LUtarjet-limit unique coracoid osteotomy Latarjet (With video)

Abstract

Background: The Latarjet procedure is an effective technique for the treatment of recurrent anterior shoulder dislocation with glenoid bone loss. However, the inevitable destruction of the coracoacromial arch may result in humeral head translation. The aim of the study is to introduce a modified Latarjet technique with coracoacromial arch preservation as well as its short term clinical outcomes. Methods: We propose a novel individualized flexible arthroscopic suture button fixation Latarjet technique called ‘LUtarjet’ with video. Precise measurements of the coracoid process, glenoid deficiency and osteotomy plane were made preoperatively. Only three arthroscopic portals were needed and limit unique coracoid osteotomy was performed with coracoacromial arch preservation. The mini window splitting of the subscapularis was performed from the posterior to the anterior direction and the split window was as small as 8–10 mm in length. Results: A total of 27 patients (25.6 ± 5.4 years) were included in the study. The average surgical duration was 55.6 ± 6.3 min and the mean follow-up time was 8.1 ± 1.5 months. The functional score was significantly improved at the last follow-up. Radiologic evidence showed that the bone graft healing was placed in the desired position. No complications were found. Conclusions: We present a fast, easy, accurate, safe arthroscopic ‘LUtarjet’ technique called FEAST that can simplify the arthroscopic Latarjet process and achieve a satisfactory bone graft position and satisfactory short-term clinical outcomes. Level of evidence: IV, case series.

Keywords

Latarjet / Recurrent anterior shoulder dislocation / Glenoid bone loss / Suture button fixation / Coracoacromial arch

References

[1] Latarjet M.Treatment of recurrent dislocation of the shoulder. Lyon Chir. 1954; 49: 994-7.

[2] Walch G, Charret P, Pietro-Paoli H, Dejour H. Anterior recurrent luxation of the shoulder. Postoperative recurrences. Rev Chir Orthop Reparatrice Appar Mot. 1986; 72: 541-55.

[3] Young AA, Maia R, Berhouet J, Walch G. Open Latarjet procedure for management of bone loss in anterior instability of the glenohumeral joint. J Shoulder Elb Surg. 2011; 20: S61-9. https://doi.org/10.1016/j.jse.2010.07.022.

[4] Joshi MA, Young AA, Balestro JC, Walch G. The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes. Clin Sports Med. 2013; 32: 731-9.

[5] Giles JW, Boons HW, Elkinson I, Faber KJ, Ferreira LM, Johnson JA, et al. Does the dynamic sling effect of the Latarjet procedure improve shoulder stability? A biomechanical evaluation. J Shoulder Elb Surg. 2013; 22: 821-7.

[6] Yamamoto N, Muraki T, An KN, Sperling JW, Cofield RH, Itoi E, et al. The stabilizing mechanism of the Latarjet procedure: a cadaveric study. J Bone Joint Surg Am. 2013; 95: 1390-7.

[7] Bhatia S, Frank RM, Ghodadra NS, Hsu AR, Romeo AA, Bach BR Jr, et al. The outcomes and surgical techniques of the latarjet procedure. Art Ther. 2014; 30: 227-35.

[8] Schmid SL, Farshad M, Catanzaro S, Gerber C. 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. https://doi.org/10.2106/JBJS.K.00380.

[9] Hardy A, Sabatier V, Laboudie P, Schoch B, Nourissat G, Valenti P, et al. Outcomes after Latarjet procedure: patients with first-time versus recurrent dislocations. Am J Sports Med. 2020; 48: 21-6.

[10] Hurley ET, Jamal MS, Ali ZS, Montgomery C, Pauzenberger L, Mullett H. Long-term outcomes of the Latarjet procedure for anterior shoulder instability: a systematic review of studies at 10-year follow-up. J Shoulder Elb Surg. 2019; 28: e33-9. https://doi.org/10.1016/j.jse.2018.08.028.

[11] Rollick NC, Ono Y, Kurji HM, Nelson AA, Boorman RS, Thornton GM, et al. Long-term outcomes of the Bankart and Latarjet repairs: a systematic review. Open Access J Sports Med. 2017; 8: 97-105.

[12] Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R, Kochhar T. The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Art Ther. 2007; 23: e1241-5. https://doi.org/10.1016/j.arthro.2007.06.008.

[13] Lafosse L, Boyle S, Gutierrez-Aramberri M, Shah A, Meller R. Arthroscopic latarjet procedure. Orthop Clin North Am. 2010; 41: 393-405.

[14] Boileau P, Gendre P, Baba M, Thélu CÉ, Baring T, Gonzalez JF, et al. A guided surgical approach and novel fixation method for arthroscopic Latarjet. J Shoulder Elb Surg. 2016; 25: 78-89.

[15] Gendre P, Thélu CE, d’Ollonne T, Trojani C, Gonzalez JF, Boileau P. Coracoid bone block fixation with cortical buttons: An alternative to screw fixation? Orthop Traumatol Surg Res. 2016; 102: 983-7.

[16] Boileau P, Saliken D, Gendre P, Seeto BL, d’Ollonne T, Gonzalez JF, et al. Arthroscopic Latarjet: suture-button fixation is a safe and reliable alternative to screw fixation. Art Ther. 2019; 35: 1050-61.

[17] Xu J, Liu H, Lu W, Zhu W, Peng L, Ouyang K, et al. Clinical outcomes and radiologic assessment of a modified suture button arthroscopic Latarjet procedure. BMC Musculoskelet Disord. 2019; 20: 173.

