Clinical and Anatomic Predictors of Outcomes After the Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Combined Glenoid and Humeral Bone Defects

Authors:

William R Mook, Maximilian Petri, Joshua A Greenspoon, Marilee P Horan, Grant J Dornan, Peter J Millett

Abstract:

When anterior shoulder instability persists after initial surgical repair, one should evaluate glenoid and humeral bony loss in addition to the potential failure of soft tissue structures from the index stabilization procedure. The importance of identifying6 and quantifying glenoid bone loss has been demonstrated in the evaluation and treatment of patients with recurrent anterior shoulder instability. Humeral defects (Hill-Sachs lesions) and their location also may play a role in persistent glenohumeral instability. Current surgical techniques can be divided into 4 nonmutually exclusive categories: (1) open or arthroscopic anteroinferior capsulolabral repairs with or without capsular shift, (2) anatomic versus nonanatomic bony augmentation procedures guided by the size of the glenoid and/or humeral bone deficit, (3) posterior capsulodesis and rotator cuff tenodesis procedures of the Hill-Sachs lesion (remplissage), and/or (4) partial or total prosthetic arthroplasty options for the treatment of bony defects less amenable to biological reconstruction.

Burkhart and De Beer6 found an unacceptable high failure rate of arthroscopic repair in patients with bone defects involving greater than 25% of the glenoid face width. They emphasized the importance of identifying the defect and tailoring the surgical procedure to the known deficit. Since their initial report, increased awareness of osseous deficits of the glenoid has led to numerous reports of favorable short- to long-term outcomes after coracoid transfer procedures, including the Latarjet procedure, in patients with anteroinferior glenoid bone deficits. Furthermore, because objective radiographic quantification of humeral-sided bony lesions has not been easily translated into clinical practice and the importance of these lesions has not been reproducibly demonstrated, humeral-sided Hill-Sachs lesions have largely been ignored. The importance of the medial extension of a Hill-Sachs lesion as it relates to its size, as opposed to strict quantification of the volume of a Hill-Sachs lesion, has been described by Yamamoto and colleagues32 with the concept of the ‘‘glenoid track.’’ The glenoid track concept estimates the likelihood of engagement between the injured glenoid and the articular contact area of the humeral head, or Hill-Sachs interval (HSI), when the arm is in an abducted and externally rotated position.

Additionally, several authors have described anatomic variations of the coracoid among the general population to help guide surgical decision making regarding the use of the coracoid as a local bone graft, as opposed to alternative grafting options. Combined quantification of the anatomy of the coracoid, glenoid, and Hill-Sachs lesion has also yet to be correlated with the outcomes of the Latarjet procedure. Anatomic variables such as the size of the conjoined tendon, thickness of the subscapularis tendon, size and location of the Hill-Sachs lesion, and size of the postoperative glenoid track may also be important in the success of the Latarjet procedure.

The goals of our study were 3-fold: (1) to quantify the local osseous and soft tissue anatomy of patients undergoing the Latarjet procedure relative to their bipolar bone loss, (2) to evaluate the diagnostic reproducibility and prognostic utility of these radiological measurements, and (3) to correlate preoperative patient characteristics with the outcomes of the open Latarjet procedure. We hypothesized that there are anatomic variations in the local anatomy and preoperative patient characteristics that are predictive of postoperative stability and patient-reported subjective outcomes.

For the complete study: Clinical and Anatomic Predictors of Outcomes After the Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Combined Glenoid and Humeral Bone Defects

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Clinical and Anatomic Predictors of Outcomes After the Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Combined Glenoid and Humeral Bone Defects

Authors:

Abstract:

About the Author: Peter Millett, MD