadan
Iran

Abstract

Introduction: This study compared the midterm outcomes of pain, apprehension and range of motion in the shoulder after three arthroscopic procedures including Bankart repair, Bankart repair plus remplissage, and Latarjet surgeries, in patients with recurrent anterior shoulder dislocation. Materials and Methods: We evaluated 128 patients who had undergone anterior shoulder instability surgery at least 4 years ago in our centre based on pain, apprehension and range of motion of both shoulders. Pain was assessed with visual analogue scale, apprehension by physical examination and range of motion with goniometer. We divided them into three groups based on their treatment: (1) Bankart repair, (2) Bankart remplissage and (3) Laterjet procedure. Results: There were 34 patients with Bankart repair, 68 with Bankart remplissage and 26 with Latarjet procedure. The mean of follow-up time was 6.2 years. There was only one re-dislocation. Apprehension was positive in two patients of Bankart repair, eight patients of Bankart remplissage and none of Latarjet procedure groups. The movement limitation average of the external rotation was 9.12° in Bankart repair, 7° in Bankart rempilssage and 18.53° in Latarjet procedure groups. The means of visual analogue scales were 0.29, 0.76, and 0.38 in Bankart repair, Bankart remplissage and Latarjet procedure groups. Conclusion: All operations had had satisfactory results. Remplissage does not induce more restriction on the range of motion. However, in case of more bone loss in the humeral head, apprehension seems to be more positive in those who do remplissage. Latarjet procedure seems to be very effective but causes more range of motion restrictions.



How to cite this article:
Saremi H, Saneii A, Goodarzi B. Midterm clinical results of bankart repair, bankart remplissage, and latarjet procedures for treating recurrent anterior shoulder dislocation.Adv Hum Biol 2021;11:22-26


How to cite this URL:
Saremi H, Saneii A, Goodarzi B. Midterm clinical results of bankart repair, bankart remplissage, and latarjet procedures for treating recurrent anterior shoulder dislocation. Adv Hum Biol [serial online] 2021 [cited 2021 Dec 4 ];11:22-26
Available from: https://www.aihbonline.com/text.asp?2021/11/4/22/328391


Full Text



 Introduction



The shoulder joint has the largest range of motion of all joints with little inherent bony stability. It is a frequently dislocated joint in the body (up to 47/100,000 people each year).[1] Throughout the wide range of shoulder activities, the humeral head (ball of the shoulder joint) remains precisely centred in the glenoid (the joint socket).[2] Shoulder instability encompasses a wide spectrum from subluxation to frank dislocation with a high prevalence, affecting mainly the young, active population with a significant impact on the quality of life.[3]

In the early 20th century, Perthes and Bankart described an avulsion of anterior inferior labrum from the glenoid rim. Afterwards, several open and arthroscopic techniques were described to address the anterior shoulder instability.[4] The Bankart repair focuses on the anatomical re-attachment of the labrum to the glenoid rim. It has been described initially using an open technique and more recently with arthroscopic techniques as well.[5] Although Bankart lesion can be repaired to provide stability, it is more complicated when there is bone loss in the glenoid or humeral head.

When there is a significant glenoid bone loss, transfer of the coracoid process to the anterior glenoid (Latarjet procedure) extends the bony articular arc of the glenoid.[5] Latarjet procedure can improve the anterior stability.[6] Adding the conjoint tendon may provide dynamic stability as well. This procedure addresses the issue of glenoid bone loss that has recently been identified as a key factor in recurrent instability; however, due to its significant complications, especially in case of technical problems, it is not chosen as the initial treatment for recurrent anterior shoulder dislocation without significant glenoid bone loss.[7]

The remplissage technique, which was initially described by Wolff, is an arthroscopic method to fill the Hill-Sachs lesion using infraspinatus tenodesis and posterior capsulodesis. This technique was designed to prevent recurrent instability by making the Hill-Sachs lesion extra-articular, consequently eliminating Hill-Sachs' engagement with the anterior glenoid rim.[8]

Arthroscopic remplissage done in conjunction with arthroscopic Bankart repair is a safe and effective procedure for patients with engaging Hill-Sachs lesions and subcritical glenoid bone loss. Although both of the included clinical and biomechanical studies suggest minimal changes in glenohumeral range of motion after the remplissage procedure, making strong conclusions are limited by the heterogeneity of reports about range of motion results and lack of comparative studies.[9]

In this study, we aimed to compare the midterm clinical results of three procedures, including Bankart repair, Bankart repair plus remplissage and Latarjet surgery, in patients with recurrent anterior shoulder dislocations.

