Hypothesis. Recurrent shoulder dislocation is associated with bony defect of the glenoid rim, commonly seen along with bankart tear - a soft tissue injury of glenoid labrum. This cadaveric study compares the bone block effect of coracoid transfer using using two common techniques, Classical Latarjet technique and the Congruent-Arc Latarjet. We hypothesized that the force needed to dislocate the shoulder would be greater in Congruent Arc technique than the Classical Latarjet, because of increased contact surface area as a result of greater linear dimensions. Material and methods. We dissected 14 cadaveric shoulders. A bony Bankart lesion was created in form of an inverted pear glenoid. The humeral head was attached to a pulley system that was sequentially loaded until the shoulder dislocated anteriorly. The force needed to dislocate was noted. This was repeated after coracoid transfer with two common techniques, Classical Latarjet technique and the Congruent-Arc Latarjet. Results. The mean force required to dislocate shoulder post-Classical Latarjet technique was 325.71N, compared to 123.57 N in uncorrected shoulder. Similarly, the mean force required to dislocate shoulder post Congruent-Arc Latarjet technique was 327.14 N compared to 123.57 N in uncorrected shoulder. The two-tailed P value in either case was less than 0.0001, thus statistically significant. Unpaired t-test was done to compare the force required to dislocate the shoulder post procedure. Mean force required to dislocate shoulder post-Classical Latarjet, was 325.7N compared to 327N in post-Congruent Arc. The two-tailed P value equals 0.9020 and the 95% confidence interval was from −25.05 to 22.19, thus the difference was not statistically significant. Conclusion. The results confirm that both (Classical and Congruent-Arc Latarjet) techniques are good for addressing the shoulder instability, however bone block effect provided by one is not superior to other

The Latarjet procedure is a well described method to stabilize anterior shoulder instability. There are concerns of high complication rates, one of these being a painful shoulder without instability due to screw irritation. The arthroscopic changes in the shoulder at time of screw removal compared to those pre-Latarjet have not been described in the literature. We conducted a retrospective review of arthroscopic videos between 2015 and 2022 of 17 patients at the time of their Latarjet screw removal and where available (n=13) compared them to arthroscopic findings at time of index Latarjet. Instability was an exclusion criterion. X-rays prior to screw removal were assessed independently by two observers blinded to patient details for lysis of the graft. Arthroscopic assessment of the anatomy and pathological changes were made by two shoulder surgeons via mutual consensus. An intraclass correlation coefficient (ICC) was analyzed as a measure for the inter-observer reliability for the radiographs. Our cohort had an average age of 21.5±7.7 years and an average period of 16.2±13.1 months between pre- and post-arthroscopy. At screw removal all patients had an inflamed subscapularis muscle with 88% associated musculotendinous tears and 59% had a pathological posterior labrum. Worsening in the condition of subscapularis muscle (93%), humeral (31%) and glenoid (31%) cartilage was found when compared to pre-Latarjet arthroscopes. Three failures of capsular repair were seen, two of these when only one anchor was used. X-ray review demonstrated 79% of patients had graft lysis. Excellent inter-rater reliability was observed with an ICC value of 0.82. Our results show a high rate of pathological change in the subscapularis muscle, glenoid labrum and articular cartilage in the stable but painful Latarjet. 79% of patients had graft lysis with prominent screws on X-ray

