Traditional versus congruent-arc Latarjet anatomic and biomechanical perspective

Rossi, Luciano; Tanoira, Ignacio; Cicco, Franco L. De; Ranalletta, Maximiliano

doi:10.1302/2058-5241.6.200074

Cited by 11 publications

(12 citation statements)

References 37 publications

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“…Latarjet is one of the most widely used surgical procedures for treating significant bone defects of the glenoid surface and failed Bankart repairs [2 – 4] . Although the TL procedure is effective for the management of recurrent anterior shoulder instability, it is not without complications.…”

Section: Discussionmentioning

confidence: 99%

“…The Latarjet procedure, also known as the coracoid process transfer, is one of the most performed and reliable procedures for treating recurrent anterior shoulder instability in patients with a significant bone defect of the glenoid surface [1 – 4] . In the traditional Latarjet (TL) procedure, the inferior surface of the coracoid process (CP) is transferred with the conjoint tendon to the anterior glenoid rim.…”

Section: Introductionmentioning

confidence: 99%

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

Ünsal¹,

Yıldırım²,

Kayalar³

2022

J Orthop Surg Res

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Background We created patient-based 3D finite-element (FE) models that simulate the congruent-arc Latarjet (CAL) and traditional Latarjet (TL) procedures and then compared their stress distribution patterns with different arm positions and glenoid defects. Methods The computed tomography data of 10 adult patients (9 men and 1 woman, ages: 18–50 years) were used to develop the 3D FE glenohumeral joint models. Twenty-five and 35% bony defects were created on the anterior glenoid rim, and the coracoid process was transferred flush with the glenoid by the traditional and congruent-arc techniques using two half-threaded screws. A load was applied to the greater tuberosity toward the center of the glenoid, and a tensile force (20 N) was applied to the coracoid tip along the direction of the conjoint tendon. The distribution patterns of the von Mises stress in the traditional and congruent-arc Latarjet techniques were compared. Results The mean von Mises on the graft was significantly greater for the TL technique than for the CAL. While the von Mises stress was greater in the distal medial part of the graft in the TL models, a higher stress concentration was observed in the distal lateral edge of the coracoid graft in the CAL models. The proximal medial part of the graft exhibited significantly lower von Mises stress than the distal medial part when compared according to technique, defect size, and arm position. Increasing the glenoid defect from 25 to 35% resulted in a significant increase in stress on the lateral side of the graft in both models. Conclusion The stress distribution patterns and stress magnitude of the coracoid grafts differed according to the procedure. Due to placing less stress on the proximal–medial part of the graft, the CAL technique may lead to insufficient stimulation for bone formation at the graft–glenoid interface, resulting in a higher incidence of graft osteolysis. Clinical relevance The CAL technique may lead to a higher incidence of graft osteolysis. Level of evidence Basic Science Study; Computer Modeling.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ünsal¹,

Yıldırım²,

Kayalar³

2022

J Orthop Surg Res

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“…Moreover, the bone distance around the screw has been associated with tolerance of screw-positioning error in Latarjet. 2 Attributing to the minimum coracoid bone graft length for safe screw insertion and the maximum osteotomy length that varies among individuals, preoperatively predicting SM is advocated for an efficient shoulder surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

3D MRI PD‐SPACE‐COR Predicting Safety Margin for Coracoid Transfer

Ren

Huang

Peng

et al. 2023

Orthopaedic Surgery

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Objective: The maximum bone length available for coracoid process transfer varies among individuals, while no preoperative guideline has been developed for predicting the safety margin (SM) in Latarjet shoulder reconstruction. The aim of the study was to evaluate the 3D MRI proton density (PD)-weighted sampling perfection with application-optimized contrasts using different flip-angle evolution (SPACE) sequence in preoperatively predicting SM for coracoid transfer. Methods:The post-multiplanar reconstructed images were obtained from 24 volunteers (17 males, seven females) to determine the clarity and sensitivity of the PD-SPACE-COR and PD-SPACE-FS-COR protocols. Furthermore, the distance from the coracoid tip to the lateral edge of the attachment of trapezoid ligament (TL) was measured. To evaluate the accuracy of 3D MRI prediction, a cadaveric cohort has been launched in 32 shoulders (nine males, seven females). The distance between the tip of coracoid process and the outmost edge of TL footprint, namely, the SM, was measured.Results: A better sensitivity was found in PD-SPACE-COR in detecting coracoclavicular ligaments (CCLs), including TL and conoid ligament (CL), compared to PD-SPACE-FS-COR by ranking, McNemar test (P = 0.001), and kappa coefficients (κ = 0.51, P = 0.43). The SM determined by the PD-SPACE-COR protocol was 24.28 AE 2.17 mm while that by cadaveric morphometry was 25.53 AE 2.84 mm. No difference was found between measurements (P = 0.78). Conclusion:This research provides new insights for preoperatively geometrical planning coracoid transfer by 3D MRI PD-SPACE-COR, which motivates personalized medicine in orthopedics.

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“…Calvo et al reported 11.8% of cases that remained off-track after undergoing a Latarjet procedure and they had a significantly higher rate of failure than those that converted to ‘on-track’ ( 12 ). In this clinical setting, some authors have suggested the congruent-arc technique as it provides approximately 5 mm more bone augmentation ( 13 ), while others might consider a better option addressing the Hill–Sachs lesion by adding a remplissage to the Latarjet procedure ( 14 ) or to increase the glenoid surface by means of a free bone graft ( 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ).…”

Section: Introductionmentioning

confidence: 99%

Recurrence of instability after Latarjet procedure: causes, results and treatment algorithm

et al. 2022

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Latarjet modifies the anatomy of the shoulder, and subsequent revision surgery is challenging. It is mandatory to determine the cause of recurrence in order to select the best treatment option. A CT scan is needed to measure glenoid track and evaluate coracoid graft status: position, degree of consolidation, and osteolysis. Conservative management can be advocated in selected patients in whom the instability level does not interfere with the activities they wish to perform. Surgical treatment is based on the glenoid track measurement and coracoid graft suitability. The coracoid graft is considered suitable if it preserves the conjoint tendon insertion, does not show osteolysis, and is large enough to reconstruct the glenoid surface. Adding a remplissage is recommended for those cases with a coracoid graft insufficient to convert large off-track Hill–Sachs lesions into on-track. If the coracoid graft is suitable to reconstruct bone defects in terms of size and viability but is poorly positioned or avulsed, graft repositioning can be a valid option. In patients with unsuitable coracoid bone graft, free bone graft is the revision technique of choice. The size of the graft should be large enough to restore the glenoid surface and to convert any off-track Hill–Sachs lesion into on-track. There is a small group of patients in whom bone defects were properly addressed but Latarjet failed due to hyperlaxity or poor soft tissue quality. Extraarticular capsular reinforcement is suggested in this population.

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Traditional versus congruent-arc Latarjet anatomic and biomechanical perspective

Cited by 11 publications

References 37 publications

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

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

3D MRI PD‐SPACE‐COR Predicting Safety Margin for Coracoid Transfer

Recurrence of instability after Latarjet procedure: causes, results and treatment algorithm

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