Accurate coracoid graft placement through use of a drill guide for the Latarjet procedure

Abstract

The Latarjet procedure has widely become the preferred treatment option for recurrent anterior glenohumeral instability in the presence of glenoid bone loss. The success of this procedure is largely dependent on accurate placement of the coracoid bone graft relative to the glenoid margin. With malpositioning of the coracoid graft, complications can arise, such as recurrent instability if placed too medially or impingement and subsequent early degenerative changes if positioned too laterally. To increase the accuracy and reproducibility of coracoid graft placement, we developed a simple and efficient drill guide that assists in accurate and safe positioning of the graft against the anterior glenoid to provide a congruent articular surface. A new drill guide was used in 12 consecutive open Latarjet procedures. Accuracy of placement of the graft with respect to the anterior glenoid rim was assessed using postoperative computed tomography imaging. Accurate graft placement with a distance between the glenoid and the graft surface of less than 1 mm was obtained in all 12 interventions. The mean angulation of the screws relative to the glenoid face was 4.3° (range, 1°-7°). All screw heads were positioned medial to the articular edge of the graft, and the distance was always greater than 3 mm. The use of a simple drill guide allows safe and accurate graft placement during an open Latarjet procedure.