Anatomical study of the limited osteotomy suture button fixation Latarjet procedure with coracoacromial ligament preservation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIANG Xinzhi ^1,2,3 , LIANG Daqiang ¹ ^△ , WU Bing ¹ , LI Jintao ^2,3 , LI Hao ¹ ,  LU Wei ^1,2 ,  XIE Denghui ^2,3 ,  LIU Haifeng ¹

1. Department of Sports Medicine, the Second People’s Hospital of Shenzhen, the First Affiliated Hospital of Shenzhen University, Shenzhen Guangdong, 518025, P. R. China;
2. Department of Orthopedics 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;

Corresponding author：

LU Wei, Email: 4415147@qq.com; XIE Denghui, Email: 13802408767@163.com; LIU Haifeng, Email: 819811255@qq.com

Keywords：

Suture button fixation Latarjet procedure; coracoacromial ligament; glenoid; limited osteotomy; applied anatomy

DOI：

10.7507/1002-1892.202403123

Video：

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Objective To investigate the morphological characteristics of the glenohumeral joint (including the glenoid and coracoid) in the Chinese population and determine the feasibility of designing coracoid osteotomy based on the preoperative glenoid defect arc length by constructing glenoid defect models and simulating suture button fixation Latarjet procedure. Methods Twelve shoulder joint specimens from 6 adult cadavers donated voluntarily were harvested. First, whether the coracoacromial ligament and conjoint tendon connected was anatomically observed and their intersection point was identified. The vertical distance from the intersection point to the coracoid, the maximum allowable osteotomy length starting from the intersection point, and the maximum osteotomy angle were measured. Next, the anteroinferior glenoid defect models of different degrees were randomly constructed. The arc length and area of the glenoid defect were measured. Based on the arc length of the glenoid defect of the model, the size of coracoid oblique osteotomy was designed and the actual length and angle of the coracoid osteotomy were measured. A limited osteotomy suture button fixation Latarjet procedure with the coracoacromial ligament and pectoralis minor preservation was performed and the position of coracoid block was observed. Results All shoulder joint specimens exhibited crossing fibers between the coracoacromial ligament and the conjoint tendon. The vertical distance from the tip of the coracoid to the coracoid return point was 24.8-32.2 mm (mean, 28.5 mm). The maximum allowable osteotomy length starting from the intersection point was 26.7-36.9 mm (mean, 32.0 mm). The maximum osteotomy angle was 58.8°-71.9° (mean, 63.5°). Based on the anteroinferior glenoid defect model, the arc length of the glenoid defect was 22.6-29.4 mm (mean, 26.0 mm); the ratio of glenoid defect was 20.8%-26.2% (mean, 23.7%). Based on the coracoid block, the length of the coracoid osteotomy was 23.5-31.4 mm (mean, 26.4 mm); the osteotomy angle was 51.3°-69.2° (mean, 57.1°). There was no significant difference between the arc length of the glenoid defect and the length of the coracoid osteotomy (P>0.05). After simulating the suture button fixation Latarjet procedure, the highest points of the coracoid block (suture loop fixation position) in all models located below the optimal center point, with the bone block concentrated in the anteroinferior glenoid defect position. Conclusion The size of the coracoid is generally sufficient to meet the needs of repairing larger glenoid defects. The oblique osteotomy with preserving the coracoacromial ligament may potentially replace the traditional Latarjet osteotomy method.

Citation： LIANG Xinzhi, LIANG Daqiang, WU Bing, LI Jintao, LI Hao, LU Wei, XIE Denghui, LIU Haifeng. Anatomical study of the limited osteotomy suture button fixation Latarjet procedure with coracoacromial ligament preservation. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(6): 691-695. doi: 10.7507/1002-1892.202403123 Copy

