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van Spanning SH, Lafosse T, Athwal GS, Favorito P, Meislin RJ, Lallemand G, Vogels J, Lafosse L, Buijze GA. How to salvage the fractured coracoid during the Latarjet Procedure? An empirical approach. Orthop Traumatol Surg Res 2024:103919. [PMID: 38879002 DOI: 10.1016/j.otsr.2024.103919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/16/2024] [Accepted: 06/12/2024] [Indexed: 07/02/2024]
Abstract
The Latarjet procedure is a frequently used stabilization procedure in case of anterior shoulder instability with critical glenoid bone loss and/or off-track Hill Sachs lesions. Although uncommon, intra-operative graft fractures do occur. When confronted with this potentially challenging intra-operative complication, having a secondary solution is paramount to achieve a successful outcome. This technical note provides a treatment algorithm that may function as a useful guideline to assist surgeons that experience this potentially complex unintended event during a Latarjet procedure. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
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Affiliation(s)
- Sanne H van Spanning
- Alps Surgery institute, Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Clinique Générale, Annecy, France; The Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, The Netherlands; Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG hospital, Amsterdam, The Netherlands
| | - Thibault Lafosse
- Alps Surgery institute, Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Clinique Générale, Annecy, France
| | - George S Athwal
- St. Joseph's Health Care, Western University, Roth McFarlane Hand and Upper Limb Center, London, ON, Canada
| | - Paul Favorito
- The Christ Hospital. Division Chief of the Shoulder and Upper Extremity Service in the Department of Orthopedics, Cincinnati, OH, USA
| | - Robert J Meislin
- Department of Orthopedic Surgery, New York University Langone Health, NY, NY, USA
| | - Geoffroi Lallemand
- Alps Surgery institute, Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Clinique Générale, Annecy, France
| | - Jérôme Vogels
- Institut chirurgical de la main et du membre supérieur, 17 avenue Condorcet, 69100 Villeurbanne, France
| | - Laurent Lafosse
- Alps Surgery institute, Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Clinique Générale, Annecy, France
| | - Geert Alexander Buijze
- Alps Surgery institute, Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Clinique Générale, Annecy, France; Hand and Upper Extremity Surgery Unit, Department of Orthopaedic Surgery, Lapeyronie Hospital, Montpellier University Medical Center, Montpellier, France; Amsterdam University Medical Center, Department of Orthopaedic Surgery, Amsterdam, The Netherlands.
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Khan AZ, Fares MY, Abboud JA. Distal Radius Allograft for Glenohumeral Instability: A Novel Osteochondral Allograft Reconstruction Option in the Setting of Glenoid Bone Loss. Am J Sports Med 2024; 52:201-206. [PMID: 38164671 DOI: 10.1177/03635465231210938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Distal tibial allograft (DTA) reconstruction for glenoid bone loss is nonanatomic, as it does not match the glenoid radius of curvature (ROC) in the anterior-posterior (AP) plane. The dorsal articular portion of the distal radius has not been previously described as an allograft reconstruction option for glenoid bone loss. PURPOSE To evaluate distal radius fresh-frozen allograft (DRA) as a potential match for glenoid reconstruction. STUDY DESIGN Controlled laboratory study. METHODS Eighteen fresh-frozen human cadaveric specimens-including 6 shoulder, 6 wrist, and 6 tibia specimens-were used. The ROC and the graft length were measured in the superior-inferior (SI) plane. A 30% defect was created in all glenoid specimens, and both DTAs and DRAs were harvested to assess graft fit after fixation. Computed tomography analysis was used to assess bony ROC and bone mineral density (BMD). RESULTS The cadaveric specimens had a mean age of 77 years. The mean SI glenoid length was 39.7 mm compared with 36.8 mm for the DRA and 30 mm for the DTA. The ROC in the SI plane was 29 ± 5.3 mm for the glenoid, 37.8 ± 4.9 mm for the DRA, and 24 ± 3.7 mm for the DTA. In the AP plane, the ROC was 39.6 ± 6.6 mm for the glenoid, 30.4 ± 18.6 mm for the DRA, and 126.3 ± 9.5 mm for the DTA. On computed tomography analysis, the ROC in the SI plane was 30.4 ± 1.5 mm for the glenoid, 30.3 ± 5.6 mm for the DRA, and 24.5 ± 9.4 mm for the DTA. In the AP plane, the ROC was 30.8 ± 2 mm for the glenoid, 19.1 ± 2.3 mm for the DRA, and 46.7 ± 21.7 mm for the DTA. The BMD was 226.3 ± 79 Hounsfield units (HU) for the glenoid, 228.5 ± 94.7 HU for the DRA, 235 ± 96.2 HU for the coracoid process, and 235.1 ± 84.6 HU for the DTA. CONCLUSION Compared with the DTA, the DRA had a greater mean graft length in the SI plane, providing utilization in cases of larger bony defects; the DRA has a more acute ROC in the AP plane (closer to that of the glenoid), providing a greater potential buttress to anterior humeral translation. Compared with currently utilized grafts, the DRA BMD was not significantly diminished. This study presents the DRA as a novel allograft reconstruction option in the setting of anterior glenoid bone loss; further biomechanical and clinical investigation is indicated.
