Morphological Analysis of the Scapula and Its Implications in Bristow-Latarjet Procedure

Background:Recurrent shoulder dislocation and anterior instability are most commonly attributed to pathology of the capsulolabral complex with the presence of bony loss at the humeral and glenoid surfaces. Unassessed bone loss has been a cause of failure of primary soft tissue procedures or recurrence of symptoms, despite adequate address of soft tissue pathology.Purpose:To study the anthropometric and radiologic dimensions of the coracoid in relation to glenoid bone loss, its adequacy in filling glenoid defects in an Indian population, and whether the choice of surgical technique (congruent arc vs classical) and graft positioning alters the surgical results. This study also intended to establish whether computed tomography measurements correlate with actual anthropometric measurements.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 64 participants with 108 healthy shoulders were included in this study. Additionally, 100 skeletally mature bone specimens of the scapula were measured to assess glenoid diameter as well as coracoid width and length in 2 perpendicular planes with a humeral subtraction 3-dimensional en face glenoid view.Results:Specimen and participant measurements proved that the congruent arc technique was able to fill up to 50% more glenoid bone loss than the classical technique in an Indian population (mean ± SD, 13.45 ± 6.97 vs 7.96 ± 4.89 mm, respectively), with computed tomography being the best and most accurate modality to study it. The mean difference in the bone block length restoration of the glenoid bony arc was 5.41 ± 2.08 mm. Radii of curvature were congruent in populations of the Indian subcontinent.Conclusion:The congruent arc technique can be performed in an Indian population but with caution and careful presurgical assessment of bone loss. However, adequate coracoid dimension to accommodate the implant for fixation without failure must be ensured, as anthropometry suggests the existence of a subset of the population in whom the graft may have compromised width for accommodating standard implants for fixation.

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“…This shows significantly lower values as compared with the literature on a non-Indian population. 11,23,28,31…”

Section: Resultsmentioning

confidence: 99%

Anthropometric and Radiologic Measurements of Coracoid Dimensions and Clinical Implications in an Indian Population

Joshi

Gupta

Tanwar

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…Although the literature is clear in showing consistent joint stabilization results, few studies report the risk factors and incidence of Latarjet complications, which ranges from 0 to 30%. 2 3 4 5 6 7 8 9 10 11 12 The most frequently reported complications include neurological injury, infection, instability recurrence, fracture and graft pseudoarthrosis. In addition, the treatment of these complications often requires a surgical revision.…”

Section: Introductionmentioning

confidence: 99%

“…A literatura é clara em mostrar resultados consistentes na estabilização articular; porém, poucos estudos relatam a incidência e os fatores de risco relacionados às complicações desta técnica, que variam de 0 a 30%. 2 3 4 5 6 7 8 9 10 11 12 Dentre as complicações mais frequentemente relatadas, citam-se: lesão neurológica, infecção, recidiva da instabilidade, fratura e pseudoartrose do enxerto. Além disso, muitas vezes o tratamento dessas complicações impõe a necessidade de revisão cirúrgica.…”

Section: Introductionunclassified

Incidência e fatores de risco das complicações da cirurgia de Latarjet

Cohen

Fonseca

Gribel

et al. 2020

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo A cirurgia de Latarjet é bem estabelecida para o tratamento da instabilidade anterior do ombro. Apresenta complicações específicas com taxas de até 30%. Nosso objetivo é avaliar a incidência e os fatores de risco associados às complicações após a cirurgia de Latarjet. Métodos Analisamos retrospectivamente 102 pacientes submetidos ao procedimento. Dividimos as complicações em três tipos: clínicas, relacionadas ao enxerto e relacionadas aos implantes. Todos os pacientes foram submetidos a radiografias e tomografia computadorizada (TC). Os fatores de risco analisados foram gênero, idade, cirurgia prévia, epilepsia e experiência do cirurgião. Resultados Um total de 102 pacientes consecutivos (108 casos) foram avaliados. A média de idade foi 33,7 anos (18 a 61 anos), com 88 homens e 14 mulheres. A taxa de complicações foi de 21,2%, sendo 12% clínicas, 7,4% relacionadas ao enxerto e 2,7% relacionadas ao implante. As mais frequentes foram apreensão anterior (oito casos) e posicionamento lateral do enxerto, em seis casos. A TC foi realizada com o mínimo de 6 meses em 79 casos (73%), evidenciando a consolidação do enxerto em 75 pacientes (94.9%). Nenhum caso de não união apresentou instabilidade. Dez pacientes (9.2%) precisaram de cirurgia de revisão. Os fatores de risco relacionados às complicações foram epilepsia (p = 0.0325), experiência do cirurgião (p = 0.0499) e pacientes ≥ 40 anos (p = 0.0151). Não houve correlação com gênero e cirurgia prévia. Conclusão A taxa de complicações após a cirurgia de Latarjet foi de 21,2%, com 9% necessitando de revisão cirúrgica. Epilepsia, idade > 40 anos e experiência do cirurgião foram fatores de risco.

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Distribution and Morphological Measurement of Bony Spurs on the Coracoid Process in a Chinese Population

Zhang

et al. 2019

Med Sci Monit

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Background There are few studies on distributions or morphological measurements for bony spurs form at the attachment points of the ligaments and tendons on the coracoid process. The aim of this study was to investigate their most common sites and morphological characteristics, and to propose possible reasons. Material/Methods Scapulae with bony spurs on the coracoid process were selected from 377 intact and dry Chinese scapulae. The distribution, height, and transverse and longitudinal diameter of the bony spurs were measured in each coracoid process. Results We selected 71 scapulae, 36 left and 35 right, that had bony spurs, from 377 scapulae. The bony spurs were most commonly located at the attachment point of the superior transverse scapular ligament (STSL) (31, 23.66%), while the trapezoid ligament (TL) accounted for the smaller proportion (8, 6.11%). The TSL was the highest, with the minimum transverse and longitudinal diameter, while the TL had the greatest transverse and longitudinal diameters. Only the TSL and TL had a statistically significant difference between the left and the right bony spur regarding the longitudinal diameter (P<0.05). Conclusions Bony spurs are more likely to form at the attachment points of ligaments and tendons on the coracoid process, which has a greater risk of traction injuries or attachment points avulsion fractures.

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Morphological Analysis of the Scapula and Its Implications in Bristow-Latarjet Procedure

Abstract: Citation: Silva JDO, Damas CN, Sá MCC, Torres JMCF. Morphological analysis of the scapula and its implications in Bristow-latarjet procedure. Acta Ortop Bras. [online]. 2017;25(1):34-7. Available from

Cited by 3 publications

References 19 publications

Anthropometric and Radiologic Measurements of Coracoid Dimensions and Clinical Implications in an Indian Population

Anthropometric and Radiologic Measurements of Coracoid Dimensions and Clinical Implications in an Indian Population

Incidência e fatores de risco das complicações da cirurgia de Latarjet

Distribution and Morphological Measurement of Bony Spurs on the Coracoid Process in a Chinese Population

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