Computed Tomography–Based Preoperative Planning Provides a Pathology and Morphology-Specific Approach to Glenohumeral Instability With Bone Loss

Lamplot, Joseph D.; Brusalis, Christopher M.; Apostolakos, John; Langhans, Mark T.; Hancock, Kyle J.; Pinnamaneni, Sridhar; Kontaxis, Andreas; Warren, Russell F.; Rodeo, Scott A.; Greditzer, Harry G.; Taylor, Samuel A.

doi:10.1016/j.arthro.2021.01.021

Cited by 8 publications

(11 citation statements)

References 55 publications

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“…Two studies recently described reliable methods of evaluating preoperative coracoid dimensions, although these techniques utilized CT instead of MRI. 14 , 19 Jia et al 14 performed 3-dimensional reconstruction of 84 shoulder CT scans, but these coracoid length measurements did not account for the clinically relevant anatomy of the coracoclavicular (CC) ligament. Lamplot et al 19 also evaluated multiplanar reconstructed CT scans to evaluate preoperative coracoid dimensions and devised a protocol more specific to the typical osteotomy utilized during the Latarjet procedure.…”

Section: Discussionmentioning

confidence: 99%

“… 14 , 19 Jia et al 14 performed 3-dimensional reconstruction of 84 shoulder CT scans, but these coracoid length measurements did not account for the clinically relevant anatomy of the coracoclavicular (CC) ligament. Lamplot et al 19 also evaluated multiplanar reconstructed CT scans to evaluate preoperative coracoid dimensions and devised a protocol more specific to the typical osteotomy utilized during the Latarjet procedure. 21 Specifically, the axial view was utilized to identify the anterior aspect of the coracoid base (located at the junction of the vertical inferior pillar and the horizontal superior pillar) and measure its distance from the tip of the coracoid.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative 2-dimensional MRI scans were analyzed for coracoid length and width by 3 independent reviewers: 2 research assistants and an orthopaedic surgery resident (R.W.P., D.A.D., D.H.) trained in coracoid dimension measurements by a musculoskeletal radiologist. Instead of measuring longitudinal coracoid length according to previously published CT techniques, 14 , 19 coracoid length was measured on axial MRI sequences as the distance from the CC ligament insertion to the distal tip to maximize clinical applicability ( Figure 1 ). Because the CC ligament insertion and the distal tip of the coracoid were often on different MRI slices, a specific measurement protocol was utilized by all 3 reviewers ( Figure 2 ).…”

Section: Methodsmentioning

confidence: 99%

“…These cutoffs were selected as the whole numbers nearest the means of coracoid length and width in this patient cohort, with several CT studies finding a mean coracoid length between 21 and 24 mm. 14 , 16 , 19 Demographic and postoperative outcomes were compared between shorter and longer coracoids, narrower and wider coracoids, and male and female coracoid dimensions. Independent-samples t tests were utilized to calculate P values for parametric data, and Mann-Whitney tests were used to calculate P values for nonparametric data.…”

Section: Methodsmentioning

confidence: 99%

“…We referenced scales introduced in previously published radiology literature for the interpretation of ICC values, in which <0.50 was considered weak reliability, 0.50 to 0.69 moderate, 0.70 to 0.89 good, and >0.90 excellent. 19 …”

Section: Methodsmentioning

confidence: 99%

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Effect of Preoperative MRI Coracoid Dimensions on Postoperative Outcomes of Latarjet Treatment for Anterior Shoulder Instability

Paul

DeBernardis

Hameed

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Preoperative coracoid dimensions may affect the size of the bone graft transferred to the glenoid rim and thus the postoperative outcomes of Latarjet coracoid transfer. Purpose: To determine the effect of coracoid length and width as measured on preoperative magnetic resonance imaging (MRI) on outcomes after Latarjet treatment of anterior shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent primary Latarjet surgery between 2009 and 2019 and had preoperative MRI scans and minimum 2-year postoperative outcomes. Longitudinal coracoid length was measured on axial MRI sequences as the distance from the coracoclavicular ligament insertion to the distal tip. Comparisons were made between shorter and longer coracoids and between narrower and wider coracoids. The outcomes of interest were recurrent instability, reoperation, complications, return to sport (RTS), and American Shoulder and Elbow Surgeons (ASES) score. Independent-samples t test, Mann-Whitney test, chi-square test, and Fisher exact test were used to compare outcomes between groups, and univariate correlation coefficients were calculated to evaluate the relationships between demographics and coracoid dimensions. Results: Overall, 56 patients were included (mean age, 28.4 years). The mean ± SD coracoid length was 21.6 ± 2.4 mm and width 10.0 ± 1.0 mm. Relative to patients with a longer coracoid (≥22 mm; n = 26), patients with a shorter coracoid (<22 mm; n = 30) had similar rates of recurrent instability (shorter vs longer; 6.7% vs 3.8%), complications (10.0% vs 15.4%), reoperation (3.3% vs 7.7%), and RTS (76.5% vs 58.8%) and similar postoperative ASES scores (85.0 vs 81.6) ( P ≥ .05 for all). Likewise, relative to patients with a wider coracoid (≥10 mm; n = 27), patients with a narrower coracoid (<10 mm; n = 29) had similar prevalences of recurrent instability (narrower vs wider; 6.9% vs 3.7%), complications (17.2% vs 7.4%), reoperation (3.5% vs 7.4%), and RTS (66.7% vs 68.4%) and similar postoperative ASES scores (87.1 vs 80.0) ( P ≥ .05 for all). Conclusion: Patients undergoing Latarjet coracoid transfer had similar postoperative outcomes regardless of preoperative coracoid dimensions. These findings should be confirmed in a larger cohort before further clinical recommendations are made.

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