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Affiliation(s)
- Adam Z Khan
- Southern California Permanente Medical Group, Panorama City, California, USA
| | - Mohamad Y Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Joseph A Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
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Rauck RC, Brusalis CM, Jahandar A, Lamplot JD, Dines DM, Warren RF, Gulotta LV, Kontaxis A, Taylor SA. Complete Restoration of Native Glenoid Width Improves Glenohumeral Biomechanics After Simulated Latarjet. Am J Sports Med 2023; 51:2023-2029. [PMID: 37249128 DOI: 10.1177/03635465231174910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The amount of glenoid width that must be restored with a Latarjet procedure in order to reestablish glenohumeral stability has not been determined. PURPOSE/HYPOTHESIS The purpose of this article was to determine the percentage of glenoid width restoration necessary for glenohumeral stability after Latarjet by measuring anterior humeral head translation and force distribution on the coracoid graft. The hypothesis was that at least 100% of glenoid width restoration with Latarjet would be required to maintain glenohumeral stability. STUDY DESIGN Controlled laboratory study. METHODS Nine cadaveric shoulders were prepared and mounted on an established shoulder simulator. A lesser tuberosity osteotomy (LTO) was performed to allow accurate removal of glenoid bone. Coracoid osteotomy was performed, and the coracoid graft was sized to a depth of 10 mm. Glenoid bone was sequentially removed, and Latarjet was performed using 2 screws to reestablish 110%, 100%, 90%, and 80% of native glenoid width. The graft was passed through a subscapularis muscle split, and the LTO was repaired. A motion tracking system recorded glenohumeral translations, and force distribution was recorded using a TekScan pressure sensor secured to the glenoid face and coracoid graft. Testing conditions included native; LTO; Bankart tear; and 110%, 100%, 90%, and 80% of glenoid width restoration with Latarjet. Glenohumeral translations were recorded while applying an anteroinferior load of 44 N at 90° of humerothoracic abduction and 0° or 45° of glenohumeral external rotation. Force distribution was recorded without an anteroinferior load. RESULTS Anterior humeral head translation progressively increased as the proportion of glenoid width restored decreased. A marked increase in anterior humeral head translation was found with 90% versus 100% glenoid width restoration (10.8 ± 3.0 vs 4.1 ± 2.6 mm, respectively; P < .001). Greater glenoid bone loss also led to increased force on the coracoid graft relative to the native glenoid bone after Latarjet. A pronounced increase in force on the coracoid graft was seen with 90% versus 100% glenoid width restoration (P < .001). CONCLUSION Anterior humeral head translation and force distribution on the coracoid graft dramatically increased when <100% of the native glenoid width was restored with a Latarjet procedure. CLINICAL RELEVANCE If a Latarjet is unable to fully restore the native glenoid width, surgeons should consider alternative graft sources to minimize the risk of recurrent instability or coracoid overload.
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Affiliation(s)
- Ryan C Rauck
- Division of Sports Medicine, Department of Orthopaedic Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Christopher M Brusalis
- Sports Medicine Institute, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Amirhossein Jahandar
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Joseph D Lamplot
- Division of Sports Medicine, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David M Dines
- Sports Medicine Institute, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Russell F Warren
- Sports Medicine Institute, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Lawrence V Gulotta
- Sports Medicine Institute, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andreas Kontaxis
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Samuel A Taylor
- Sports Medicine Institute, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Kim BI, Hudson CP, Taylor DC, Anakwenze OA, Dickens JF, Lau BC. Distal Clavicle Autograft Versus Traditional and Congruent Arc Latarjet Procedures: A Comparison of Surface Area and Glenoid Apposition With 3-Dimensional Computed Tomography and 3-Dimensional Magnetic Resonance Imaging. Am J Sports Med 2023; 51:1295-1302. [PMID: 36927084 DOI: 10.1177/03635465231157430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Limited studies have compared graft-glenoid apposition and glenoid augmentation area between the Latarjet procedure and distal clavicle graft in glenohumeral stabilization. Additionally, preoperative planning is typically performed using computed tomography (CT), and few studies have used 3-dimensional (3D) magnetic resonance imaging (MRI) reformations to assess graft dimensions. PURPOSE The purpose of this study was 2-fold: (1) to compare bony apposition, glenoid augmentation, and graft width among coracoid and distal clavicle bony augmentation techniques and (2) to determine the viability of 3D MRI to assess bone graft dimensions. STUDY DESIGN Controlled laboratory study. METHODS A total of 24 patients with recurrent glenohumeral instability and bone loss were included in this study. 