Does preoperative glenoid bony defect determine final coracoid graft positioning in arthroscopic Latarjet?
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Résumé
Background It has been demonstrated that the accurate positioning of the graft is key to restoring shoulder stability and preventing future arthrosis development. Preoperative anteroinferior glenoid bone loss is frequently encountered when performing a Latarjet, and it has not been determined yet if the amount of bony defect can influence graft positioning. The aim of the study was to determine if a preoperative glenoid bony defect has an influence on the final coracoid graft position in the arthroscopic Latarjet procedure. Methods Fifty-five patients who underwent the arthroscopic Latarjet procedure were included, with a minimum follow-up of 2 years. There were 51 men (92.7%). Mean age was 29.1 (SD 7.63). Western Ontario Shoulder Instability Index, Rowe, and Single Assessment Numeric Evaluation scores were fulfilled. All measurements were performed by a musculoskeletal radiologist based on a multiplanar bidimensional CT scan. Dimensions of the glenoid, glenoid defect, and glenoid track were calculated. Position of the graft was evaluated in the axial (distance to glenoid surface, angulation of the graft and screws) and sagittal planes (percentage of the coracoid graft below the equator) as described by Kany et al and Barth et al respectively. Results There was a glenoid defect in 41 patients (74.5 %). Mean width of the defect was 4.32 mm (SD 3.08) which represented 15.3% of the native glenoid surface (SD 10.8). 78.2% of the patients were offtrack preoperatively, and 11.9% remained offtrack postoperatively. The final glenoid diameter with the graft was 32.1 mm (SD 4.34). Mean distance from the graft to the glenoid at 50% height was 1.1 mm (SD 2.19 mm) and at 25% height was 1.31 mm (SD 2.05). Mean angulation of the superior and inferior screws were 26.9° (SD 8.2°) and 27.1° (SD 7.35°), respectively. In 81.8% of the cases, the graft was deemed to be flush with the glenoid. The percentage of the coracoid graft under the equator of the glenoid was 71.2 % (SD 21.8). There was not a statistically significant difference in screw angulation or graft positioning in the axial plane when comparing patients who had a glenoid defect with those who did not, or depending on the size ( P > .05). Percentage of graft below the equator was, however, lower in patients without bony defect ( P = .04). Conclusion This study showed that accurate position of the coracoid graft is achieved in the presence of a glenoid bony defect. In the cases of intact glenoid, the height of the graft should be carefully evaluated.
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