Arthroscopic Latarjet procedure: is optimal positioning of the bone block and screws possible? A prospective computed tomography scan analysis

Abstract

Hypothesis: We hypothesized that the arthroscopic Latarjet procedure could be performed with accurate bone block positioning and screw fixation with a similar rate of complications to the open Latarjet procedure.

Methods: In this prospective study, 105 shoulders (104 patients) underwent the arthroscopic Latarjet procedure performed by the same senior surgeon. The day after surgery, an independent surgeon examiner performed a multiplanar bidimensional computed tomography scan analysis. We also evaluated our learning curve by comparing 2 chronologic periods (30 procedures performed in each period), separated by an interval during which 45 procedures were performed.

Results: Of the 105 shoulders included in the study, 95 (90.5%) (94 patients) were evaluated. The coracoid graft was accurately positioned relative to the equator of the glenoid surface in 87 of 95 shoulders (91.5%). Accurate bone-block positioning on the axial view with "circle" evaluation was obtained for 77 of 95 shoulders (81%). This procedure was performed in a lateralized position in 7 of 95 shoulders (7.3%) and in a medialized position in 11 shoulders (11.6%). The mean screw angulation with the glenoid surface was 21°. One patient had transient axillary nerve palsy. Of the initial 104 patients, 3 (2.8%) underwent revision. The analysis of our results indicated that the screw-glenoid surface angle significantly predicted the accuracy of the bone-block positioning (P = .001). Our learning curve estimates showed that, compared with our initial period, the average surgical time decreased, and the risk of lateralization showed a statistically significant decrease during the last period (P = .006).

Conclusions: This study showed that accurate positioning of the bone block onto the anterior aspect of the glenoid is possible, safe, and reproducible with the arthroscopic Latarjet procedure without additional complications compared with open surgery.

Keywords: Arthroscopic Latarjet; CT scan analysis; bone block; shoulder instability.