Recurrent shoulder instability in those with bony defects is a difficult surgical problem to resolve. Burkhart and De Beer described an unacceptably high recurrence rate for arthroscopic Bankart repair in the presence of an inverted-pear glenoid with or without an engaging Hill-Sachs lesion, with suggestions that an open modified Latarjet procedure should be recommended in such patients. The Congruent-Arc Latarjet is a modification of the Latarjet open bony stabilisation for shoulder instability developed by Burkhart and De Beer. It involves rotation of the coracoid so the curved under-surface lies congruent with the glenoid. At the Royal Derby Hospital, UK, this procedure has been adopted by our four shoulder surgeons, two of whom undertook fellowship training with De Beer, we studied the outcomes of the patients who had undergone the modified Congruent-Arc Latarjet procedure in our department. Fifty-two consecutive patients were identified over a five-year period at the Royal Derby Hospital or Derbyshire Royal Infirmary between 2006 and 2010 inclusive. With the approval of the clinical audit department, the data was collected using theatre records and clinical coding information to identify the patient group. A review of the case notes and local PACS system was undertaken to establish pre and post-operative examination findings, radiology findings regarding Hill-Sachs defects and glenoid bone loss, re-dislocation rates and post-operative function with return to normal activity. The endpoints of this study were aimed at finding out whether patients did return to normal function, were able to continue doing activity that would have provoked dislocation prior to surgery, and how many of the cases re-dislocated. No surgeon consultant had a patient who re-dislocated after this procedure. The follow-up period was from 1 year to 6 years post-operatively. The complications of this procedure were found to be the dislodgement of bone anchors in 2 patients, who required further arthroscopy to remove the suture anchor from the gleno-humeral joint. One patient had prolonged functionally limiting loss of external rotation, which resolved after intensive physiotherapy at 7 months follow up. We will provide graphical representation of the pre and post operative functional scores. We have demonstrated that the Congruent-Arc Latarjet is a reproducible procedure in the hands of surgeons other than the original authors, particularly when comparing our current 0% re-dislocation rate with the published literature, which suggests that 3.9% of patients undergoing this procedure with greater than 25% bone loss of the glenoid or an engaging Hill-Sachs will re-dislocate post-operatively, and this is better than the 6% re-dislocation rate of the standard Bristow-Latarjet procedure

Purpose:. We aimed to assess the short and medium term complications of patients who had undergone Latarjet procedures. We also compared this to a group of patients who over a similar period underwent an open Bankhart procedure to assess the complication profiles between the two groups. Method:. We retrospectively reviewed the notes and X-rays of all patients identified by surgical log books and or operation codes for instability. Eighty seven patients (88 shoulders) underwent Latarjet procedures between 2002 and 2010. Patients were phoned to obtain a telephonic Oxford shoulder score. There were 44 patients with 46 shoulders in the open Bankhart group. Results:. Complications were seen in 27 patients in the Latarjet group. These included: 5 nerve injuries (3 axillary nerves, 1 musculocutaneous nerve, 1 possible suprascapular nerve) 4 of which resolved; 6 screw related complications and 7 early recurrences of the instability. There was a total reoperation rate of 8%. Patients who developed complications had an average post op Oxford score at last follow up of 36.1, while those without complications had an average score of 14.8. In the group of patients who underwent Bankhart procedures there were no recorded short or medium term complications. We specifically did not look at recurrence rates in either group as we felt our follow up times would not reflect this adequately. Conclusion:. Modified Latarjet procedure appears to have a higher short and medium term complication rate compared to the open Bankhart procedure. Once a complication occurs following a Latarjet reconstruction outcomes are significantly worse

