Modified Latarjet splitting subscapularis muscle under arthroscopy: an anatomical study based on axillary nerve, glenoid, and subscapularis muscle_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIANG Xinzhi ^1,2,3 , LIANG Daqiang ¹ , QIU Zhihe ⁴ , LI Sheng ¹ , WU Bing ¹ , LI Hao ¹ , HUANG Gang ⁴ , LU Wei ¹ ,  XIE Denghui ^2,3 ,  LIU Haifeng ¹

1. Department of Sports Medicine, Shenzhen University First Affiliated Hospital (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518035, P. R. China;
2. Department of Orthopedic Medical Center, Joint Surgery and Sports Medicine, the Third Affiliated Hospital of Southern Medical University, Guangzhou Guangdong, 510630, P. R. China;
3. Orthopedic Hospital of Guangdong Province, Guangdong Academy of Orthopedics, Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou Guangdong, 510630, P. R. China;
4. Orthopaedic Hospital of Shenzhen Longgang, Shenzhen Guangdong, 518116, P. R. China;

Corresponding author：

XIE Denghui, Email: 13802408767@163.com; LIU Haifeng, Email: 819811255@qq.com

Keywords：

Latarjet procedure; subscapularis muscle splitting; axillary nerve; glenoid; arthroscopy

DOI：

10.7507/1002-1892.202302059

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To testify the spatial relationship between the subscapularis muscle splitting window and the axillary nerve in modified arthroscopic Latarjet procedure, which could provide anatomical basis for the modification of the subscapularis muscle splitting. Methods A total of 29 adult cadaveric shoulder specimens were dissected layer by layer, and the axillary nerve was finally confirmed to walk on the front surface of the subscapularis muscle. Keeping the shoulder joint in a neutral position, the Kirschner wire was passed through the subscapularis muscle from back to front at the 4 : 00 position of the right glenoid circle (7 : 00 position of the left glenoid circle), and the anterior exit point (point A, the point of splitting subscapularis muscle during Latarjet procedure) was recorded. The vertical and horizontal distances between point A and the axillary nerve were measured respectively. Results In the neutral position of the shoulder joint, the distance between the point A and the axillary nerve was 27.37 (19.80, 34.55) mm in the horizontal plane and 16.67 (12.85, 20.35) mm in the vertical plane. Conclusion In the neutral position of the shoulder joint, the possibility of axillary nerve injury will be relatively reduced when radiofrequency is taken from the 4 : 00 position of the right glenoid (7 : 00 position of the left glenoid circle), passing through the subscapularis muscle posteriorly and anteriorly and splitting outward.

Citation： LIANG Xinzhi, LIANG Daqiang, QIU Zhihe, LI Sheng, WU Bing, LI Hao, HUANG Gang, LU Wei, XIE Denghui, LIU Haifeng. Modified Latarjet splitting subscapularis muscle under arthroscopy: an anatomical study based on axillary nerve, glenoid, and subscapularis muscle. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(5): 556-560. doi: 10.7507/1002-1892.202302059 Copy

