Accuracy of Coracoid Bone Graft Placement: Open versus Arthroscopic Latarjet

Russo, Adriano; Grasso, Andrea; Arrighi, Annalisa; Pistorio, Angela; Molfetta, Luigi

doi:10.1055/s-0037-1603934

Cited by 23 publications

(29 citation statements)

References 17 publications

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“…By comparison, AL had lower accuracy rates across all clusters, reaching a maximum of 78%. The latter finding is similar to the results of a study comparing graft placement accuracy in open Latarjet versus AL 12 ; in that study, 76% of arthroscopic cases had optimal coracoid graft positioning based on postoperative CT scan. It should also be noted that in the same study, open Latarjet cases demonstrated 100% accuracy of graft placement.…”

Section: Discussionsupporting

confidence: 86%

“…It should also be noted that in the same study, open Latarjet cases demonstrated 100% accuracy of graft placement. 12 Thus, AAGR preserves the accuracy of graft placement attained with an open procedure while providing the advantages of an arthroscopic approach. However, the factors responsible for difficulties in lower graft positioning for AL are yet to be established.…”

Section: Discussionmentioning

confidence: 99%

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Arthroscopic Anatomic Glenoid Reconstruction: Analysis of the Learning Curve

Moga

Konstantinidis

Coady

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Anatomic glenoid reconstruction involves the use of distal tibial allograft for bony augmentation of the glenoid surface. An all-arthroscopic approach was recently described to avoid damage to the subscapularis tendon and preserve the capsule and labrum.Purpose:To explore and compare change in surgical time between 2 proposed methods used for the treatment of anterior shoulder instability—arthroscopic anatomic glenoid reconstruction (AAGR) and arthroscopic Latarjet (AL)—over successive procedures. We also compared graft positioning on the anterior glenoid surface between the 2 methods.Study Design:Cohort study; Level of evidence, 3.Methods:This was a single-surgeon retrospective review of 54 cases of surgically treated recurrent anterior shoulder instability: 27 had AAGR with distal tibial allograft, while the other 27 had AL. AAGR with the distal tibial allograft was the primary choice for the treatment of anterior shoulder instability; however, AL was performed when tibial allograft was not available from the bone bank. Thus, there was an overlapping period for those 2 procedures. Procedure start and end times were recorded, and duration was calculated. Postoperative 3-dimensional computed tomography scans were reviewed, and graft position was judged to be in the lower third (desired position), middle third, or upper third of the anterior glenoid surface. To assess learning, these data were organized in chronological order of surgery, and each surgical cohort was divided into 3 chronological clusters of 9 patients each. Learning was assessed through change in operative time over successive clusters, change in variability of operative time among clusters, and change in graft positioning among clusters. Statistical analysis comprised a 2-tailed independent-sample t test and the Levene test for equality of variance.Results:Our study found that AAGR was significantly faster to perform than AL in the early (P = .001), middle (P = .001), and late (P = .05) clusters of each cohort. Duration of surgery did not significantly improve across clusters within each cohort (P = .15-.79). There were no significant changes in the variability of surgical time in the AAGR group (P = .09) or the AL group (P = .13). Desired positioning of the bone graft on the anterior glenoid surface (lower third) was identified more commonly in the AAGR cohort.Conclusion:AAGR is faster to learn and perform than AL for the treatment of recurrent anterior shoulder instability with significant glenoid bone loss. The current study found higher rates of desired graft positioning for AAGR clusters.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Arthroscopic Anatomic Glenoid Reconstruction: Analysis of the Learning Curve

Moga

Konstantinidis

Coady

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…Five of the included studies reported on radiographic outcomes. Three of the five studies ( n = 126 arthroscopic, 106 open, p > 0.05) found no significant difference in the coracoid graft positioning between the two techniques [ 13 , 18 , 19 ], one study ( n = 25 arthroscopic, 21 open, p = 0.025) found the arthroscopic technique to be significantly more likely to have ideal graft positioning [ 18 ], and conversely one study ( n = 44 arthroscopic, 46 open, p < 0.001) found the open procedure to be significantly more likely to have ideal graft positioning [ 17 ]. Three of the studies reported on screw divergence angles, two studies ( n = 69 arthroscopic, 67 open, p = 0.10–0.12) found no significant difference between the two techniques [ 17 , 18 ], and one study ( n = 28 arthroscopic, 36 open, p = 0.017) found the open technique to have significantly less rates of excessively (> 10°) divergent screws [ 10 ].…”

