INFLUENCE OF THE CORACOID BLOCK POSITION ON SENSATION OF POSTOPERATIVE APPREHENSION IN CHRONIC TRAUMATIC ANTERIOR INSTABILITY

Abstract

Purpose: The purpose of this work was to determine whether the position of the coracoid block used for surgical stabilisation of the shoulder using the Patte procedure has an influence or not on persistent postoperative apprehension.

Material and methods: Forty patients, mean age 26 years (19–37) operated on by the same surgeon (PV) were reviewed retrospectively at mean 40 months (24–60). Instability was expressed by dislocation (70%), subluxation (20%), or both (10%). Hyperlaxity was not found in any of the patients. The same surgical technique was used in all cases: subscapular discision along the axis of the fibres and fixation of the coracoid block using a single cortical lag screw (4.5 mm) with a washer. Radiological assessment at review included a three-quarter AP view in rotation and a glenoid lateral view (Bernageau). The height of the block was measured from the equator of the glenoid and lateral position in relation to the glenohumeral joint line (medial, flush, lateral).

Results: The block was always in an inferior position, flush in 70%, medial in 22% and slightly overhanging in 8%. Twenty percent of the patients experienced persistent apprehension for extreme abduction and external rotation; only one patient with a flush block reported apprehension compared with seven among patients with a medial block. There were two cases of recurrent dislocation and two episodes of subluxation in the patients with a medial block; none required revision. Function was assessed with the DASH: mean score was 6.7 for the entire series, 10 for patients with a medial block and 4.2 for those with flush blocks.

Conclusion: This retrospective analysis emphasises the difficulty and the necessity of rigorous technique to obtain an “ideal” position of the coroacoid block. When the technique is perfectly performed in patients with posttraumatic chronic instability without hyperlaxity, apprehension disappears with little risk of recurrence.