Ninety-day complications following the Latarjet procedure

Frank, Rachel M.; Gregory, Bonnie; O’Brien, Michael J.; Bernardoni, Eamon D.; Verma, Nikhil N.; Cole, Brian J.; Nicholson, Gregory P.; Romeo, Anthony A.

doi:10.1016/j.jse.2018.06.022

Cited by 61 publications

(57 citation statements)

References 18 publications

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“…A systematic review of 45 studies with 1,904 shoulders documented a 30% complication rate for Bristow-Latarjet procedures, with a recurrent dislocation rate of 2.9%, recurrent subluxation rate of 5.8%, and reoperation rate of 7%. 13 Recently, Frank et al 14 reported that the 90-day complication rate after the Latarjet procedure was 7.5%, with 6 of 10 cases requiring surgery. The American Board of Orthopaedic Surgery Part II database showed that subspecialty specialization was associated with an increased use of bone-block augmentation procedures with a 20.8% reported complication rate.…”

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confidence: 99%

Editorial Commentary: Glenoid Track Instability Management Score or Instability Severity Index Score—Will This Decrease Latarjet Abuse?

Barber

Howard

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Open treatment of anterior shoulder instability using a coracoid transfer, such as the Latarjet procedure, is associated with low recurrence rates but with significant complications such as nerve injury, arthrosis, and graft osteolysis. However, an arthroscopic Bankart procedure, although less invasive and with a low complication rate, has the possibility of a higher recurrent instability rate. Scoring systems such as the Instability Severity Index Score, created to select patients for an arthroscopic Bankart procedure or coracoid transfer, have varying levels of success. Often, the scoring system selects a relatively high percentage of patients for the coracoid transfer, possibly undermining its widespread adoption. The relation between glenoid and humeral bone loss has produced the concept of "on-track" and "off-track," which impacts recurrent instability rates. Merging the on-track and off-track concept with the new Glenoid Track Instability Management Score may produce an algorithm that more accurately assesses the need for the Latarjet procedure or arthroscopic stabilization.

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Section: See Related Article On Page 56mentioning

confidence: 99%

Editorial Commentary: Glenoid Track Instability Management Score or Instability Severity Index Score—Will This Decrease Latarjet Abuse?

Barber

Howard

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The Latarjet procedure with its various amendments has been the most commonly used bone block technique [10,11]. However, while the Latarjet procedure has proved to be reliable to manage recurrent anterior shoulder instability with large glenoid bone defects, there have been concerns of a high surgical complication rate associated with this procedure [12][13][14]. A large recent review reported an overall complication rate in the open Latarjet procedure of 15%, with a 7% rate of unplanned reoperations [15].…”

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confidence: 99%

Iliac Crest Bone Grafting for the Management of Anterior Shoulder Instability in Patients with Glenoid Bone Loss: a Systematic Review of Contemporary Literature

et al. 2020

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Background: A number of clinical trials have been published assessing the role of iliac crest bone grafting for the management of recurrent anterior instability with glenoid bone loss in contemporary practice. We therefore performed a systematic review of contemporary literature to examine the effect of iliac crest bone grafting on postoperative outcomes of these patients. Our hypothesis is that contemporary iliac crest bone block techniques are associated with low reoperation and complication rates combined with satisfactory functional results. Methods:The US National Library of Medicine (PubMed/MEDLINE), the Cochrane Database of Systematic Reviews, and EMBASE were searched between January 2008 and December 2019 for relevant publications.Results: Following the application of the inclusion-exclusion criteria, nine articles were found eligible for our analysis. In total, 261 patients (mean age range, 25.5-37.5 years; mean follow-up range, 20.6-42 months) were included in the studies of the current review. The mean modified Coleman score was 48.6 (range 37-65), indicating an overall low-to-moderate methodological quality. In the short term, the overall all-cause reoperation rate was 6.1%, while the rate of recurrent instability was 4.8%. The graft non-union rate was 2.2%, while the rate of osteolysis, graft fracture, and infection was 0.4%, 0.9%, and 1.7%, respectively. Finally, hardware-related complications, such as screw breakage or symptomatic mechanical irritation around the screw insertion, occurred in 3.9% of the patients. Conclusions: Iliac crest bone block techniques in contemporary practice are safe and effective in the short-term (< 4 years) follow-up for the management of anterior shoulder instability with substantial glenoid bone deficiency. However, further studies of higher quality and longer follow-up are required to establish the therapeutic value of these techniques as well as to clarify whether there are differences in the outcomes of arthroscopic and open iliac crest bone block procedures.

