Can a Drill Guide Improve the Coracoid Graft Placement During the Latarjet Procedure? A Prospective Comparative Study With the Freehand Technique

Abstract

Background:One of the factors that can affect the success of the Latarjet procedure is accurate coracoid graft (CG) placement.Hypothesis:The use of a guide can improve placement of the CG and screw positioning in the sagittal and axial planes as compared with the classic open (“freehand”) technique.Study Design:Cohort study; Level of evidence, 2.Methods:A total of 49 patients who underwent a Latarjet procedure for the treatment of recurrent anterior shoulder instability were prospectively included; the procedure was performed with the freehand technique in 22 patients (group 1) and with use of a parallel drill guide during screw placement in 27 patients (group 2). All patients underwent a postoperative computed tomography scan with the same established protocol. The scans were used to evaluate and compare the position of the CG in the sagittal and axial planes, the direction of the screws (α angle), and overall contact of the graft with the anterior surface of the glenoid after the 2 surgical techniques.Results:The CG was placed >60% below the native glenoid equator in 23 patients (85.2%) in group 2, compared with 14 patients (63.6%) in group 1 (P = .004). In the axial plane, the position of the CG in group 2 patients was more accurate (85.2% and 88.9% flush) at the inferior and middle quartiles of the glenoid surface (P = .012 and .009), respectively. Moreover, with the freehand technique (group 1), the graft was in a more lateral position in the inferior and middle quartiles (P = .012 and .009, respectively). No differences were found between groups 1 and 2 regarding the mean α angle of the superior (9° ± 4.14° vs 11° ± 6.3°, P = .232) and inferior (9.5° ± 6° vs 10° ± 7.5°, P = .629) screws. However, the mean contact angle (angle between the posterior coracoid and the anterior glenoid surface) with the freehand technique (3.8° ± 6.8°) was better than that of the guide (8.55° ± 8°) (P = .05).Conclusion:Compared with the classic freehand operative technique, the parallel drill guide can ensure more accurate placement of the CG in the axial and sagittal planes, although with inferior bone contact.

Screw Removal Can Resolve Unexplained Anterior Pain Without Recurrence of Shoulder Instability After Open Latarjet Procedures

“…Complications after Latarjet procedures are mostly due to technical mistakes, such as inadequate screw length or malpositioning, 5,16,18 which can cause bone-block malunion 35 or degenerative arthritis of the glenohumeral joint. 27 As surgeons accumulate experience, the risk for these complications decreases.…”

Editorial Commentary: Computed Tomography-based Analysis of the Arthroscopic Latarjet Procedure Suggests Graft Positioning Is More Variable than Expected

“…This finding is in accordance with recent studies, where the use of a drill guide ensured a more accurate and reproducible graft positioning compared with the freehand technique in the open Latarjet procedure. 9,23 We see the problem with inaccurate graft placement even more aggravated in patients with inherently flat glenoids 24,25 or when excessive anterior glenoid bone loss is evident and the glenoid concavity of the paleoglenoid is difficult to reconstruct intraoperatively. In such cases, surgeons run the risk of "over-reconstructing" the glenoid concavity and fix the graft with screws that are too medially directed and overhanging.…”

Arthroscopic Trillat technique for chronic post-traumatic anterior shoulder instability: outcomes at 2 years of follow-up

“…Lafosse and Rosso 47 also reserved their arthroscopic bone block for experienced surgeons. The positioning of the coracoid graft in the Latarjet is essential 34 and demanding, with a long learning curve, 21 both in the open technique 7 and with arthroscopy. 18,42 The average operating time for the arthroscopic Latarjet was longer at 146 minutes for Cunningham et al 18 when compared with 51 minutes for the arthroscopic Trillat.…”