 Methods



We did this quasi-experimental study at our centre on patients who had undergone different types of surgery for treating recurrent anterior shoulder dislocation (Bankart repair, Bankart repair plus remplissage and Latarjet surgeries). They had undergone surgery from June 2011 to June 2016.

The inclusion criterion was having done this treatment at least 4 years before our study. Patients who could not attend the final examination or had any problem in their normal shoulder were excluded from the study. All patients signed an informed consent before being examined in the study.

The indication for doing Bankart remplissage was having an engaging Hill-Sachs test during arthroscopy. The indication for doing Latarjet procedure was more than 25% anterior glenoid loss in the pre-surgery 3D computed tomography scan or measurement during arthroscopy [Figure 1]. One of the authors evaluated all patients under the supervision of a specialist unaware of the patients' previous surgery type.{Figure 1}

Range of motion of the operated shoulder was measured using a stainless-steel goniometer (JAMAR Co., USA) in terms of the external rotation in the neutral arm position and in 90° abduction of the arm compared to the normal shoulder. The apprehension test was evaluated in sitting and supine positions.[10],[11],[12] We used the visual analogue scale for measuring pain. This scale can help in easier grading of pain to be used in different specialties including orthopaedic surgery.[13],[14],[15] Data were analysed by Kolmogorov–Smirnov test and paired t-test using the Statistical Package for the Social Sciences (SPSS) software version 21 and IBM SPSS version21(IBM,Armonk,NY,USA).

 Results



There were 128 patients, of whom 34 patients had underwent arthroscopic Bankart repair, 26 patients open Latarjet and 68 patients Bankart repair plus remplissage procedures [Table 1]. Their mean of age was 27 years old (16–54-year-old). Mean of follow-up time was 6.2 years (4–9 years). There was only one re-dislocation which had happened 5 years after the operation in the Bankart remplissage group.{Table 1}

Apprehension test was positive for two patients (5.8%) in the Bankart repair, eight patients (11.7%) in the Bankart remplissage and none in the Latarjet surgery groups [Table 2]. Average of movement limitation was 9.12° in the Bankart repair, 7° in the Bankart remplissage and 18.5° in the Latarjet groups for external rotation in the side arm. This average for the external rotation in 90° of abduction was 8.76° in the Bankart repair, 10.44° in the Bankart remplissage and 16.61° in the Latarjet surgery groups [Table 3].{Table 2}{Table 3}

The mean of visual analogue scale score for shoulder pain had decreased significantly in all of the three surgeries, post- versus pre-operations (P < 0.001). At the final follow-up, there was no significant difference between pain in the three groups (P > 0.05). The means of visual analogue scales were 0.29, 0.76, and 0.38 in the Bankart repair, Bankart remplissage and Latarjet procedure groups [Table 4].{Table 4}

The mean, t-test, and P value types show that there was a significant difference between pain before and after the surgery in all of the three surgeries (P > 0.001). There was no significant difference in post-operative pain between the three groups.

 Discussion



This study compared the outcomes of the three surgeries i.e., arthroscopic Bankart repair, Bankart repair plus remplissage and open Latarjet surgeries, for treating recurrent anterior shoulder dislocation with a mean of 6.2-year follow-up. Recurrent anterior shoulder instability is a costly and debilitating problem that is a challenge for orthopaedic surgeons. Recurrent dislocations lead to structural damage to the shoulder joint[11] as well as functional disability and reduced work capacity.[12]

The pathology associated with traumatic anterior shoulder instability has been well described in the literature.[17],[18],[19],[20],[21],[22],[23],[24],[25] The clinical studies have indicated that capsulolabral separation from the glenoid (Bankart lesion) is the most common pathology.