1.	Hurley ET, Jamal MS, Ali ZS, et al. Long-term outcomes of the Latarjet procedure for anterior shoulder instability: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg, 2019, 28(2): e33-e39.
2.	Mizuno N, Denard PJ, Raiss P, et al. Long-term results of the Latarjet procedure for anterior instability of the shoulder. J Shoulder Elbow Surg, 2014, 23(11): 1691-1699.
3.	Hovelius L, Sandström B, Sundgren K, et al. One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: study Ⅰ-clinical results. J Shoulder Elbow Surg, 2004, 13(5): 509-516.
4.	Boileau P, Mercier N, Roussanne Y, et al. Arthroscopic Bankart-Bristow-Latarjet procedure: the development and early results of a safe and reproducible technique. Arthroscopy, 2010, 26(11): 1434-1450.
5.	Lafosse L, Boyle S, Gutierrez-Aramberri M, et al. Arthroscopic latarjet procedure. Orthop Clin North Am, 2010, 41(3): 393-405.
6.	Lafosse L, Lejeune E, Bouchard A, et al. The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy, 2007, 23(11): 1242. e1-e5.
7.	Moroder P, Schulz E, Wierer G, et al. Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: a prospective randomized trial. J Shoulder Elbow Surg, 2019, 28(7): 1298-1307.
8.	Zhu Y, Jiang C, Song G. Arthroscopic versus open Latarjet in the treatment of recurrent anterior shoulder dislocation with marked glenoid bone loss: A prospective comparative study. Am J Sports Med, 2017, 45(7): 1645-1653.
9.	Hurley ET, Lim Fat D, Farrington SK, et al. Open versus arthroscopic Latarjet procedure for anterior shoulder instability: A systematic review and meta-analysis. Am J Sports Med, 2019, 47(5): 1248-1253.
10.	Horner NS, Moroz PA, Bhullar R, et al. Open versus arthroscopic Latarjet procedures for the treatment of shoulder instability: a systematic review of comparative studies. BMC Musculoskelet Disord, 2018, 19(1): 255. doi: 10.1186/s12891-018-2188-2.
11.	Woodmass JM, Wagner ER, Solberg M, et al. Latarjet procedure for the treatment of anterior glenohumeral instability. JBJS Essent Surg Tech, 2019, 9(3): e31. doi: 10.2106/JBJS.ST.18.00025.
12.	Young AA, Maia R, Berhouet J, et al. Open Latarjet procedure for management of bone loss in anterior instability of the glenohumeral joint. J Shoulder Elbow Surg, 2011, 20(2 Suppl): S61-S69.
13.	Lädermann A, Denard PJ, Arrigoni P, et al. Level of the subscapularis split during arthroscopic Latarjet. Arthroscopy, 2017, 33(12): 2120-2124.
14.	Athwal GS, Meislin R, Getz C, et al. Short-term complications of the arthroscopic Latarjet procedure: A north American experience. Arthroscopy, 2016, 32(10): 1965-1970.
15.	Domos P, Lunini E, Walch G. Contraindications and complications of the Latarjet procedure. Shoulder Elbow, 2018, 10(1): 15-24.
16.	Freehill MT, Srikumaran U, Archer KR, et al. The Latarjet coracoid process transfer procedure: alterations in the neurovascular structures. J Shoulder Elbow Surg, 2013, 22(5): 695-700.
17.	Alfaraidy M, Alraiyes T, Moatshe G, et al. Low rates of serious complications after open Latarjet procedure at short-term follow-up. J Shoulder Elbow Surg, 2023, 32(1): 41-49.
18.	Hendy BA, Padegimas EM, Kane L, et al. Early postoperative complications after Latarjet procedure: a single-institution experience over 10 years. J Shoulder Elbow Surg, 2021, 30(6): e300-e308.
19.	Yoo JC, Kim JH, Ahn JH, et al. Arthroscopic perspective of the axillary nerve in relation to the glenoid and arm position: a cadaveric study. Arthroscopy, 2007, 23(12): 1271-1277.
20.	Eakin CL, Dvirnak P, Miller CM, et al. The relationship of the axillary nerve to arthroscopically placed capsulolabral sutures. An anatomic study. Am J Sports Med, 1998, 26(4): 505-509.
21.	Gracitelli ME, Ferreira AA, Benegas E, et al. Arthroscopic Latarjet procedure: safety evaluation in cadavers. Acta Ortop Bras, 2013, 21(3): 139-143.
22.	Hawi N, Reinhold A, Suero EM, et al. The anatomic basis for the arthroscopic Latarjet procedure: A cadaveric study. Am J Sports Med, 2016, 44(2): 497-503.
23.	Xu J, Liu H, Lu W, et al. Modified arthroscopic Latarjet procedure: Suture-button fixation achieves excellent remodeling at 3-year follow-up. Am J Sports Med, 2020, 48(1): 39-47.
24.	Deng Z, Long Z, Lu W. LUtarjet-limit unique coracoid osteotomy Latarjet (With video). Burns Trauma, 2022, 10: tkac021. doi: 10.1093/burnst/tkac021.