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“…2,4 This nerve courses anteriorly through the arm to provide motor innervation to the coracobrachialis through a number of twigs, as described by Flatow et al 4 The MCN has been cited to be approximately 5 cm from the base of the coracoid, and this area has been referred as the safe zone for orthopaedic shoulder surgery. 1,5,8,[11][12][13] Michel Latarjet was one of the first surgeons to study the anatomy of the nerve in relation to the coracoid process. 9 He observed a number of twigs branching off the MCN to innervate the coracobrachialis before the main nerve penetration.…”

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confidence: 99%

Relationship of the Musculocutaneous Nerve and Its Twigs to the Coracoid Process: An Operative Exposure

Singh

Yang

Wiley

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: A musculocutaneous nerve (MCN) injury is a rare complication of the Latarjet procedure. Most of these injuries are neurapraxias and resolve with time; however, permanent injuries can occur. Understanding the anatomy and relationship of the MCN to the coracoid process is essential to prevent injuries. Purpose: To provide realistic, in situ–referenced measurements for the Latarjet procedure. Study Design: Descriptive laboratory study. Methods: A total of 12 matched-pair cadaveric specimens (24 fresh-frozen shoulders) were dissected. Coracoid osteotomy was performed, and the MCN and its respective twigs were identified. Measurements were made from the coracoid process to the entry site of the nerve twigs and trunk into the coracobrachialis muscle. Results: Overall, 70.8% of specimens had twigs; however, there was a discrepancy in the presence (41.7%) and number (75.0%) of twigs in the paired specimens. The most proximal twigs were, on average, 33.5 ± 8.1 mm (range, 21.9-47.6 mm) from the coracoid process. The main trunk was, on average, 51.1 ± 14.4 mm (range, 16.7-71.9 mm) from the coracoid process. In 33.3% of specimens, the nerve entered the coracobrachialis at a distance shorter than 5 cm below the coracoid process, and this increased to 91.7% when the twigs were accounted for. Conclusion: The previously described safe zone of 5 cm below the coracoid process may not be reliable to protect the MCN or its twigs. Using 3 cm would decrease the chances of damaging a twig or the main trunk. In 33.3% of the specimens, the nerve entered the coracobrachialis at a distance shorter than 5 cm below the coracoid process, and this increased to 91.7% when twigs were accounted for. Clinical Relevance: As the Latarjet procedure is an emerging technique, it is essential to be aware of the anatomic structures and the relation between different neural structures to anatomic points of reference. Therefore, the results of this study add significant information for a safe surgical procedure for the majority of patients suffering from shoulder instability.

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Ninety-day complications following the Latarjet procedure

Cited by 61 publications

References 18 publications

Editorial Commentary: Glenoid Track Instability Management Score or Instability Severity Index Score—Will This Decrease Latarjet Abuse?

Editorial Commentary: Glenoid Track Instability Management Score or Instability Severity Index Score—Will This Decrease Latarjet Abuse?

Iliac Crest Bone Grafting for the Management of Anterior Shoulder Instability in Patients with Glenoid Bone Loss: a Systematic Review of Contemporary Literature

Relationship of the Musculocutaneous Nerve and Its Twigs to the Coracoid Process: An Operative Exposure

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