Biceps Brachii Alterations Following the Latarjet Procedure: A Prospective Multicenter Study.

Lucca Lacheta,Peter Habermeyer,Mark Tauber,Sepp Braun,Marco-Christopher Rupp,Frank Martetschläger,Andrea Achtnich,Andreas B Imhoff

doi:10.3390/jcm10235487

Abstract

Purpose: To prospectively investigate the postoperative forearm supination and elbow flexion strength of both upper extremities and popeye deformity in patients who underwent a mini-open Latarjet procedure for anterior shoulder instability. Methods: Patients who underwent a mini-open Latarjet procedure at two specialized shoulder centers were prospectively evaluated preoperatively (T0) and at least 6 months (T1) after surgery. Subjects were tested for elbow flexion and forearm supination strength of both upper extremities using an isometric dynamometer and customized torque dynamometer. Clinical outcome was assessed by the Constant Score (CS), American Shoulder and Elbow Score (ASES) and Simple Shoulder test (SST). Popeye deformity was defined as a distalization of the greatest circumference of the biceps muscle belly towards the lateral epicondyle of the elbow. Results: A total of 20 patients with a mean age of 27 ± 6 years were included in the study. At a mean follow-up of 10 ± 3 months, the elbow flexion strength was restored to the preoperative state (p = 0.240). Forearm supination strength significantly decreased at final follow-up, to 88 % in the surgical arm (p = 0.015) vs. 90 % in the non-surgical arm (p = 0.023). There was no statistical difference when comparing both arms concerning elbow flexion strength (p = 0.510) and forearm supination strength (p = 0.495). No significant popeye deformity was observed in both arms (p = 0.111 vs. p = 0.508). Clinical outcome scores improved significantly from 73 ± 18 to 82 ± 13 (p = 0.014) for CS and 76 ± 22 to 89 ± 12 (p = 0.008) for ASES score preoperatively to final follow-up. No difference in the SST was documented (p = 0.10). Conclusion: The Latarjet procedure showed to preserve elbow flexion strength and provided comparable forearm supination strength compared to the uninjured arm with reliable clinical outcome in this study population. However, a decrease of forearm supination strength in both arms was persistent at a mean of 10 months postoperatively. No popeye deformity was noted in the postoperative examinations. Level of evidence: Case series, Level III.

Highlights

Anterior shoulder instability mostly affects a young and active population [1,2]
The main finding of this study is the preservation of elbow flexion strength and the excellent postoperative clinical outcome in patients treated with the Latarjet procedure at a mean follow-up of 10 months
We found comparable results for forearm flexion strength compared to the uninjured, healthy arm, both arms showed a significant decrease of forearm supination strength over time compared to the preoperative state

Summary

Introduction

One commonly described surgical technique for bony augmentation is the Latarjet procedure, involving a transfer of the coracoid process to the anterior glenoid with its attached conjoint tendons (M. biceps brachii and M. coracobrachialis) through a subscapularis muscle split [7]. This open or arthroscopic technique can be used as a salvage procedure for failed primary soft tissue stabilization, as a first-line treatment in the case of bony defects or for patients at high risk [8]. The recurrence and revision rates were low, up to 6.5% in the studied population [9]

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