Shoulder Structure and Function Following the Modified Latarjet Procedure: A Clinical and Radiological Review

Abstract

Background

To evaluate the clinical and radiological outcomes of the modified Latarjet procedure for traumatic, antero-inferior glenohumeral joint instability.

Methods

Case series were used with a mean follow-up of 21.3 months for clinical and radiological review and 47.2 months for recurrent instability. Shoulder function was evaluated by clinical examination and validated shoulder scales: Western Ontario Shoulder Stability Index (WOSI), Melbourne Instability Shoulder Score (MISS) and l'Insalata Shoulder Questionnaire. Shoulder structure was evaluated by computed tomography.

Results

Thirty-two cases were enrolled (mean age 27.0 years). One patient reported a redislocation during the follow-up period. Clinical examination revealed that the median external rotation (at 0° and 90° abduction) was reduced on the operative side by 7.5° (p < 0.01) and 10° (p < 0.001), respectively. Subjective shoulder function was good. Mean (SD) scores on the WOSI, MISS and l'Insalata scales were 78.0 (19.7), 75.8 (11.5) and 89.3 (9.9), respectively. No loss of subscapularis strength was identified (p > 0.05). Radiological evaluation revealed a mean (SD) pre-operative glenoid surface area loss of 169.5 (48.5) mm² reconstituted surgically by a bone block of 225.4 (73.8) mm². Subscapularis muscle bulk was reduced on the operative side, above the level of the muscle split (p < 0.05).

Conclusions

The Latarjet procedure reliably restores lost glenoid surface area, shoulder stability, strength and function. A small loss of external rotation is expected and related to altered subscapularis anatomy.

Keywords

Latarjet subscapularis shoulder function instability

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References

Hovelius

. Incidence of shoulder dislocation in Sweden. Clin Orthop Relat Res 1982; 166: 127–31.

Simonet

Melton

III Cofield

Ilstrup

. Incidience of anterior shoulder dislocation in Olmsted County, Minnesota. Clin Orthop Relat Res 1984; 186: 186–91.

Nofsinger

Browning

Burkhart

Pedowitz

. Objective preoperative measurement of anterior glenoid bone loss: a pilot study of a computer based method using unilateral 3-dimensial computer tomography. Arthroscopy 2011; 27: 322–9.

Provencher

Bhatia

Ghodadra

, et al. Recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am 2010; 92: 133–51.

Piasecki

Verma

Romeo

Levine

Bach

Provencher

. Glenoid bone deficiency in recurrent anterior shoulder instability: diagnosis and management. J Am Acad Orthop Surg 2009; 17: 482–93.

Hovelius

Korner

Lundberg

, et al. The coracoid transfer for recurrent dislocation of the shoulder: technical aspects of the Bristow-Latarjet procedure. J Bone Joint Surg Am 1983; 65: 926–34.

Burkhart

De Beer

Johannes

, et al. Results of modified Latarjet reconstruction in patients with anteroinferior instability and signicant bone loss. Arthroscopy 2007; 23: 1033–41.

Schmid

Farshad

Catanzaro

Gerber

. The Latarjet procedure for the treatment of recurrence of anterior instability of the shoulder after operative repair: a retrospective case series of forty-nine consecutive patients. J Bone Joint Surg Am 2012; 94: e75.

Burkhart

De Beer

. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 2000; 16: 677–94.

10.

Symeonides

. The significance of the subscapularis muscle in the pathogenesis of recurrent anterior dislocation of the glenohumeral joint. J Bone Joint Surg Br 1972; 54: 476–83.

11.

Latarjet

. Treatment of recurrent dislocation of the shoulder. Lyno Chir 1954; 49: 994–1003.

12.

Maynou

Cassagnaud

Mestdagh

. Function of subscapularis after surgical treatment for recurrent instability of shoulder using a bone-block procedure. J Bone Joint Surg Br 2005; 87B: 1096–101.

13.

L'Insalata

Warren

Cohen

Altchek

Peterson

. A self-adminstered questionnaire for assessment of symptoms and functions of the shoulder. J Bone Joint Surg Am 1997; 79: 738–48.

14.

Kirkley

Griffin

McLintock

. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. Am J Sports Med 1996; 26: 764–72.

15.

Watson

Story

Dalziel

Hoy

Shimmin

Woods

. Anew clinical outcome measure of glenohumeral joint instability: the MISS questionnaire. J Shoulder Elbow Surg 2005; 14: 22–30.

16.

Parten

Burkhart

. The inverted pear glenoid: an indicator of significant glenoid bone loss. Arthroscopy 2004; 20: 169–74.

17.

Sugaya

Moriishi

Dohi

Kon

Tsuchiya

. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am 2003; 85A: 878–84.

18.

Hantes

Venouziou

Bargiotas

Metafratzi

Karantanas

Malizos

. Repair of an anteroinferior glenoid defect by the Latarjet procedure: quantitative assessment of the repair by computed tomography. Arthroscopy 2010; 26: 1021–6.

19.

Patte

Bernageau

Bancel

. The anteroinferior vulnerable point of the glenoid rim. In: Bateman

Welsch

, eds. Surgery of the shoulder. New York, NY: Marcel Dekker, 1985:94–9.

20.

Patte

Debeyre

. Luxations recidivantes de l'epaule. Encycl Med. Chir. Paris-Technique chirurgicale. Orthopedie 1980; 44265: 4.4–02.

21.

Weppe

Magnussen

Lustig

Demey

Neyret

Servien

. A biomechanical evaluation of bicortical metal screw fixation versus absorbable interference screw fixation after coracoid transfer for anterior shoulder instability. Arthroscopy 2001; 27: 1358–63.

22.

De Beer

Burkhart

Roberts

, et al. The congruent arc Latarjat. Tech Shoulder Elbow Surg 2009; 10: 62–7.

23.

Giles

Boons

Elkinson

, et al. Does the dynamic sling effect of the Latarjet procedure improve shoulder stability? A biomechanical evaluation. J Shoulder Elbow Surg 2013; 22: 821–7.

24.

Wellmann

de Ferrari

Smith

, et al. Biomechanical investigation of the stabilization principle of the Latarjet procedure. Arch Orthop Trauma Surg 2012; 132: 377–86.

25.

Elkousy

Gartsman

Labriola

O'Connor

Edwards

. Subscapularis function following the Latarjet coracoid transfer for recurrent anterior shoulder instability. Orthopedics 2010; 33: 802.

26.

Dossim

Abalo

Dosseh

Songne

Ayite

Gnandi-Pio

. Bristow-Latarjet repairs for anterior instability of the shoulder: clinical and radiographic results at mean 8.2 years follow-up. Chir Main 2008; 27: 26–30.

27.

Di Giacomo

Costantini

de Gasperis

, et al. Coracoid graft osteolysis after the Latarjet procedure for anteroinferior shoulder instability: a computed tomography scan study of twenty-six patients. J Shoulder Elbow Surg 2011; 20: 989–95.

28.

Paladini

Merolla

De Santis

Campi

Porcellini

. Long-term subscapularis strength assessment after Bristow-Latarjet procedure: isometric study. J Shoulder Elbow Surg 2012; 21: 42–7.