To evaluate the efficacy of using a novel button-suture construct in place of traditional screws to provide bone block fixation for the Latarjet procedure. Four paired cadaveric shoulders (n=8) were denuded, with the exception of the conjoint tendon on the coracoid, and were potted. A 15% anterior glenoid bone defect was simulated. Right and left specimens were randomised into two groups: double-screw versus quadruple-button Latarjet reconstruction techniques. A uniaxial mechanical actuator loaded the Latarjet reconstructed glenoid articular surface via a 47mm diameter metallic hemisphere. Cyclic loading between 50–200N was applied to the glenoid at a rate of 1Hz for 1000 cycles. Testing was repeated three times for conjoint tendon loads of 0N, 10N and 20N. The relative positions of three points on the inferior, central and superior edges of the coracoid bone fragment were optically tracked with respect to a glenoid coordinate system throughout testing. Screw and button constructs were compared on the basis of maximum relative displacement at these points (RINF, RCENT, RSUP). Statistical significance was assessed using a paired-samples t-test in SPSS. When conjoint tendon loading was not present the double screw and quadruple button constructs were not significantly (P>0.779) different (0N: RINF: 0.11 (0.05)mm vs. 0.12 (0.03)mm, RCENT: 0.12 (0.04)mm vs. 0.12 (0.03)mm, RSUP: 0.13 (0.04)mm vs. 0.12 (0.03)mm). Additionally, the double screw construct was not found to differ (P>0.062) from the quadruple button in terms of resultant coracoid displacement for all central and superior points, regardless of conjoint loading (10N: RCENT: 0.11 (0.03)mm vs. 0.19 (0.05)mm, RSUP: 0.11 (0.01)mm vs. 0.18 (0.04)mm; 20N: RCENT: 0.13 (0.01)mm vs. 0.30 (0.13)mm, RSUP: 0.13 (0.03)mm vs. 0.26 (0.14)mm). It was only for the inferior point with conjoint loading of 10N and 20N that the double screw construct began to produce significantly lower displacements than the quadruple button (10N: RINF: 0.11 (0.03)mm vs. 0.23 (0.05)mm, P=0.047; 20N: RINF: 0.12 (0.02)mm vs. 0.39 (0.15)mm, P=0.026). The results of the screw and button constructs when conjoint tendon loading was absent suggest that the button may be a suitable substitute to the screw when the coracoid is used as a bone block. Due to the small resultant displacements (max: screw = 0.19mm, button = 0.52mm), it is suggested that buttons may also act as a substitute to screws for Latarjet procedures, provided conjoint tendon overloading is minimised during the post-operative graft healing period. These in-vitro results support the in-vivo results of Boileau et al (2015) that demonstrated the suture-button technique to be an excellent alternative to screw fixation Latarjet, with graft healing in 91% of their subjects

Coracoid fractures during screw insertion and graft osteolysis are serious concerns with standard screw fixation techniques in Latarjet procedure. This study tends to evaluate the outcome of mini open Latarjet using Arthrex mini-plate for coracoids graft fixation. We did retrospective analysis of 30 patients with recurrent anterior shoulder instability after arthroscopic Bankart's repair. A low profile wedge plate (Arthrex) with two low profile screws was used for fixation of the coracoid graft. CT analysis was performed at final follow up to see graft union and results were evaluated using American shoulder and elbow score (ASES) and Western Ontario shoulder instability score (WOSIS). Mean follow up time was 24 months. Postoperatively, mean forward elevation was 162.8 degrees and external rotation was 44.6 degrees. All patients returned to their previous occupation. None reported to be having any recurrent subluxation post-surgery. The mean ASES score was 92.5 while the mean WOSIS score was 76.84%. Only one patient had screw backing out from the plate. There was no case of coracoid graft osteolysis. The mini-open Latarjet procedure with graft fixation with Arthrex mini-plate provides satisfactory outcome and stabilization in patients who present with dramatic bone loss and failed soft tissue reconstruction. It not only ensures early rehabilitation but also minimum loss of external rotation. The only drawback is the relatively high cost of the implant

The Latarjet procedure is a successful primary and revision option for anterior shoulder instability; however recent reports have highlighted varying complication rates. Our aim was to prospectively study clinical, functional and radiological outcomes of patients undergoing this procedure. 50 consecutive patients underwent a Latarjet coracoid transfer between 2006 and 2012. Mean age was 27 years (17–63), 48 were male. Pre-/post-operative imaging, Oxford Shoulder Instability Score (OISS), American Shoulder & Elbow Surgeons score (ASES), Subjective Shoulder Value score (SSV) and clinical evaluation were documented. Mean follow up was 32 months (6–74). There were no dislocations or revision procedures. Subluxation occurred in one patient only. 95% of shoulders were subjectively graded “excellent” or “good;” 5% “fair;” and none as “poor”. The mean pre-op ASES was 58(50–66) and 95(92–98) post-operatively (p< 0.001). The mean pre-operative OISS was 19(18–22) and 43(41–45) post-operatively (p<0.001). The mean SSV increased from 46% to 89% (p < 0.001). 98% of patients considered their surgery to be “successful” and 95% would recommend the procedure to a friend. 82% returned to sport at their previous level. There were no infective or metalwork-related complications. Five experienced transient neurological symptoms all of which resolved within three months. These results suggest that the Latarjet procedure is safe and reliable with low complication rates

