Abstract
Background: The Latarjet procedure is a popular technique with the aim of the reconstruction of glenoid cavity bone defects in patients with chronic anterior shoulder instability. Studies have shown that the Congruent arc Latarjet procedure is better able to reconstruct larger defects than the Classic Latarjet, but there is a lack of information on the limitations of both methods. Methods: The dimensions of the glenoid width and the native coracoid process of two groups with 35 Formol-Carbol embalmed scapulae each were measured using a digital caliper. The relationship between the coracoid graft and the anterior-posterior diameter of the glenoid cavity was calculated to determine the maximum defect size of the glenoid cavity width, which can be treated by both Latarjet techniques. Results: The average restorable defect size of the anterior segment of the glenoid cavity was 28.4% ± 4.6% (range 19.2%–38.8%) in the Classic Latarjet group, and 45.6% ± 5.2% (range 35.7%–57.1%) in the Congruent arc Latarjet group. Based on our results, the feasibility of the Classic Latarjet procedure to reconstitute the anatomical width of the glenoid cavity was 86% in a 25% bone loss scenario, and only 40% in a 30% bone loss scenario. Conclusion: Based on our results we are unable to define a clear threshold for the optimal Latarjet graft position. In glenoid cavity defects <20%, the Classic Latarjet technique usually provides enough bone stock for anatomical reconstruction. Defects ≥35% of the glenoid cavity width should only be treated with a coracoid graft in the Congruent arc position. In the critical area between 20% and 35% of bone loss, we suggest the preoperative assessment of coracoid dimensions, based on which the graft position can be planned to restore the anatomical anterior-posterior diameter of the glenoid cavity.
Highlights
In patients with recurrent shoulder instability, the incidence of bone lesions of the anterior and anterior-inferior parts of the glenoid cavity is high—in some studies up to 70%–90% of the cases [1,2,3]
Our study shows that the probability of a Classic Latarjet procedure to reconstitute the anatomical glenoid cavity width ranges between 19.2% and 38.8%
We agree with other study groups [30,31] and conclude that the graft position should be decided on a case-to-case-basis, after consideration of all the pros and cons, with the important ancillary suggestion to determine both the amount of glenoid bone loss and coracoid dimensions in the preoperative planning stage to ensure the full anatomical reconstruction of the glenoid cavity width. This seems to become important in defects involving more than 20% of the glenoid width, as our results show that the feasibility of anatomical reconstruction of the glenoid width using Classic Latarjet grafts declines from 86% in a 25% bone loss scenario, to 40% in a 30% bone loss scenario
Summary
In patients with recurrent shoulder instability, the incidence of bone lesions of the anterior and anterior-inferior parts of the glenoid cavity is high—in some studies up to 70%–90% of the cases [1,2,3]. The Latarjet procedure is a popular technique with the aim of the reconstruction of glenoid cavity bone defects in patients with chronic anterior shoulder instability. The relationship between the coracoid graft and the anterior-posterior diameter of the glenoid cavity was calculated to determine the maximum defect size of the glenoid cavity width, which can be treated by both Latarjet techniques. The feasibility of the Classic Latarjet procedure to reconstitute the anatomical width of the glenoid cavity was 86% in a 25% bone loss scenario, and only 40% in a 30% bone loss scenario. In the critical area between 20% and 35% of bone loss, we suggest the preoperative assessment of coracoid dimensions, based on which the graft position can be planned to restore the anatomical anterior-posterior diameter of the glenoid cavity
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