Arthroscopic Bankart repair is a well-known treatment of anterior shoulder instability with satisfactory results.[26],[27],[28],[29],[30] In a systematic review of studies with 10-year follow-up, Alison et al. reported 16% re-dislocation and 26% positive apprehension test results after doing Bankart repair for recurrent instability. However, recurrent instability rates after arthroscopic Bankart repair vary from 9.4% to 35.3%.[31] Thomas et al. studied 56 patients who had undergone Bankart repair. After a mean of 11.9 years after the surgery, the mean of external rotation loss was 12° (0°–30°).[32] In our study, we had no re-dislocation in the Bankart repair group. The reason might be that we did a midterm follow-up. Thus, 5.8% positive apprehension might lead to re-dislocation in a longer follow-up time.

Loss of external rotation in our Bankart repair group is consistent with the results mentioned in the literature. Engaging Hill-Sachs lesion refers to the glenoid rim involvement when the shoulder is physiologically abducted and externally rotated. Engaging Hill-Sachs lesions lead to recurrent instability and a high rate of failure when treated only with arthroscopic Bankart repair.[33]

Wolf et al. presented an arthroscopic technique to treat traumatic shoulder instability in patients with a large Hill-Sachs lesion. The procedure, known as remplissage, consists of an arthroscopic capsulotenodesis of the posterior capsule and infraspinatus tendon to fill the Hill-Sachs lesion.[34]

In a systematic review, John et al. evaluated six studies including 167 patients to investigate the outcome of remplissage procedure.[35] In the studies with motion measurements, shoulder motion was not affected postoperatively (P > 0.05); mean of external rotation changed from 57.2 to 54.6. Nine of 167 studied shoulders had experienced an episode of recurrent glenohumeral instability (overall recurrence rate = 5.4%). In our study, re-dislocation was 1.5% in the Bankart remplissage group. However, as apprehension was positive in 11.7% of the patients, we expect to have more re-dislocations in future.

Although most studies indicate no increase of range of motion restriction after Bankart repair plus remplissage procedure,[35] some studies have claimed a decreased range of motion after it. Deutsch et al. reported a case, in which a patient treated with the arthroscopic remplissage lost his shoulder external rotation 2 years later.[36] In our study, Banker remplissage did not increase the external rotation restriction in neutral arm position or in abduction. The high apprehension rate in our Bankart remplissage group makes us think more about doing Latarjet procedure on patients with <25% glenoid loss who have engaging Hill-Sachs instead of doing Bankart remplissage. Still, more studies are required to determine the amount of glenoid bone loss accompanying engaging Hill-Sachs suitable for doing Latarjet surgery.

Laterjet procedure is about transferring the coracoid process and its attached conjoined tendon to the anterior glenoid. It is an effective method for tackling recurrent instability in patients with recurrent anterior instability and high degrees of glenoid bone loss.[37] In a systematic review of ten studies on Latarjet procedure, the rate of recurrent anterior shoulder instability ranged from 0% to 8%. Five of the studies had reported post-operative complications.

Burkhart et al.[38] reported five complications in 102 patients, including hematoma in two (one of which was drained), asymptomatic loose screws in two and asymptomatic fibrous non-union in one patient (no revision required). Lafosse et al.[39] reported two post-operative hematomas, one intraoperative graft fracture, one transient musculocutaneous nerve palsy that fully recovered, four cases of non-union and three shoulders with osteolysis around screws. Schmid et al.[40] reported complications in six of their 49 patients (12%): four had delayed wound healing, one had a post-operative frozen shoulder and one had malunion of the coracoid to the glenoid rim. Finally, Shah et al.[41] reported complications in 12 of their 48 patients (25% complication rate): infection in three (6%), recurrent instability in four (8%) and neurologic injury in five patients (10%). Hurley et al.[42] found 8.5% post-operative recurrence rate after Latarjet procedure in studies with more than 10-year follow-up.

