Accuracy of Latarjet graft and screw position after using novel drill guide

Hartel, Maximilian; Weiser, Lukas; Hoffmann, Michael; Wehrenberg, Uwe; Heinemann, Axel; Rueger, Johannes M.; Briem, D.

doi:10.1007/s00068-016-0703-4

Cited by 5 publications

(7 citation statements)

References 17 publications

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“…Both arthroscopic techniques were less reproducible than the open technique with respect to sagittal plane graft positioning. A positive effect of using a glenoid guide on coracoid positioning has also been reported by Klatte et al 22 in a cadaveric study. With the arthroscopically-assisted procedure, we also had an improved outcome regarding coracoid integration (81.8% versus 62.5%) and less graft resorption (18.2% versus 37.5%).…”

Section: Discussionsupporting

confidence: 76%

Arthroscopically-assisted Latarjet: an easy and reproducible technique for improving the accuracy of graft and screw placement

Taverna

Guarrella

Cartolari³

et al. 2017

Shoulder & Elbow

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The Latarjet procedure is a challenging procedure for which a key point is the correct placement of the coracoid graft onto the glenoid neck and correct position of the screws. The present study substantiates a clear benefit for the use of a guide with an arthroscopically-assisted technique in terms of graft and hardware placement. At short-term follow-up, there appears to be a benefit for graft integration and avoidance of resorption.

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Section: Discussionsupporting

confidence: 76%

Arthroscopically-assisted Latarjet: an easy and reproducible technique for improving the accuracy of graft and screw placement

Taverna

Guarrella

Cartolari³

et al. 2017

Shoulder & Elbow

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“…Therefore, several CT scan–based clinical or cadaveric studies attempted to evaluate CG position after Latarjet procedure. 7 , 8 , 17 – 19 , 22 The use of a parallel drill guide (customized or not) has been shown to provide good graft placement in the axial and sagittal planes of the glenoid. 7 , 18 , 19 However, no clear comparison with the classic open technique had ever been performed.…”

Section: Discussionmentioning

confidence: 99%

“…26 Therefore, guide-assisted operations simplifying the surgical steps have been proposed. 17,22 Given the importance of the appropriate coracoid position, the purpose of this prospective study was to assess graft placement after the Latarjet procedure, comparing the classic freehand technique with the guide-assisted method. The hypothesis was that the guide application allows for more accurate graft placement and better contact with the anterior glenoid surface, providing improved reproducibility of the technique.…”

mentioning

confidence: 99%

Can a Drill Guide Improve the Coracoid Graft Placement During the Latarjet Procedure? A Prospective Comparative Study With the Freehand Technique

Barth

Boutsiadis

Neyton

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:One of the factors that can affect the success of the Latarjet procedure is accurate coracoid graft (CG) placement.Hypothesis:The use of a guide can improve placement of the CG and screw positioning in the sagittal and axial planes as compared with the classic open (“freehand”) technique.Study Design:Cohort study; Level of evidence, 2.Methods:A total of 49 patients who underwent a Latarjet procedure for the treatment of recurrent anterior shoulder instability were prospectively included; the procedure was performed with the freehand technique in 22 patients (group 1) and with use of a parallel drill guide during screw placement in 27 patients (group 2). All patients underwent a postoperative computed tomography scan with the same established protocol. The scans were used to evaluate and compare the position of the CG in the sagittal and axial planes, the direction of the screws (α angle), and overall contact of the graft with the anterior surface of the glenoid after the 2 surgical techniques.Results:The CG was placed >60% below the native glenoid equator in 23 patients (85.2%) in group 2, compared with 14 patients (63.6%) in group 1 (P = .004). In the axial plane, the position of the CG in group 2 patients was more accurate (85.2% and 88.9% flush) at the inferior and middle quartiles of the glenoid surface (P = .012 and .009), respectively. Moreover, with the freehand technique (group 1), the graft was in a more lateral position in the inferior and middle quartiles (P = .012 and .009, respectively). No differences were found between groups 1 and 2 regarding the mean α angle of the superior (9° ± 4.14° vs 11° ± 6.3°, P = .232) and inferior (9.5° ± 6° vs 10° ± 7.5°, P = .629) screws. However, the mean contact angle (angle between the posterior coracoid and the anterior glenoid surface) with the freehand technique (3.8° ± 6.8°) was better than that of the guide (8.55° ± 8°) (P = .05).Conclusion:Compared with the classic freehand operative technique, the parallel drill guide can ensure more accurate placement of the CG in the axial and sagittal planes, although with inferior bone contact.

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“…The use of a graft holder that has a buttress effect while drilling should be considered essential for graft preparation with smaller-diameter bits and screws for fixation in an Indian population. 26,31,32,35 Based on the present study, it is not possible to comment on the minimum graft dimensions for performing a successful Latarjet procedure, because studies have used alternative fixation methods (as described in detail 6,13,17 ).…”

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

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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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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Accuracy of Latarjet graft and screw position after using novel drill guide

Cited by 5 publications

References 17 publications

Arthroscopically-assisted Latarjet: an easy and reproducible technique for improving the accuracy of graft and screw placement

Arthroscopically-assisted Latarjet: an easy and reproducible technique for improving the accuracy of graft and screw placement

Can a Drill Guide Improve the Coracoid Graft Placement During the Latarjet Procedure? A Prospective Comparative Study With the Freehand Technique

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

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