Primary Open Latarjet Procedure Results in Functional Differences but No Structural Changes in Subscapularis Muscle Quality vs the Healthy Contralateral Shoulder at Long-term Follow-up

Abstract

Background: There are concerns that the Latarjet procedure results in loss of glenohumeral rotation and strength and in subscapularis dysfunction. The long-term effects of this procedure on subscapularis quality, glenohumeral rotation, and strength are unknown. Purpose/Hypothesis: To analyze the long-term effect of the primary open Latarjet procedure using a muscle-splitting approach on internal and external rotation and strength, as well as subscapularis muscle quality as compared with the healthy contralateral side. We hypothesized that the primary open Latarjet procedure is associated with a reduction of long-term shoulder strength and function and decreased subscapularis quality. Study Design: Case series; Level of evidence, 4. Methods: A total of 42 patients who underwent a primary open Latarjet procedure for recurrent anterior shoulder instability at a mean age of 26 years (range, 18-36) were reviewed after a mean follow-up of 8.4 years (range, 5-12). The subscapularis muscle volume and fat fraction of both shoulders were assessed. Bilateral active internal rotation (IR) and external rotation (ER), as well as IR and ER strength, were assessed by isokinetic testing (concentric, eccentric, and fatigability). Results: Active IR (0.6-point difference, P < .001) and ER (4° difference, P = .010) were significantly greater in healthy contralateral shoulders. The IR strength of the operated shoulder was significantly less than that of the healthy shoulder in concentric and eccentric testing (range of deficit, 4%-6%; P < .05). Also, the ER strength of the operated shoulder was significantly less than that of the healthy shoulder in concentric testing (11% deficit, P < .05). Subscapularis muscle volume was significantly greater in the operated shoulder (4% difference, P = .022), and there was no significant difference in fat fraction ( P = .114). Conclusions: The primary open Latarjet procedure was associated with significantly decreased active IR and ER and strength when compared with the healthy contralateral shoulder. The clinical influence of these findings is yet to be defined. There was no increased subscapularis muscle fatty degeneration but a minimal hypertrophy on the operated side at long-term follow-up.

Strength after the arthroscopic Latarjet procedure: Are shoulder internal rotation, elbow flexion & supination strength decreased?

“…6 However, Ernstbrunner et al reported reduced strength in internal and external rotation of the shoulder after open Latarjet surgery. 7 In a sample of 20 patients, Malavolta et al similarly evaluated shoulder and elbow strength after open Latarjet surgery, however, they reported reduced strength of external rotation and forearm supination, findings that differ from ours. 8 In a sample of 20 patients undergoing open Latarjet surgery, Lacheta et al reported reduced forearm supination strength but did not affect elbow flexion at a mean follow up of 9.8 months.…”

The Influence of Glenoid Bone Loss and Graft Positioning on Graft and Cartilage Contact Pressures After the Latarjet Procedure

“…43 A simulated Latarjet procedure was then performed in these 2 different bone loss conditions under the 3 humeral head configurations. The distal 25 mm of the coracoid process was cut and transferred to the anteroinferior region of the glenoid 22,49 so that the bone graft was flush with the glenoid bone (mediolateral direction) and approximately 75% of the graft surface was below the glenoid equator of the inferior two-thirds of the glenoid height (craniocaudal direction). 42 Then, two 4.5-mm cortical screws separated by 10 mm were positioned at an angle of 10°to the glenoid plane 10 to secure the graft to the glenoid neck.…”

Surgical Technique for the Latarjet Procedure Using Non-Cannulated Screws

“…It provides a triple blocking effect to increase anterior shoulder stability, and this has been well described in the literature. [1][2][3][4][5][6] Although the indications vary from surgeon to surgeon, we typically consider Latarjet for high-risk patients for recurrent instability who have any glenoid bone loss or low-risk patients who have between 15% and 30% anterior glenoid bone loss. 3,7 For those lower risk patients with \15% glenoid bone loss, we typically perform an Surgical Techniques arthroscopic stabilization procedure.…”

“…It provides a triple blocking effect to increase anterior shoulder stability, and this has been well described in the literature. 1-6…”