Accuracy of Coracoid Bone Graft Placement: Open versus Arthroscopic Latarjet

Abstract

Purpose The aim of this study was to compare the accuracy of the coracoid bone graft placement with the open Latarjet-Patte and arthroscopic Latarjet (arthro-Latarjet) procedures in the treatment of anterior instability of the shoulder.

Methods Forty-six patients affected by anterior shoulder instability were divided into two groups. In group A (n = 25), patients were operated by arthroscopic Latarjet (arthro-Latarjet) procedure and in group B (n = 21), patients were operated by open Latarjet-Patte procedure. Instrumental investigation was based on three-dimensional computed tomography (3D-CT) at a minimum 1-year follow-up. Graft placement and integration, divergence and posterior protrusion of the screws, and glenohumeral osteoarthritis were considered as outcomes. Statistical analysis was performed with chi-square or Fisher's exact test. Significance was set at p < 0.05.

Results Positioning of the coracoid graft proved to be optimal in 76% (19/25) of patients of group A and in 100% (21/21) of patients of group B (Fisher's exact test, p = 0.025). Screw placement with respect to the glenoid surface showed a posterior divergence in 44% (11/25) of patients in group A and in 24% (5/21) of patients in group B (p = 0.15). Posterior protrusion of screw was observed in 76% (19/25) of patients in group A and 71.4% (15/21) of patients in group B (p = 0.73). Graft integration was present in 76% (19/25) of patients in group A and 85.7% (18/21) of patients in group B (Fisher's exact test, p = 0.48). Mild signs of glenohumeral osteoarthritis were observed in 12% (3/25) of patients in group A and 28.6% (6/21) of patients in group B (Fisher's exact test, p = 0.26).

Conclusion Patients operated with open Latarjet-Patte procedure showed better results than those of the arthro-Latarjet group in reference to the positioning of the graft on the coronal plane (p = 0.025). No significant differences between the groups were observed for graft integration, divergence of the screws, posterior protrusion of the screws, and osteoarthritis.

Level of Evidence Level II, nonrandomized prospective comparative study.

Keywords

arthroscopic - coracoid graft - instability - Latarjet-Patte - shoulder - computed tomography

• References

• 1 van der Linde JA, van Wijngaarden R, Somford MP, van Deurzen DF, van den Bekerom MP. The Bristow-Latarjet procedure, a historical note on a technique in comeback. Knee Surg Sports Traumatol Arthrosc 2016; 24 (02) 470-478
• 2 Emami MJ, Solooki S, Meshksari Z, Vosoughi AR. The effect of open Bristow-Latarjet procedure for anterior shoulder instability: a 10-year study. Musculoskelet Surg 2011; 95 (03) 231-235
• 3 Hovelius 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 (07) 1095-1101
• 4 Provencher MT, Bhatia S, Ghodadra NS. , et al. Recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am 2010; 92 (Suppl. 02) 133-151
• 5 Joshi MA, Young AA, Balestro JC, Walch G. The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes. Orthop Clin North Am 2015; 46 (01) 105-111
• 6 Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R, Kochhar T. The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy 2007; 23 (11) 1242.e1-1242.e5
• 7 Nourissat G, Delaroche C, Bouillet B, Doursounian L, Aim F. Optimization of bone-block positioning in the Bristow-Latarjet procedure: a biomechanical study. Orthop Traumatol Surg Res 2014; 100 (05) 509-513
• 8 Balg F, Boileau P. The instability severity index score. a simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007; 89 (11) 1470-1477
• 9 Bouliane M, Saliken D, Beaupre LA, Silveira A, Saraswat MK, Sheps DM. Evaluation of the instability severity index score and the Western Ontario Shoulder Instability Index as predictors of failure following arthroscopic Bankart repair. Bone Joint J 2014; 96-B (12) 1688-1692
• 10 Gordins V, Hovelius L, Sandström B, Rahme H, Bergström U. Risk of arthropathy after the Bristow-Latarjet repair: a radiologic and clinical thirty-three to thirty-five years of follow-up of thirty-one shoulders. J Shoulder Elbow Surg 2015; 24 (05) 691-699
• 11 Lädermann A, Denard PJ, Burkhart SS. Injury of the suprascapular nerve during Latarjet procedure: an anatomic study. Arthroscopy 2012; 28 (03) 316-321
• 12 Samilson RL, Prieto V. Dislocation arthropathy of the shoulder. J Bone Joint Surg Am 1983; 65 (04) 456-460
• 13 Latarjet M. Technic of coracoid preglenoid arthroereisis in the treatment of recurrent dislocation of the shoulder. Lyon Chir 1958; 54 (04) 604-607
• 14 Pichon H, Startun V, Barthelemy R, Saragaglia D. Comparative study of the anatomic and clinical effect of Weaver or subtotal subscapularis tendon section in Latarjet procedure [Article in French]. Rev Chir Orthop Repar Appar Mot 2008; 94 (01) 12-18
• 15 Di Giacomo G, Costantini A, de Gasperis N. , et al. Coracoid graft osteolysis after the Latarjet procedure for anteroinferior shoulder instability: a computed tomography scan study of twenty-six patients. J Shoulder Elbow Surg 2011; 20 (06) 989-995
• 16 Allain J, Goutallier D, Glorion C. Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am 1998; 80 (06) 841-852
• 17 Cassagnaud X, Maynou C, Mestdagh H. Results of 106 Latarjet-Patte procedures: computed tomography analysis at 7.5 years follow-up. Rev Chir Orthop Repar Appar Mot 2003; 89 (08) 683-692
• 18 Hovelius L, Körner L, Lundberg B. , et al. The coracoid transfer for recurrent dislocation of the shoulder. Technical aspects of the Bristow-Latarjet procedure. J Bone Joint Surg Am 1983; 65 (07) 926-934
• 19 Huguet D, Pietu G, Bresson C, Potaux F, Letenneur J. Anterior instability of the shoulder in athletes: apropos of 51 cases of stabilization using the Latarjet-Patte intervention. Acta Orthop Belg 1996; 62 (04) 200-206
• 20 Walch G, Charret P, Pietro-Paoli H, Dejour H. Anterior recurrent luxation of the shoulder. Postoperative recurrences. Rev Chir Orthop Repar Appar Mot 1986; 72 (08) 541-555
• 21 Kraus TM, Graveleau N, Bohu Y, Pansard E, Klouche S, Hardy P. Coracoid graft positioning in the Latarjet procedure. Knee Surg Sports Traumatol Arthrosc 2016; 24 (02) 496-501