Clinical Outcomes of the Traditional Latarjet Versus the Congruent Arc Modification for the Treatment of Recurrent Anterior Shoulder Instability: A Meta-analysis

Abstract

Background: Few studies have compared clinical outcomes between the traditional Latarjet procedure for anterior shoulder instability and the congruent arc modification to the Latarjet procedure. Purpose: To systematically evaluate the literature for the incidence of recurrent instability, clinical outcomes, radiographic findings, and complications for the traditional Latarjet procedure and the congruent arc modification and to compare results of each search. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review and meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies published between January 1990 and October 2020 that described clinical outcomes of the traditional Latarjet and the congruent arc modification with a follow-up range of 2 to 10 years. The difference in surgical technique was analyzed using a chi-square test for categorical variables, while continuous variables were evaluated using a Student t test. Results: In total, 26 studies met the inclusion criteria: 20 studies describing the traditional Latarjet procedure in 1412 shoulders, and 6 studies describing the congruent arc modification in 289 shoulders. No difference between procedures was found regarding patient age at surgery, follow-up time, Rowe or postoperative visual analog scores, early or late complications, return-to-sport timing, or incidence of improper graft placement or graft fracture. A significantly greater proportion of male patients underwent glenoid augmentation using the congruent arc modification versus traditional Latarjet ( P < .001). When comparing outcomes, the traditional Latarjet procedure demonstrated a lower incidence of fibrous union or nonunion ( P = .047) and broken, loose, or improperly placed screws ( P < .001), and the congruent arc modification demonstrated improved outcomes with regard to overall return to sport ( P < .001), return to sport at the same level ( P < .001), incidence of subluxation ( P = .003) or positive apprehension ( P = .002), and revision surgery for recurrent instability ( P = .027). Conclusion: Outcomes after the congruent arc modification proved at least equivalent to the traditional Latarjet procedure in terms of recurrent instability and return to sport, although early and late complications were equivalent. The congruent arc procedure may be an acceptable alternative to traditional Latarjet for the treatment of anterior shoulder instability with glenoid bone loss; however, long-term outcomes of this procedure are needed.

Comparison of two coracoid process transfer techniques on stress shielding using three-dimensional finite-element model

“…In addition, there is a shorter bone distance around the screw with the CAL technique, which makes it very difficult to perform in patients with small coracoids [34] . Moreover, a higher incidence of broken, loose, or improperly placed screws have been reported with the CAL technique, although no difference was observed in graft positioning [30] . Male patients were significantly more likely to undergo augmentation using the CAL technique.…”

“…That the medial stress is less in the CAL technique than in the TL may cause insufficient stimulation for bone formation at the graft–glenoid interface, which could eventually lead to a greater incidence of graft osteolysis or nonunion. Mengers et al analyzed 26 studies comparing TL and CAL techniques, identifying that the fibrous or nonunion incidence was greater for the CAL technique [30] . Graft osteolysis may occur if a larger than necessary graft is used because the graft does not experience adequate forces from the humeral head and subsequently resorbs in accordance with Wolff’s law [17] .…”

“…In a recent meta-analysis comparing the TL and CAL modifications, patients undergoing CAL were less likely to have recurrent subluxation, postoperative complications, and reoperations and were more likely to return to sports and activities. [30] …”

Distal Clavicle Autograft Versus Traditional and Congruent Arc Latarjet Procedures: A Comparison of Surface Area and Glenoid Apposition With 3-Dimensional Computed Tomography and 3-Dimensional Magnetic Resonance Imaging

“…Leveraging the 3D CT and 3D MRI reformations of the coracoid process and distal clavicle, we sought to compare 5 autologous graft orientations for restoring glenoid bone loss in patients with glenohumeral instability: (1) standard Latarjet procedure (SLJ), (2) congruent arc Latarjet procedure (CLJ), and 3 positional variations of the distal clavicle autograft attached to the glenoid via its (3) posterior surface (DCP), (4) inferior surface (DCI), and (5) resected end (DCR) (Figure 1). 17,22,25…”

“…Leveraging the 3D CT and 3D MRI reformations of the coracoid process and distal clavicle, we sought to compare 5 autologous graft orientations for restoring glenoid bone loss in patients with glenohumeral instability: (1) standard Latarjet procedure (SLJ), (2) congruent arc Latarjet procedure (CLJ), and 3 positional variations of the distal clavicle autograft attached to the glenoid via its (3) posterior surface (DCP), (4) inferior surface (DCI), and (5) resected end (DCR) (Figure 1). 17,22,25 Radiological Measurement Technique 3D CT and 3D MRI measurements of coracoid width, thickness, and length were performed in a similar fashion to previous 2-dimensional imaging studies. 12 The coracoid width and length were measured on a superior view of the coracoid process (Figure 2A).…”