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