The Latarjet procedure is a successful primary and revision option for anterior shoulder instability; however recent reports have highlighted varying complication rates. Our aim was to prospectively study clinical, functional and radiological outcomes of patients undergoing this procedure. 50 consecutive patients underwent a Latarjet coracoid transfer between 2006 and 2012. Mean age was 27 years (17–63), 48 were male. Pre-/post-operative imaging, Oxford Shoulder Instability Score (OISS), American Shoulder & Elbow Surgeons score (ASES), Subjective Shoulder Value score (SSV) and clinical evaluation were documented. Mean follow up was 32 months (6–74). There were no dislocations or revision procedures. Subluxation occurred in one patient only. 95% of shoulders were subjectively graded “excellent” or “good;” 5% “fair;” and none as “poor”. The mean pre-op ASES was 58(50–66) and 95(92–98) post-operatively(p<0.001). The mean pre-operative OISS was 19(18–22) and 43(41–45) post-operatively(p<0.001). The mean SSV increased from 46% to 89%(p < 0.001). 98% of patients considered their surgery to be “successful” and 95% would recommend the procedure to a friend. 82% returned to sport at their previous level. There were no infective or metalwork-related complications. 5 experienced transient neurological symptoms all of which resolved within 3 months. These results suggest that the Latarjet procedure is safe and reliable with low complication rates

Recurrent anterior shoulder instability (RASI) is related to progressive bone loss on the glenoid and on the humeral head. Bone deficit magnitude is a well-recognized predictor of recurrence of instability after an arthroscopic Bankart surgery, but the best way to measure it is unknown. In this study, we want to determine which measurement method is the best predictor of recurrence of instability and function. For 10 years now, all patients undergoing surgery for RASI in 4 centers are included in a prospective study: the LUXE cohort. Patients with a pre-operative CT-scan and a minimum of 1-year follow-up were included. ISIS score was used to stratify patients. WOSI and Quick-Dash questionnaires were used to characterise function. Bone defects were assessed using the Clock method, the Glenoid Ratio, the Humeral Ratio, the Glenoid Track method and the angle of engagement in the axial plane. A total of 262 patients are now included in the LUXE study. One hundred and three patients met the inclusion criteria for analysis with a majority of male (79%) and a mean age is 28 years old. The median number of dislocations prior to surgery was 6. Seventy patients had an arthroscopic Bankart repair and 33 patients underwent an open Latarjet procedure. The ISIS score for these groups were of 2.7 and 4.8 respectively (p<0.001). The mean bone defect on the glenoid was of 1h51 with the Clock method (range: 0h-4h48; SD=1h46) and of 9% for the glenoid ratio (0–37%, 10%). On the humeral side, the bone defect was of 1h59 (0h-4h08; 0h49) for the Humeral clock method, 15% (0–36%; 6%) with the ratio method and 71 degrees of external rotation (SD=30 degrees) with the angle of engagement measurement. On the combined evaluations, 53 patients presented an off-track lesion, with mean combined hours of 3h53 (SD= 2h13). The greatest correlation obtained was between the glenoid ratio and the glenoid clock method (r=0.919, p<0.001). Eighteen patients had a recurrence of shoulder dislocation after the initial surgery, leading to a recurrence rate of 23% in arthroscopic surgery versus six percent after a Latarjet (OR= 4.6, p=0.034). No bone defect was correlated to Latarjet failure. For the arthroscopic group, the risk of recurrence was related to a smaller angle of engagement of the Hill-Sachs (p=0.05), a smaller Humeral clock measurement (p=0.034) and a longer follow-up (p=0.006). No glenoid or combined measurements were correlated with arthroscopic procedure failure. Recurrence of dislocation was associated to worst function according to the WOSI (1036 vs 573, p=0.002) and DASH (32 vs 15, p=0.03). Even with lower ISIS score, arthroscopic procedures are still leading to high risk of recurrence in this “all comer” consecutive cohort study AND it is related to humeral side parameters. Recurrence is also affecting daily function and creating higher anxiety related to the shoulder

