A pilot study of blood supply of the coracoid process and the coracoid bone graft after Latarjet osteotomy.

Zhenhan Deng,Ying Li,Liangquan Peng,Wei Lu,Ronak Naveenchandra Kotian,Jian Xu,Weimin Zhu,Daqiang Liang,Daping Wang,Haifeng Liu,Xuchun Li

doi:10.1042/bsr20190929

Zhenhan Deng, Ying Li + Show 9 more

Open Access

https://doi.org/10.1042/bsr20190929

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Abstract

Latarjet osteotomy is still one of the most reliable and commonly used surgeries in treating recurrent anterior shoulder dislocation. The coracoid process (CP) is the main structure of this surgery. However, the blood supply of CP is not fully understood, and the extent of destruction of blood supply of coracoid bone graft after Latarjet osteotomy procedure is still controversial. Five embalmed cadaveric upper limbs specimens were employed for macro observation of the blood supply of CP. The conjoint tendon (CT) and CP interface were dissected for histology. Sixteen fresh frozen shoulder specimens were used for perfusion and micro CT scanning. Eight specimens were used to present the whole vessel structure of CP. The other eight underwent Latarjet osteotomy procedure. The coracoid bone grafts in both groups were scanned to clarify the remnant blood supply. It was found that the CP was nourished by supra-scapular artery (SSA), thoracic-acromial artery and branch from second portion of the axillary artery (AA). After Latarjet osteotomy procedure, no artery from CT was detected to penetrate the CP at its attachment. Only in one specimen the blood vessel that originated from the CT penetrated the bone graft at the inferior side. Therefore, most of the blood supply was destroyed although there is a subtle possibility that the vessels derived from the CT nourished the inferior side of the CP. In a nutshell, CP is a structure with rich blood supply. The traditional Latarjet osteotomy procedure would inevitably cut off the blood supply of the coracoid bone graft.

Highlights

Anterior shoulder dislocation is the most common type of joint dislocation
After careful observation of the embalmed specimens, we found that the coracoid process (CP)’s arterial supply included branch of supra-scapular artery (SSA), acromial branch of thoraco-acromial artery (ABTAA) and branch derived from the second portion of axillary artery (AA)
We found that the branch of SSA and the branch of ABTAA were relatively consistent nutrient arteries of the CP

Summary

Introduction

The process of dislocation can cause glenoid bone defects due to impingement between humeral head and antero-inferior glenoid rim [1]. Latarjet procedure is an effective method to repair the defective glenoid in the treatment of recurrent anterior dislocation of the shoulder joint [2,3]. The coracoid bone graft is transferred through a split of subscapularis (SUBS) to the defective glenoid and fixed. The transferred coracoid bone graft is expected to heal and prevent the humeral head from dislocating off the glenoid. CP osteotomy may arouse a concern of damage to the blood supply of the coracoid bone graft, and may result in graft absorption and nonunion [5]. Whether or not the traditional Latarjet osteotomy procedure causes damage to the blood supply of the CP is still. The present study aims at providing the anatomical basis for the effect on blood supply of the CP as well as clarifying the effect of Latarjet osteotomy procedure on the blood supply of the coracoid bone graft by exploring the characteristics and changes in the blood supply before and after osteotomy

Materials and methods

Latarjet procedure and perfusion

Results

Discussion