Stiffness and loss of external rotation are an important complication of Latarjet procedure. Some studies have reported a significant loss of external rotation after this procedure.[42],[43],[44],[45] However, in a multicentred study of 390 cases, Metais et al. found only about 5° of stiffness without any significant differences between the methods.[46]

In our study, there was no re-dislocation or apprehension in the Latarjet group. However, there was a mean of 18.54° range of motion restriction in the side arm's external rotation and 16.61° restriction of external rotation in abduction. As the main cause of loss of external rotation after this procedure is subscapularis tenotomy,[47] we think that this amount of range of motion restriction is related to our technique of subscapularis tenotomy. We cut the superior part of the tendon 1 cm medial to insertion instead of a transverse cut. Although it leads to more range of motion restriction while leading to more stability, we had no re-dislocation or apprehension in our patients.

We evaluated shoulder pain after all the three procedures with visual analogue scale. There was no significant difference between them. This means that probably Bankart remplissage and Latarjet procedures do not induce more pain.

 Conclusion



Bankart Repair, Bankart repair plus remplissage and Latarjet procedures have satisfactory midterm results considering shoulder stability, range of motion and pain. Remplissage does not seem to induce any external rotation restriction on patients with engaging Hill-Sachs and those undergoing Bankart repair. However, it seems that the apprehension rate is high when there is accompanying glenoid bone loss even <25%. We recommend more studies with long-term follow-up to evaluate these findings.

Latarjet procedure is effective in restoring stability. Range of motion restriction may be significant in using a superior part tenotomy of the subscapularis tendon instead of a transverse tenotomy. Comparative studies are necessary to investigate this finding. There is no significant difference in pain outcomes regarding doing daily activities between the three procedures. A study with long-term follow-up and more cases is recommended to compare the results of these procedures.