3D CT and 3D MRI reformations were utilized to measure pertinent dimensions for 5 orientations of coracoid and distal clavicle autografts: (1) standard Latarjet procedure (SLJ), (2) congruent arc Latarjet procedure (CLJ), (3) distal clavicle attached by its posterior surface (DCP), (4) distal clavicle attached by its inferior surface (DCI), and (5) distal clavicle attached by its resected end (DCR). Glenoid augmentation was defined as the graft surface area contributing to the glenoid. Bone-on-bone apposition was defined as the graft-glenoid contact area for bone healing potential, and graft width was pertinent for fixation technique. Glenoid bone loss ranged from 0% to 34%. Paired t tests were used to compare graft sizes between patients and compare 3D CT versus 3D MRI measurements. RESULTS The CLJ had the largest graft surface area (mean, 318.41 ± 74.44 mm2), while the SLJ displayed the most bone-on-bone apposition (mean, 318.41 ± 74.44 mm2). The DCI had the largest graft width (mean, 20.62 ± 3.93 mm). Paired t tests revealed no significant differences between the Latarjet techniques, whereas distal clavicle grafts varied significantly with orientation. All 3D CT and 3D MRI measurements were within 1 mm of each other, and only 2 demonstrated a statistically significant difference (coracoid width: 13.03 vs 13.98 mm, respectively [P = .010]; distal clavicle thickness: 9.69 vs 10.77 mm, respectively [P = .002]). 3D CT and 3D MRI measurements demonstrated a strong positive correlation (r > 0.6 and P < .001 for all dimensions). CONCLUSION Glenoid augmentation, bony apposition, and graft width varied with coracoid or distal clavicle graft type and orientation. Differences between 3D CT and 3D MRI were small and likely not clinically significant. CLINICAL RELEVANCE 3D MRI is a viable method for preoperative planning and graft selection in glenoid bone loss.
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Affiliation(s)
- Billy I Kim
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Caroline P Hudson
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Dean C Taylor
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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Paul RW, DeBernardis DA, Hameed D, Clements A, Kamel SI, Freedman KB, Bishop ME. Effect of Preoperative MRI Coracoid Dimensions on Postoperative Outcomes of Latarjet Treatment for Anterior Shoulder Instability. Orthop J Sports Med 2022; 10:23259671221083967. [PMID: 35923867 PMCID: PMC9340370 DOI: 10.1177/23259671221083967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Preoperative coracoid dimensions may affect the size of the bone graft transferred to the glenoid rim and thus the postoperative outcomes of Latarjet coracoid transfer. Purpose: To determine the effect of coracoid length and width as measured on preoperative magnetic resonance imaging (MRI) on outcomes after Latarjet treatment of anterior shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent primary Latarjet surgery between 2009 and 2019 and had preoperative MRI scans and minimum 2-year postoperative outcomes. Longitudinal coracoid length was measured on axial MRI sequences as the distance from the coracoclavicular ligament insertion to the distal tip. Comparisons were made between shorter and longer coracoids and between narrower and wider coracoids. The outcomes of interest were recurrent instability, reoperation, complications, return to sport (RTS), and American Shoulder and Elbow Surgeons (ASES) score. Independent-samples t test, Mann-Whitney test, chi-square test, and Fisher exact test were used to compare outcomes between groups, and univariate correlation coefficients were calculated to evaluate the relationships between demographics and coracoid dimensions. Results: Overall, 56 patients were included (mean age, 28.4 years). The mean ± SD coracoid length was 21.6 ± 2.4 mm and width 10.0 ± 1.0 mm. Relative to patients with a longer coracoid (≥22 mm; n = 26), patients with a shorter coracoid (<22 mm; n = 30) had similar rates of recurrent instability (shorter vs longer; 6.7% vs 3.8%), complications (10.0% vs 15.4%), reoperation (3.3% vs 7.7%), and RTS (76.5% vs 58.8%) and similar postoperative ASES scores (85.0 vs 81.6) ( P ≥ .05 for all). Likewise, relative to patients with a wider coracoid (≥10 mm; n = 27), patients with a narrower coracoid (<10 mm; n = 29) had similar prevalences of recurrent instability (narrower vs wider; 6.9% vs 3.7%), complications (17.2% vs 7.4%), reoperation (3.5% vs 7.4%), and RTS (66.7% vs 68.4%) and similar postoperative ASES scores (87.1 vs 80.0) ( P ≥ .05 for all). Conclusion: Patients undergoing Latarjet coracoid transfer had similar postoperative outcomes regardless of preoperative coracoid dimensions. These findings should be confirmed in a larger cohort before further clinical recommendations are made.
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Affiliation(s)
- Ryan W. Paul
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | | | - Daniel Hameed
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Ari Clements
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Sarah I. Kamel
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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