[18] Xu J, Liu H, Lu W, Deng Z, Zhu W, Peng L, et al. Modified arthroscopic Latarjet procedure: suture-button fixation achieves excellent Remodeling at 3-year follow-up. Am J Sports Med. 2020; 48: 39-47.

[19] Lee TQ, Black AD, Tibone JE, McMahon PJ. Release of the coracoacromial ligament can lead to glenohumeral laxity: a biomechanical study. J Shoulder Elb Surg. 2001; 10: 68-72.

[20] Jacxsens M, Elhabian SY, Brady SE, Chalmers PN, Tashjian RZ, Henninger HB. Coracoacromial morphology: a contributor to recurrent traumatic anterior glenohumeral instability? J Shoulder Elb Surg. 2019; 28: 1316-25.e1. https://doi.org/10.1016/j.jse.2019.01.009.

[21] Su WR, Budoff JE, Luo ZP. The effect of coracoacromial ligament excision and acromioplasty on superior and anterosuperior glenohumeral stability. Art Ther. 2009; 25: 13-8.

[22] Wellmann M, Petersen W, Zantop T, Schanz S, Raschke MJ, Hurschler C. Effect of coracoacromial ligament resection on glenohumeral stability under active muscle loading in an in vitro model. Art Ther. 2008; 24: 1258-64.

[23] Panni AS, Milano G, Lucania L, Fabbriciani C, Logroscino CA. Histological analysis of the coracoacromial arch: correlation between age-related changes and rotator cuff tears. Art Ther. 1996; 12: 531-40.

[24] Boes MT, McCann PD, Dines DM. Diagnosis and management of massive rotator cuff tears: the surgeon’s dilemma. Instr Course Lect. 2006; 55: 45-57.

[25] Sakoma Y, Sano H, Shinozaski N, Itoigawa Y, Yamamoto N, Itoi E. Coverage of the humeral head by the coracoacromial arch: relationship with rotator cuff tears. Acta Med Okayama. 2013; 67: 377-83.

[26] Soslowsky LJ, An CH, DeBano CM, Carpenter JE. Coracoacromial ligament: in situ load and viscoelastic properties in rotator cuff disease. Clin Orthop Relat Res. 1996; 40-4.

[27] Hansen ML, Otis JC, Johnson JS, Cordasco FA, Craig EV, Warren RF. Biomechanics of massive rotator cuff tears: implications for treatment. J Bone Joint Surg Am. 2008; 90: 316-25.

[28] Sahu D. Capsular repair is not an important part of the Latarjet-Walch procedure. J Shoulder Elb Surg. 2021; 31: 948-56.

[29] Shah AA, Butler RB, Romanowski J, Goel D, Karadagli D, Warner JJ. Short-term complications of the Latarjet procedure. J Bone Joint Surg Am. 2012; 94: 495-501.

[30] Giacomo GD, Costantini A, de Gasperis N, De Vita A, Lin BK, Francone M, et al. Coracoid bone graft osteolysis after Latarjet procedure: a comparison study between two screws standard technique vs mini-plate fixation. Int J Shoulder Surg. 2013; 7: 1-6.

[31] Hurley ET, Schwartz LB, Mojica ES, Campbell KA, Matache BA, Meislin RJ, et al. Short-term complications of the Latarjet procedure: a systematic review. J Shoulder Elb Surg. 2021; 30: 1693-9.

[32] Athwal GS, Meislin R, Getz C, Weinstein D, Favorito P. Short-term complications of the arthroscopic Latarjet procedure: a north American experience. Art Ther. 2016; 32: 1965-70.

[33] Frank RM, Gregory B, O’Brien M, Bernardoni E, Verma NN, Cole BJ, et al. Ninety-day complications following the Latarjet procedure. J Shoulder Elb Surg. 2019; 28: 88-94.

[34] Cho CH, Na SS, Choi BC, Kim DH. Complications related to Latarjet shoulder stabilization: a systematic review. Am J Sports Med. 2021;3635465211042314. https://doi.org/10.1177/03635465211042314.

[35] Rios CG, Arciero RA, Mazzocca AD. Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2007; 35: 811-7.

[36] Swan J, Boileau P, Barth J. Arthroscopic Trillat procedure: a guided technique. Arthrosc Tech. 2020; 9: e513-9. https://doi.org/10.1016/j.eats.2019.12.004.

[37] Mascarenhas R, Rusen J, Saltzman BM, Leiter J, Chahal J, Romeo AA, et al. Management of humeral and glenoid bone loss in recurrent glenohumeral instability. Adv Orthop. 2014; 2014: 640952. https://doi.org/10.1155/2014/640952.

[38] Lafosse L, Boyle S. Arthroscopic Latarjet procedure. J Shoulder Elb Surg. 2010; 19: 2-12.

[39] Wai CJ. Axillary anatomy and history. Curr Probl Cancer. 2012; 36: 234-44.

[40] Simone JP, Streubel PN, Sanchez-Sotelo J, Steinmann SP, Adams JE. Change in the distance from the axillary nerve to the Glenohumeral joint with shoulder external rotation or abduction position. Hand (N Y). 2017; 12: 395-400.

[41] Hawi N, Reinhold A, Suero EM, Liodakis E, Przyklenk S, Brandes J, et al. The anatomic basis for the arthroscopic Latarjet procedure: a cadaveric study. Am J Sports Med. 2016; 44: 497-503.

[42] Yoo JC, Kim JH, Ahn JH, Lee SH. Arthroscopic perspective of the axillary nerve in relation to the glenoid and arm position: a cadaveric study. Art Ther. 2007; 23: 1271-7.