LATARJET EFFECT: IS IT REALLY RELATED TO THE CORACOID BLOCK ?

Abstract

Purpose: Surgical treatment of anterior shoulder instability relies heavily on the Latarjet procedure which uses a coracoid block fixed to the anteroinferior rim of the glenoid. The procedure is technically difficult, leading to a substantial number of intraoperative complications, block nonunions and partial lysis, and most importantly long-term scapular osteoarthritis. Nevertheless, in certain cases, complete lysis or removal of the block does not alter stability. Furthermore, the current technique requires partial section or discision of the subscapular fibres, the only healthy element which persists anteriorly. The question is thus whether the greatest stabilising effect arises from the hammock effect of the coracobiceps on the subscapular. We report our experience with a prospective series.

Material and methods: We initiated a prospective study in 1997 in a series of patients treated by simple section of the coracobiceps, leaving the acromiocoracoid, coracoid, and subscapular ligaments totally intact. We used a reinforcement ligament passing by the roatator interval and fixed on the glenoid at the Latarjet site which tied the subscapular and was fixed to it with four sutures. The assemble was then covered with the coracobiceps which was fixed to the subscapular ligament. Our prospective series included 65 patients with shoulder instability and recurrent pure anterior dislocation. All patients were reviewed at 3 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 years. A telephone interview was then made every year. Outcome was assessed with the Duplay score.

Results: The postoperative period was uneventful and time to recovery was shorter than with the traditional Latarjet procedure. There were no signs of reaction to the terephthalate polyethylene. At last follow-up the Duplay score was 23.6/25 for daily or sports activities, 23.6/25 for stability, 22.9/25 for pain, and 23.6/25 for motion giving a final score of 93.71/100.

Discussion: This technique has been particularly attractive for revision surgery. It appears that the block itself does not have a stabilising effect but that the predominant effect arises from the coracobiceps hammock. We are currently studying this technique with an arthroscopic approach which could be used to complement pure capsular techniques.