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Reliability of a CT reconstruction for preoperative surgical planning in the arthroscopic Latarjet procedure

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  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The arthroscopic Latarjet procedure has provided reliable results in the treatment of anterior shoulder instability. However, this procedure remains technically challenging and is related to several complications. The morphology of the coracoid and the glenoid are inconsistent. Inadequate coracoid and glenoid preparing may lead to mismatching between their surfaces. Inadequate screws lengthening and orientation are a major concern. Too long screws can lead to suprascapular nerve injuries or hardware irritation, whereas too short screws can lead to nonunions, fibrous unions or migration of the bone block. The purpose of the study was to investigate the application of virtual surgical planning and digital technology in preoperative assessment and planning of the Latarjet procedure.

Methods

Twelve patients planned for an arthroscopic Latarjet had a CT scan evaluation with multi-two-dimensional reconstruction performed before surgery. Interobserver and intraobserver reliability were evaluated. The shape of the anterior rim of the glenoid and the undersurface of the coracoid were classified. Coracoid height was measured, respectively, at 5 mm (C1) and 10 mm (C2) from the tip of the coracoid process, corresponding to the drilling zone. Measurements of the glenoid width were then taken in the axial view at 25 % (G1) and 50 % (G2) of the glenoid height with various α angles (5°, 10°, 15°, 20°, 25°, 30°) 7 mm from the anterior glenoid rim. Shapes of the undersurface of the coracoid and the anterior rim of the glenoid were noted during the surgical procedure. Post-operative measurements included the α angle.

Results

Concerning coracoid height measurements, there was an almost perfect to substantial intra- and inter-reliability, with values ranging from ICC = 0.75–0.97. For the shape of the coracoid, concordances were, respectively, perfect (ICC = 1) and almost perfect (0.87 [0.33; 1]) for the intra- and interobserver reliabilities. Concerning the glenoid, concordance was always almost perfect for 50 % height. Concordance was almost perfect for 25 % height 15° and 30° for inter- and intraobserver, for intraobserver at 0° and 25°. All the other values were still showing moderate concordance. Shape of the coracoid analysis reproducibility was perfect for both intra- and interobserver ICC = 1. There was a total agreement (ICC = 1) between the preoperative evaluation of the shape of the glenoid and the coracoid and the intraoperative assessment.

Conclusion

The ideal and accurate preoperative planning of screwing of the coracoid graft in the arthroscopic Latarjet can be achieved in the real surgery assisted by the virtual planning. The clinical importance of this study lies in the observation that this new preoperative planning could offer a simple, effective and reproducible tool for surgeons helping them to prepare in the best possible way a technically challenging procedure usually associated with a high rate of complications

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l’Hôpital, 75013, Paris, France

    Alexandre Hardy, Philippe Loriaut, Benjamin Granger, Laurent Casabianca, Hugues Pascal-Moussellard & Antoine Gerometta

  2. Department of Radiology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l’Hôpital, 75013, Paris, France

    Ahmed Neffati & Audrey Massein

Authors
  1. Alexandre Hardy
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  2. Philippe Loriaut
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  3. Benjamin Granger
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  4. Ahmed Neffati
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  5. Audrey Massein
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  6. Laurent Casabianca
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  7. Hugues Pascal-Moussellard
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  8. Antoine Gerometta
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Correspondence to Philippe Loriaut.

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Conflict of interest

All authors of this manuscript declare that they have no conflict of interest.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Hardy, A., Loriaut, P., Granger, B. et al. Reliability of a CT reconstruction for preoperative surgical planning in the arthroscopic Latarjet procedure. Knee Surg Sports Traumatol Arthrosc 26, 40–47 (2018). https://doi.org/10.1007/s00167-016-4329-1

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  • DOI: https://doi.org/10.1007/s00167-016-4329-1

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