Acknowledgement

The authors thank Muhammed Hussein Mousavinasab for editing this text.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am. 2010;92:542-9.
2Bliven KCH, Parr GP. Outcomes of the Latarjet Procedure Compared With Bankart Repair for Recurrent Traumatic Anterior Shoulder Instability. Journal of athletic training 2018;53:181-3.
3John R, Wong I. Innovative Approaches in the Management of Shoulder Instability: Current Concept Review. Curr Rev Musculoskelet Med 2019;12:386-96.
4Antunes JP, Mendes A, Prado MH, Moro OP, Miró RL. Arthroscopic Bankart repair for recurrent shoulder instability: A retrospective study of 86 cases. J Orthop 2016;13:95-9.
5Rollick NC, Ono Y, Kurji HM, Nelson AA, Boorman RS, Thornton GM, et al. Long-term outcomes of the Bankart and Latarjet repairs: A systematic review. Open Access J Sports Med 2017;8:97-105.
6Joshi MA, Young AA, Balestro JC, Walch G. The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes. The Orthopedic clinics of North America 2015;46:105-11.
7Nakhaie Amroodi M, Jafari D, Kousari AA. Results of Open Bankart Surgery for Recurrent Anterior Shoulder Dislocation with Glenoid Bone Defect and Concomitant Hill-Sachs Lesion. The Archives of Bone and Joint Surgery 2018;6:212-8.
8Aslani H, Zafarani Z, Ebrahimpour A, Salehi S, Moradi A, Sabzevari S. Early clinical results of arthroscopic remplissage in patients with anterior shoulder instability with engaging hill-sachs lesion in iran. The archives of bone and joint surgery 2014;2:43-6.
9Lazarides AL, Duchman KR, Ledbetter L, Riboh JC, Garrigues GE. Arthroscopic Remplissage for Anterior Shoulder Instability: A Systematic Review of Clinical and Biomechanical Studies. Arthroscopy 2019;35:617-28.
10Brian C, Michael B, Ann MK, John DK. The Role of Remplissage in the Setting of Shoulder Instability. Sports Medicine and Arthroscopy Review: December 2020;28:140-5.
11Flynn TW, Cleland J, Whitman J. Users' guide to the musculoskeletal examination : fundamentals for the evidence-based clinician. [Buckner, KY]; Minneapolis, Minn.: Evidence in Motion; Distributed by OPTP; 2008.
12Lizzio VA, Meta F, Fidai M, Makhni EC. Clinical Evaluation and Physical Exam Findings in Patients with Anterior Shoulder Instability. Curr Rev Musculoskelet Med 2017;10:434-41.
13Lands V, Avery D, Malige A, Stoltzfus J, Gibson B, Carolan G. Rating visualization in shoulder arthroscopy: A comparison of the visual analog scale versus a novel shoulder arthroscopy grading scale. Journal of Orthopaedics and Allied Sciences 2019;7:8-11.
14Bodian Carol A, Freedman G, Hossain S, Eisenkraft James B, Beilin Y. The Visual Analog Scale for Pain: Clinical Significance in Postoperative Patients. Anesthesiology: The Journal of the American Society of Anesthesiologists 2001;95:1356-61.
15Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy. 2007 Sep;23(9):985-90. PubMed PMID: 17868838. Epub 2007/09/18. eng.
16Hughes JL, Bastrom T, Pennock AT, Edmonds EW. Arthroscopic Bankart Repairs With and Without Remplissage in Recurrent Adolescent Anterior Shoulder Instability With Hill-Sachs Deformity. Orthopaedic journal of sports medicine 2018;6:2325967118813981.
17Adams JC. Recurrent dislocation of the shoulder. J Bone Joint Surg Br 1948;30:26-38.
18Bankart ASB. Recurrent or habitual dislocation of the shoulderjoint. BMJ 1923;2:1132-3.
19Bankart ASB. The pathology and treatment of recurrent dislocation of the shoulder joint. Br J Surg 1938;26:23-29.
20Nicola T. Anterior dislocation of the shoulder: The role of thearticular capsule. J Bone Joint Surg Am 1942;25:614-616.
21Rowe CR, Patel D, Southmayd WW. The Bankart procedure:A long-term end result. J Bone Joint Surg Am 1978;60:1-16.
22Rowe CR, Sakellarides HT. Factors related to recurrences of anterior dislocations of the shoulder. Clin Orthop 1966;20:40-
23Rowe CR, Zarins B. Recurrent transient subluxation of the shoulder. J Bone Joint Surg Am 1984;66:159-168.
24Rowe CR, Zarins B, Ciullo JV. Recurrent anterior dislocation of the shoulder after surgical repair. J Bone Joint Surg Am 1984;66:159-168.
25Altchek DW, Warren RF, Skyhar MJ, Ortiz G. T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types. J Bone Joint Surg Am 1991; 73:105-112.