1. Hurley ET, Jamal MS, Ali ZS, et al. Long-term outcomes of the Latarjet procedure for anterior shoulder instability: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg, 2019, 28(2): e33-e39.
2. Mizuno N, Denard PJ, Raiss P, et al. Long-term results of the Latarjet procedure for anterior instability of the shoulder. J Shoulder Elbow Surg, 2014, 23(11): 1691-1699.
3. Hovelius L, Sandström B, Sundgren K, et al. One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: study Ⅰ-clinical results. J Shoulder Elbow Surg, 2004, 13(5): 509-516.
4. Boileau P, Mercier N, Roussanne Y, et al. Arthroscopic Bankart-Bristow-Latarjet procedure: the development and early results of a safe and reproducible technique. Arthroscopy, 2010, 26(11): 1434-1450.
5. Lafosse L, Boyle S, Gutierrez-Aramberri M, et al. Arthroscopic latarjet procedure. Orthop Clin North Am, 2010, 41(3): 393-405.
6. Lafosse L, Lejeune E, Bouchard A, et al. The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy, 2007, 23(11): 1242. e1-e5.
7. Moroder P, Schulz E, Wierer G, et al. Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: a prospective randomized trial. J Shoulder Elbow Surg, 2019, 28(7): 1298-1307.
8. Zhu Y, Jiang C, Song G. Arthroscopic versus open Latarjet in the treatment of recurrent anterior shoulder dislocation with marked glenoid bone loss: A prospective comparative study. Am J Sports Med, 2017, 45(7): 1645-1653.
9. Hurley ET, Lim Fat D, Farrington SK, et al. Open versus arthroscopic Latarjet procedure for anterior shoulder instability: A systematic review and meta-analysis. Am J Sports Med, 2019, 47(5): 1248-1253.
10. Horner NS, Moroz PA, Bhullar R, et al. Open versus arthroscopic Latarjet procedures for the treatment of shoulder instability: a systematic review of comparative studies. BMC Musculoskelet Disord, 2018, 19(1): 255. doi: 10.1186/s12891-018-2188-2.
11. Woodmass JM, Wagner ER, Solberg M, et al. Latarjet procedure for the treatment of anterior glenohumeral instability. JBJS Essent Surg Tech, 2019, 9(3): e31. doi: 10.2106/JBJS.ST.18.00025.
12. Young AA, Maia R, Berhouet J, et al. Open Latarjet procedure for management of bone loss in anterior instability of the glenohumeral joint. J Shoulder Elbow Surg, 2011, 20(2 Suppl): S61-S69.
13. Lädermann A, Denard PJ, Arrigoni P, et al. Level of the subscapularis split during arthroscopic Latarjet. Arthroscopy, 2017, 33(12): 2120-2124.
14. Athwal GS, Meislin R, Getz C, et al. Short-term complications of the arthroscopic Latarjet procedure: A north American experience. Arthroscopy, 2016, 32(10): 1965-1970.
15. Domos P, Lunini E, Walch G. Contraindications and complications of the Latarjet procedure. Shoulder Elbow, 2018, 10(1): 15-24.
16. Freehill MT, Srikumaran U, Archer KR, et al. The Latarjet coracoid process transfer procedure: alterations in the neurovascular structures. J Shoulder Elbow Surg, 2013, 22(5): 695-700.
17. Alfaraidy M, Alraiyes T, Moatshe G, et al. Low rates of serious complications after open Latarjet procedure at short-term follow-up. J Shoulder Elbow Surg, 2023, 32(1): 41-49.
18. Hendy BA, Padegimas EM, Kane L, et al. Early postoperative complications after Latarjet procedure: a single-institution experience over 10 years. J Shoulder Elbow Surg, 2021, 30(6): e300-e308.
19. Yoo JC, Kim JH, Ahn JH, et al. Arthroscopic perspective of the axillary nerve in relation to the glenoid and arm position: a cadaveric study. Arthroscopy, 2007, 23(12): 1271-1277.
20. Eakin CL, Dvirnak P, Miller CM, et al. The relationship of the axillary nerve to arthroscopically placed capsulolabral sutures. An anatomic study. Am J Sports Med, 1998, 26(4): 505-509.
21. Gracitelli ME, Ferreira AA, Benegas E, et al. Arthroscopic Latarjet procedure: safety evaluation in cadavers. Acta Ortop Bras, 2013, 21(3): 139-143.
22. Hawi N, Reinhold A, Suero EM, et al. The anatomic basis for the arthroscopic Latarjet procedure: A cadaveric study. Am J Sports Med, 2016, 44(2): 497-503.
23. Xu J, Liu H, Lu W, et al. Modified arthroscopic Latarjet procedure: Suture-button fixation achieves excellent remodeling at 3-year follow-up. Am J Sports Med, 2020, 48(1): 39-47.
24. Deng Z, Long Z, Lu W. LUtarjet-limit unique coracoid osteotomy Latarjet (With video). Burns Trauma, 2022, 10: tkac021. doi: 10.1093/burnst/tkac021.

Chinese Journal of Reparative and Reconstructive Surgery

Modified Latarjet splitting subscapularis muscle under arthroscopy: an anatomical study based on axillary nerve, glenoid, and subscapularis muscle

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