Purpose. Coracoid transfer is an effective reconstructive procedure for complex glenohumeral joint instability. Recently, the congruent-arc Latarjet procedure has been described which orients the coracoid graft undersurface flush to the glenoid articular margin. The purported advantage of this modification is that the radii of curvature of the coracoid undersurface and the anterior glenoid rim are believed to be similar, and therefore, congruent. The purpose of this study was to determine the dimensions of the coracoid and to compare the radius of curvature (ROC) of the coracoid undersurface to the ROC of the intact glenoid and various glenoid bone-loss scenarios. Method. Thirty-four CT-based 3D models of the shoulder were examined using commercially available software. The mean dimensions of the coracoid were determined and the ROC was calculated for the coracoid undersurface, the intact glenoid as well as 20%, 35% and 50% anterior glenoid bone-loss scenarios. Intra and inter-rater statistics were calculated. Results. The mean length, width and thickness of the coracoid were: 16.8 mm, 15.0 mm, and 10.5 mm, respectively. The mean ROC values were: coracoid: 13.6 mm, intact glenoid: 13.8 mm, 20% anterior glenoid bone-loss: 27.6 mm, 35% bone-loss: 30.5 mm, and 50% bone-loss: 33.3 mm. The coracoid ROC was not significantly different from the intact glenoid (p=0.75), however, was significantly less (p<0.01) than all glenoid bone-loss scenarios. Intra- and inter-rater reliability was good/excellent. Conclusion. The congruent-arc Latarjet is truly congruent if the coracoid is fixated to an intact anterior glenoid rim. In glenoids with 20% or greater anterior bone-loss, the congruent-arc Latarjet is no longer congruent

Background:. A shoulder dislocation is defined as chronic when it has been unreduced for more than one week. Chronic anterior shoulder dislocations are commonly encountered in Kwazulu-Natal for various reasons. Different surgical options exist to treat chronic anterior shoulder dislocations. However the outcome of surgically treated chronic shoulder dislocations has not been favourable in all studies. Methods:. We report on a combined case series of chronic anterior shoulder dislocations previously treated at Edendale Hospital (EDH), Pietermaritzburg and Inkosi Albert Luthuli Central Hospital (IALCH), Durban. Patients were identified retrospectively using departmental databases and their case files were retrieved. Patient demographics, duration of dislocation, mechanism of injury and reason for delayed treatment were recorded. When available, X-rays, CT scans and MRI scans were retrieved to identify associated bony and soft tissue pathology. Surgical outcome was assessed using range of movement (ROM), change in pain severity, patient satisfaction, as well as Oxford Shoulder Instability Score (OIS) and Rowe and Zarins score. Post-operative complications including redislocations were also identified. Results:. Twenty-six patients with chronic anterior shoulder dislocations were surgically treated. The average duration of dislocation was 9 months (range 2 weeks to 7 years). The most common reason for chronicity was delayed presentation to clinic or hospital (9 patients). A Hill Sachs lesion was present in 20 patients, and a pseudo-glenoid was often encountered in dislocations present for more than 4 weeks (14 of 23 patients). Three supraspinatus ruptures and 4 biceps tears were encountered while neurological injury was uncommon (2 patients). Surgical treatment included open reduction (1 patient), open reduction and Latarjet (15 patients), hemi-arthroplasty (2 patients), hemi-arthroplasty and Latarjet (3 patients) and reverse total shoulder arthroplasty (5 patients). Eighteen patients were available for follow-up. Most patients (16 out of 18 patients) were satisfied with their outcome. This was due to improvement in pain. Regardless of the type of surgery done, post-operative range of motion and surgical outcome scores were generally poor. Two patients were unsatisfied, due to redislocations. Conclusion:. Surgical treatment of chronic anterior shoulder dislocations resulted in satisfactory pain relief but marginal improvement in range of motion and overall shoulder function