26Castagna A, Garofalo R, Conti M, Flanagin B. Arthroscopic Bankart repair: have we finally reached a gold standard? Knee Surg SportsTraumatol Arthrosc 2016;24:398-405.
27Castagna A, Markopoulos N, Conti M, Delle Rose G, Papadakou E,Garofalo R. Arthroscopic Bankart suture-anchor repair: radiologicaland clinical outcome at minimum 10 years of follow-up. Am J SportsMed 2010;38:2012-6.
28Chapus V, Rochcongar G, Pineau V, Salle de Chou E, Hulet C. Tenyearfollow-up of acute arthroscopic Bankart repair for initial anteriorshoulder dislocation in young patients. Orthop Traumatol Surg Res2015;101:889-93.
29Chen L, Xu Z, Peng J, Xing F, Wang H, Xiang Z. Effectiveness andsafety of arthroscopic versus open Bankart repair for recurrent anteriorshoulder dislocation: a meta-analysis of clinical trial data. ArchOrthop Trauma Surg 2015;135:529-38.
30Alison I. Murphya,b, Eoghan T. Hurley, MB, BCha,b,*, Daire J. Hurleya,c,Leo Pauzenberger, MDa, Hannan Mullett,Long-term outcomes of the arthroscopic Bankartrepair: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg (2019) -, 1–6
31Yohei Ono, MD, PhD a,b, Diego Alejandro D avalos Herrera, MD c,Jarret M. Woodmass, MD a, Devin B. Lemmex, MD a,Long-term outcomes following isolated arthroscopic Bankartrepair: a 9- to 12-year follow-up
32THOMAS J. GILL, LYLE J. MICHELI, FRANK GEBHARD, CHRISTIAN BINDERBankart Repair for Anterior Instability of the Shoulder. Long-Term Outcome. Journal of B on e & Jo in t Surgery,1997 volume 79 issue 6 on page s850 to 7
33Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 2000;16:677-94.
34Eugene M.WolfM.D.aE. RhettHobgoodM.D.bMichael E.PollockM.D.cChad C.SmalleyM.D.d Hill-Sachs “Remplissage”: An Arthroscopic Solution for the Engaging Hill-Sachs Lesion. The Journal of Arthroscopic & Related Surgery 2008;24:723-6.
35John A. Buza III, MS, Jaicharan J. Iyengar, MD, Oke A. Anakwenze, MD, Christopher S. Ahmad, MD,and William N. Levine, MD. Arthroscopic Hill-Sachs RemplissageA Systematic Review J Bone Joint Surg Am. 2014;96:549-55.
36Deutsch AA, Kroll DG. Decreased range of motion following arthroscopic remplissage. Orthopedics 2008;31:492.
37Peter Domos,Enricomaria Lunini,Gilles Walch,contraindications and complications of the Latarjet procedure.shoulder Elbow 2018;10:15-24.
38Burkhart SS, De Beer JF, Barth JR, Cresswell T, Roberts C,Richards DP. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significantbone loss. Arthroscopy 2007;23:1033-1041.
39Lafosse L, Boyle S. Arthroscopic Latarjet procedure. J Shoulder Elbow Surg 2010;19:2-12.
40Schmid SL, Farshad M, Catanzaro S, Gerber C. The Latarjet procedure for the treatment of recurrence of anterior instability of the shoulder after operative repair: A retrospective case series of forty-nine consecutive patients. J Bone Joint Surg Am 2012;94:e75.
41Schmid SL, Farshad M, Catanzaro S, Gerber C. The Latarjet procedure for the treatment of recurrence of anterior instability of the shoulder after operative repair: A retrospective case series of forty-nine consecutive patients. J Bone Joint Surg Am 2012;94:e75.
42Hurley ET, Jamal MS, Ali ZS, Montgomery C, Pauzenberger L,Mullett H. Long-term outcomes of the Latarjet procedure for anterior shoulder instabilityda systematic review of studies at 10-year followup. J Shoulder Elbow Surg 2019;28:e33-9.
43Burkhart, 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: 1033–1041.
44Singer, GC, Kirkland, PM, Emery, RJ. Coracoid transposition for recurrent anterior instability of the shoulder. A 20-year follow up study. J Bone Joint Surg Br 1995; 77: 73–76.
45Hovelius, L, Vikerfors, O, Olofsson, A, Svensson, O, Rahme, H. Bristow-Latarjet and Bankart: a comparative study of shoulder stabilization in 185 shoulders during a seventeen year follow-up. J Shoulder Elbow Surg 2011; 20: 1095–101.
46Metais, P, Clavert, P, Barth, J Preliminary clinical outcomes of Latarjet-Patte coracoid transfer by arthroscopy vs. open surgery: prospective multicentre study of 390 cases. French Arthroscopic Society. Orthop Traumatol Surg Res 2016; 102: S271–6.
47Maynou, C, Cassagnaud, X, Mestdagh, H. Function of subscapularis after surgical treatment for recurrent instability of the shoulder using a bone-block procedure. J Bone Joint Surg Br 2005; 87: 1096–1101