1.	Latarjet M. Treatment of recurrent dislocation of the shoulder. Lyon Chir, 1954, 49(8): 994-997.
2.	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.
3.	Hockman DE, Lucas GL, Roth CA. Role of the coracoacromial ligament as restraint after shoulder hemiarthroplasty. Clin Orthop Relat Res, 2004(419): 80-82.
4.	梁新枝, 梁达强, 丘志河, 等. 改良关节镜下Latarjet术中劈裂肩胛下肌方法: 基于腋神经、关节盂及肩胛下肌的解剖学研究. 中国修复重建外科杂志, 2023, 37(5): 556-560.
5.	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.
6.	Deng Z, Long Z, Lu W. LUtarjet-limit unique coracoid osteotomy Latarjet (with video). Burns Trauma, 2022, 10: tkac021. doi: 10.1093/burnst/tkac021.
7.	Boden RA, Burgess E, Enion D, et al. Use of bioabsorbable knotless suture anchors and associated accelerated shoulder arthropathy: report of 3 cases. Am J Sports Med, 2009, 37(7): 1429-1433.
8.	Boileau P, Duysens C, Saliken D, et al. All-arthroscopic, guided Eden-Hybbinette procedure using suture-button fixation for revision of failed Latarjet. J Shoulder Elbow Surg, 2019, 28(11): e377-e388.
9.	Boileau P, Gendre P, Baba M, et al. A guided surgical approach and novel fixation method for arthroscopic Latarjet. J Shoulder Elbow Surg, 2016, 25(1): 78-89.
10.	Boileau P, Gendre P, Saliken DJ, et al. Tensioning device increases coracoid bone block healing rates in arthroscopic Latarjet procedure with suture-button fixation. J Shoulder Elbow Surg, 2022, 31(7): 1451-1462.
11.	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.
12.	Domos P, Chelli M, Lunini E, et al. Clinical and radiographic outcomes of the open Latarjet procedure in skeletally immature patients. J Shoulder Elbow Surg, 2020, 29(6): 1206-1213.
13.	Joshi MA, Young AA, Balestro JC, et al. The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes. Orthop Clin North Am, 2015, 46(1): 105-111.
14.	Metais P, Clavert P, Barth J, et al. Preliminary clinical outcomes of Latarjet-Patte coracoid transfer by arthroscopy vs. open surgery: Prospective multicentre study of 390 cases. Orthop Traumatol Surg Res, 2016, 102(8S): S271-S276.
15.	Neyton L, Barth J, Nourissat G, et al. Arthroscopic Latarjet techniques: graft and fixation positioning assessed with 2-dimensional computed tomography is not equivalent with standard open technique. Arthroscopy, 2018, 34(7): 2032-2040.
16.	Cho CH, Na SS, Choi BC, et al. Complications related to Latarjet shoulder stabilization: a systematic review. Am J Sports Med, 2023, 51(1): 263-270.
17.	Hurley ET, Schwartz LB, Mojica ES, et al. Short-term complications of the Latarjet procedure: a systematic review. J Shoulder Elbow Surg, 2021, 30(7): 1693-1699.
18.	Haeni DL, Opsomer G, Sood A, et al. Three-dimensional volume measurement of coracoid graft osteolysis after arthroscopic Latarjet procedure. J Shoulder Elbow Surg, 2017, 26(3): 484-489.
19.	Kee YM, Kim JY, Kim HJ, et al. Fate of coracoid grafts after the Latarjet procedure: will be analogous to the original glenoid by remodelling. Knee Surg Sports Traumatol Arthrosc, 2018, 26(3): 926-932.
20.	Zhu YM, Jiang CY, Lu Y, et al. Coracoid bone graft resorption after Latarjet procedure is underestimated: a new classification system and a clinical review with computed tomography evaluation. J Shoulder Elbow Surg, 2015, 24(11): 1782-1788.
21.	梁新枝, 梁达强, 邓桢翰, 等. 改良线袢法Latarjet术后早期移植骨块微动的生物力学机制: 有限元分析. 中国运动医学杂志, 2021, 40(5): 372-379.

