A pilot study of blood supply of the coracoid process and the coracoid bone graft after Latarjet osteotomy

Abstract

Latarjet osteotomy is still one of the most reliable and commonly used surgeries in treating recurrent anterior shoulder dislocation. The coracoid process (CP) is the main structure of this surgery. However, the blood supply of CP is not fully understood, and the extent of destruction of blood supply of coracoid bone graft after Latarjet osteotomy procedure is still controversial. Five embalmed cadaveric upper limbs specimens were employed for macro observation of the blood supply of CP. The conjoint tendon (CT) and CP interface were dissected for histology. Sixteen fresh frozen shoulder specimens were used for perfusion and micro CT scanning. Eight specimens were used to present the whole vessel structure of CP. The other eight underwent Latarjet osteotomy procedure. The coracoid bone grafts in both groups were scanned to clarify the remnant blood supply. It was found that the CP was nourished by supra-scapular artery (SSA), thoracic-acromial artery and branch from second portion of the axillary artery (AA). After Latarjet osteotomy procedure, no artery from CT was detected to penetrate the CP at its attachment. Only in one specimen the blood vessel that originated from the CT penetrated the bone graft at the inferior side. Therefore, most of the blood supply was destroyed although there is a subtle possibility that the vessels derived from the CT nourished the inferior side of the CP. In a nutshell, CP is a structure with rich blood supply. The traditional Latarjet osteotomy procedure would inevitably cut off the blood supply of the coracoid bone graft.

Early Follow‐Up of Arthroscopic Latarjet Procedure with Screw or Suture‐Button Fixation for Recurrent Anterior Shoulder Instability

“…The Latarjet procedure is usually recommended when there is a significant bone loss of more than 20%-25%. It has been proven as an effective method to treat this defective glenoid since it was proposed by French surgeon Latarjet in 1954 [8][9][10] . The Latarjet procedure is a surgical technique that is aimed at restoring the congruity of the glenohumeral joint using a section of coracoid process as an augmentation of the anteroinferior glenoid rim.…”

Symptomatic Nonunion of the Coracoid Process Following Osteosynthesis Using a Suture Button for Coracoid Process and Distal Clavicle Fracture: A Case Report

“…The coracoid process is rich in blood supply; the vertical part of coracoid process is nourished by the supra-scapular artery, while the horizontal part is nourished by branches of the axillary artery [ 10 , 11 ]. The supra-scapular artery runs below and behind the clavicle toward the coracoid notch, and the branch to the coracoid process runs medial to the vertical part of the coracoid process as an intraosseous nutrient artery [ 10 , 11 ]. The lack of blood supply is one of the causes of nonunion; however, the fracture pattern in this case does not indicate a disruption of blood supply to the fracture site of the coracoid process.…”

Editorial Commentary: A Functional Capsule, Not the Type of Bone Graft, Determines Outcome After Shoulder Stabilization in Cases of Anterior Glenoid Bone Deficiency

“…7,8 Despite these consistent vascular supplies, postoperative osteolysis rates up to 39.6% have been reported, 9 due to potential anatomical and biomechanical causes. 10,11 . In their study, the authors note the exposure of the screw shaft in 46% of patients due to bone resorption, which might account for postoperative persistent anterior shoulder pain.…”