2015 ISAKOS Biennial Congress ePoster #2313

Arthroscopic Latarjet Surgery: A New Fixation Technique; Simple, Accurate and Original

Sanjay Anil Garude, MS, MCh, DNB Orth, Mumbai, Maharashtra INDIA
Lilavati Hospital and research centre, Mumbai, Maharashtra, INDIA

FDA Status Not Applicable

Summary: A new simple, accurate, cost effective and safe technique for coracoid fixation in arthroscopic Latarjet surgery without using complicated disposable jigs and cannulae.

Abstract:

Objectives:

The aim of our study was to describe a new technique for coracoid fixation in an arthroscopic Latarjet surgery that would be simple, predictable, safe, accurate and affordable.

Methods

The two key instruments devised by us for this are the parallel guide jig and the alignment gauge.

Standard diagnostic shoulder arthroscopy is performed and the extent of glenoid defect is marked.

The coracoid is completely skeletonized except for the conjoint tendon at the tip. The dimensions of the coracoid are then measured.

The coracoid is predrilled with two wires passed using the parallel guide jig 8 or 10 mm apart. These are then drilled over by the cannulated and calibrated drill bit and the distance of the drill holes from the lateral margin of the coracoid is measured using the alignment gauge. The coracoid osteotomy is then completed with a curved osteotome.

The subscapularis is split and kept apart with a switching stick.

The glenoid neck is then prepared by using the alignment gauge. This allows the screw tracts to be predrilled on the glenoid neck in a way as to allow perfect alignment of the coracoid. The parallel guide jig is used thereafter to ensure that the lower screw tract on the glenoid is also passed under vision, and is seen to be contained, entirely within the glenoid neck. This dual jigging ensures accuracy in medio lateral and supero inferior planes and thus a perfect fit for the transferred coracoid.

The two wires are over drilled with a calibrated drill to ascertain correct screw length for fixation.

Two guide wires are passed in a way as to engage the predrilled holes in the coracoid and their corresponding channels on the glenoid.

Using a cannulated “pusher” the coracoid is gently railroaded on the two wires so as to align itself perfectly against the glenoid. Since the two wires transfix the coracoid into the glenoid, the coracoid easily slides on top of these wires

The fixation is then completed using two cannulated screws.

Results

31 cases underwent an arthroscopic Latarjet surgery over 18 months.

The average duration of surgery was 125 minutes.

The average glenoid bone loss was 18%.

There were 30 males and 1 female.

29 surgeries were primary and 2 were revisions for failed Bankart repair.

We found an excellent alignment (with less than 2 mm overhang) in 29 cases. This was measured intra operatively at the end of the surgery.

Standard 3.75 mm cannulated Latarjet screw were used for fixation.

All patients recovered full flexion and abduction. 6 patients lost external rotation of 15 degrees.

All patients have felt subjectively stable and there have been no recurrences.

One case of coracoid non union was seen. At 12 months he remains asymptomatic and has been kept under regular follow up.

Conclusion

With this technique, not only have we been able to perform arthroscopic Latarjet accurately and safely, but have also managed to cut down the cost drastically without compromising on the quality of fixation.