Section: Resultsmentioning

confidence: 99%

Open versus arthroscopic Latarjet procedures for the treatment of shoulder instability: a systematic review of comparative studies

Horner

Moroz

Bhullar

et al. 2018

BMC Musculoskelet Disord

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BackgroundThe arthroscopic and open Latarjet procedures are both known to successfully treat shoulder instability with high success rates. The objective of this study was to compare the clinical outcomes and positioning of the coracoid graft and screws between the arthroscopic and open Latarjet procedures.MethodsThe electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies between database creation and 2018. Only studies directly comparing open and arthroscopic Latarjet procedures were included.ResultsThere were 8 included studies, with a total of 580 patients treated arthroscopically and 362 patients treated with an open Latarjet procedure. Several papers found significantly better standardized outcome scores for either the open or arthroscopic procedure but these findings were not consistent across papers. Patients treated with arthroscopic Latarjet procedures had significantly lower initial post-operative pain, however pain scores became equivalent by one month post-operatively. Three of the five included studies found no significant difference in the coracoid graft positioning and two of three included studies found no significant difference in screw divergence angles between the two techniques. Arthroscopic procedures (112.2 min) appear to take, on average, longer than open procedures (93.3 min). However, operative times and complication rates decrease with surgeon experience with the arthroscopic procedure. Overall 3.8% of the patients treated arthroscopically and 6.4% of the patients treated with the open procedure went on to have post-operative complications.ConclusionsBoth open and arthroscopic Latarjet procedures can be used to effectively treat shoulder instability with similarly low rates of complications, recurrent instability and need for revision surgery. Arthroscopic Latarjet procedures are associated with less early post-operative pain but require increased operative time. The evidence does not support there being any significant difference in graft or screw positioning between the two techniques. At this time neither procedure shows clear superiority over the other.

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“…25 27 28 Ainda assim, existem estudos que demonstram que o posicionamento do enxerto na cirurgia artroscópica pode ser desafiador, assim como o ângulo adequado dos parafusos. 29 30…”

Section: Discussionunclassified

Avaliação do posicionamento dos parafusos na cirurgia de Latarjet: Existe correlação entre paralelismo à glenoide e complicações radiográficas?*

Kawakami

Godoy

Cohen

et al. 2022

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Avaliar se o paralelismo dos parafusos com a glenoide na cirurgia de Latarjet interfere no posicionamento do enxerto e verificar a reprodutibilidade de um método de mensuração da posição dos parafusos. Métodos Estudo retrospectivo, multicêntrico, de pacientes com instabilidade anterior do ombro submetidos à cirurgia de Latarjet modificada e no mínimo 1 ano de seguimento pós-operatório. Dois médicos radiologistas analisaram as imagens tomográficas pós-operatórias, adquiridas em um banco de dados, para avaliação do posicionamento dos parafusos e das complicações radiográficas. Resultados Foram avaliados 34 pacientes, com idades entre 21 e 60 anos, sendo que um deles tinha acometimento bilateral dos ombros, totalizando 35 ombros avaliados. A avaliação tomográfica dos ângulos de inclinação dos parafusos não apresentou diferença entre os observadores. Houve concordância intra e interobservador para avaliação dos seguintes parâmetros cirúrgicos: posição do enxerto, presença ou não de complicações radiográficas. Conclusão A técnica descrita para mensuração do paralelismo dos parafusos na cirurgia de Latarjet apresentou uma concordância intra e inter observador muito boa e excelente, respectivamente. O paralelismo do parafuso com a glenoide é recomendado; no entanto, não é condição obrigatória e única para se evitar as complicações radiográficas.

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Accuracy of Coracoid Bone Graft Placement: Open versus Arthroscopic Latarjet

Cited by 23 publications

References 17 publications

Arthroscopic Anatomic Glenoid Reconstruction: Analysis of the Learning Curve

Arthroscopic Anatomic Glenoid Reconstruction: Analysis of the Learning Curve

Open versus arthroscopic Latarjet procedures for the treatment of shoulder instability: a systematic review of comparative studies

Avaliação do posicionamento dos parafusos na cirurgia de Latarjet: Existe correlação entre paralelismo à glenoide e complicações radiográficas?*

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