1. Latarjet M. Treatment of recurrent dislocation of the shoulder. Lyon Chir, 1954, 49(8): 994-997.
2. 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.
3. Hockman DE, Lucas GL, Roth CA. Role of the coracoacromial ligament as restraint after shoulder hemiarthroplasty. Clin Orthop Relat Res, 2004(419): 80-82.
4. 梁新枝, 梁达强, 丘志河, 等. 改良关节镜下Latarjet术中劈裂肩胛下肌方法: 基于腋神经、关节盂及肩胛下肌的解剖学研究. 中国修复重建外科杂志, 2023, 37(5): 556-560.
5. 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.
6. Deng Z, Long Z, Lu W. LUtarjet-limit unique coracoid osteotomy Latarjet (with video). Burns Trauma, 2022, 10: tkac021. doi: 10.1093/burnst/tkac021.
7. Boden RA, Burgess E, Enion D, et al. Use of bioabsorbable knotless suture anchors and associated accelerated shoulder arthropathy: report of 3 cases. Am J Sports Med, 2009, 37(7): 1429-1433.
8. Boileau P, Duysens C, Saliken D, et al. All-arthroscopic, guided Eden-Hybbinette procedure using suture-button fixation for revision of failed Latarjet. J Shoulder Elbow Surg, 2019, 28(11): e377-e388.
9. Boileau P, Gendre P, Baba M, et al. A guided surgical approach and novel fixation method for arthroscopic Latarjet. J Shoulder Elbow Surg, 2016, 25(1): 78-89.
10. Boileau P, Gendre P, Saliken DJ, et al. Tensioning device increases coracoid bone block healing rates in arthroscopic Latarjet procedure with suture-button fixation. J Shoulder Elbow Surg, 2022, 31(7): 1451-1462.
11. 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.
12. Domos P, Chelli M, Lunini E, et al. Clinical and radiographic outcomes of the open Latarjet procedure in skeletally immature patients. J Shoulder Elbow Surg, 2020, 29(6): 1206-1213.
13. Joshi MA, Young AA, Balestro JC, et al. The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes. Orthop Clin North Am, 2015, 46(1): 105-111.
14. Metais P, Clavert P, Barth J, et al. Preliminary clinical outcomes of Latarjet-Patte coracoid transfer by arthroscopy vs. open surgery: Prospective multicentre study of 390 cases. Orthop Traumatol Surg Res, 2016, 102(8S): S271-S276.
15. Neyton L, Barth J, Nourissat G, et al. Arthroscopic Latarjet techniques: graft and fixation positioning assessed with 2-dimensional computed tomography is not equivalent with standard open technique. Arthroscopy, 2018, 34(7): 2032-2040.
16. Cho CH, Na SS, Choi BC, et al. Complications related to Latarjet shoulder stabilization: a systematic review. Am J Sports Med, 2023, 51(1): 263-270.
17. Hurley ET, Schwartz LB, Mojica ES, et al. Short-term complications of the Latarjet procedure: a systematic review. J Shoulder Elbow Surg, 2021, 30(7): 1693-1699.
18. Haeni DL, Opsomer G, Sood A, et al. Three-dimensional volume measurement of coracoid graft osteolysis after arthroscopic Latarjet procedure. J Shoulder Elbow Surg, 2017, 26(3): 484-489.
19. Kee YM, Kim JY, Kim HJ, et al. Fate of coracoid grafts after the Latarjet procedure: will be analogous to the original glenoid by remodelling. Knee Surg Sports Traumatol Arthrosc, 2018, 26(3): 926-932.
20. Zhu YM, Jiang CY, Lu Y, et al. Coracoid bone graft resorption after Latarjet procedure is underestimated: a new classification system and a clinical review with computed tomography evaluation. J Shoulder Elbow Surg, 2015, 24(11): 1782-1788.
21. 梁新枝, 梁达强, 邓桢翰, 等. 改良线袢法Latarjet术后早期移植骨块微动的生物力学机制: 有限元分析. 中国运动医学杂志, 2021, 40(5): 372-379.

Chinese Journal of Reparative and Reconstructive Surgery

Anatomical study of the limited osteotomy suture button fixation Latarjet procedure with coracoacromial ligament preservation

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