Biomechanical Evaluation of the 2 Different Levels of Coracoid Graft Positions in the Latarjet Procedure for Anterior Shoulder Instability
Issued Date
2023-12-01
Resource Type
eISSN
23259671
Scopus ID
2-s2.0-85180658755
Journal Title
Orthopaedic Journal of Sports Medicine
Volume
11
Issue
12
Rights Holder(s)
SCOPUS
Bibliographic Citation
Orthopaedic Journal of Sports Medicine Vol.11 No.12 (2023)
Suggested Citation
Ganokroj P., Dey Hazra M., Dey Hazra R.O., Brady A.W., Brown J.R., Rupp M.C., Garcia A.R., Whalen R.J., Millett P.J., Provencher M.T. Biomechanical Evaluation of the 2 Different Levels of Coracoid Graft Positions in the Latarjet Procedure for Anterior Shoulder Instability. Orthopaedic Journal of Sports Medicine Vol.11 No.12 (2023). doi:10.1177/23259671231202533 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/96000
Title
Biomechanical Evaluation of the 2 Different Levels of Coracoid Graft Positions in the Latarjet Procedure for Anterior Shoulder Instability
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: In the Latarjet procedure, the ideal placement of the coracoid graft in the medial-lateral position is flush with the anterior glenoid rim. However, the ideal position of the graft in the superior-inferior position (sagittal plane) for restoring glenohumeral joint stability is still controversial. Purpose: To compare coracoid graft clockface positions between the traditional 3 to 5 o'clock and a more inferior (for the right shoulder) 4 to 6 o'clock with regard to glenohumeral joint stability in the Latarjet procedure. Study Design: Controlled laboratory study. Methods: A total of 10 fresh-frozen cadaveric shoulders were tested in a dynamic, custom-built robotic shoulder model. Each shoulder was loaded with a 50-N compressive load while an 80-N force was applied in the anteroinferior axes at 90° of abduction and 60° of shoulder external rotation. Four conditions were tested: (1) intact, (2) 6-mm glenoid bone loss (GBL), (3) Latarjet procedure fixed at 3- to 5-o’clock position, and (4) Latarjet procedure fixed at 4- to 6-o’clock position. The stability ratio (SR) and degree of lateral humeral displacement (LHD) were recorded. A 1-factor random-intercepts linear mixed-effects model and Tukey method were used for statistical analysis. Results: Compared with the intact state (1.77 ± 0.11), the SR was significantly lower after creating a 6-mm GBL (1.14 ± 0.61, P =.009), with no significant difference in SR after Latarjet 3 to 5 o'clock (1.51 ± 0.70, P =.51) or 4 to 6 o'clock (1.55 ± 0.68, P =.52). Compared with the intact state (6.48 ± 2.24 mm), LHD decreased significantly after GBL (3.16 ± 1.56 mm, P <.001) and Latarjet 4 to 6 o'clock (5.48 ± 3.39 mm, P <.001). Displacement decreased significantly after Latarjet 3 to 5 o'clock (4.78 ± 2.50 mm, P =.04) compared with the intact state but not after Latarjet 4 to 6 o'clock (P =.71). Conclusion: The Latarjet procedure in both coracoid graft positions (3-5 and 4-6 o’clock) restored the SR to the values measured in the intact state. A more inferior graft position (fixed at 4-6 o’clock) may improve shoulder biomechanics, but additional work is needed to establish clinical relevance. Clinical Relevance: An inferior coracoid graft fixation, the 4- to 6-o’clock position, may benefit in restoring normal shoulder biomechanics after the Latarjet procedure.