2017 ISAKOS Biennial Congress ePoster #2023

 

Coracoid Graft Osteolysis and Subscapularis Muscle Strength Post Latajet Procedure for Antero-Inferior Shoulder Instability; A Prospective Study

John Edmund Benny, MS, FASM, Tiruchirapalli, Tamil Nadu INDIA
Karthick Murugappan Selvaraj, MS DNB FAOA, Coimbatore, Tamil Nadu INDIA
David V. Rajan, MS(Orth), MNAMS(Orth), FRCS(G), Coimbatore, Tamil Nadu INDIA

Ortho-One Orthopaedic Speciality Centre, Coimbatore, Tamil Nadu, INDIA

FDA Status Cleared

Summary

Is the Bone Block Effect of Latarjet the principal effect in the treatment of shoulder instability?

Abstract

Introduction

The Latarjet procedure is the recommended surgical procedure in patients for the treatment of anteroinferior shoulder instability in patients with bone loss above 20%, in high demand patients and in failed bankart surgeries. However, the coracoid bone graft which is transferred undergoes osteolysis and has been well documented in the literature. The aim of the study is to assess the extent of osteolysis and the location of osteolysis. The strength of the subscapularis muscle following the procedure was also assessed.

Materials And Methods

A total of 20 patients were prospectively followed atleast 6 months post Latarjet procedure. Computed tomography scan analysis to determine the location and the amount of the coracoid graft
Osteolysis was done. The strength of the subscapularis muscle was assessed usind a dynamometer and compared with the normal side.

Results

Osteolysis was definitely noted in 16 of the 20 cases following latarjet. The most significant osteolysis was noticed in by the superficial part of the proximal coracoid graft, and the distal region of the coracoid graft was the least involved and had the best union. The subscapularis muscle strength was found to weak in 60% of the subjects following latarjet procedure.

Discussion

Latarjet is definitely the recommended surgical procedure following recurrent anteroinferior bankart surgery a significant amount of osteolysis though happens in the patients which is location specific. This asks for questioning of the principle effect of the surgical mechanism which is the bone block effect. The strength of the subscapularis muscle is also decresed in 12(60%) of patients though further follow is needed.

Conclusion

Our study suggests that the Latarjet procedure’s bone-block effect may not be the sole principal effect in its treatment of antero-inferior shoulder instability patients. The significance and the strength of the subscapularis muscle has to be researched further.