Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 132, Issue 3, pp 377–386 | Cite as

Biomechanical investigation of the stabilization principle of the Latarjet procedure

  • M. WellmannEmail author
  • H. de Ferrari
  • T. Smith
  • W. Petersen
  • C. H. Siebert
  • J. D. Agneskirchner
  • C. Hurschler
Arthroscopy and Sports Medicine

Abstract

Purpose

The purpose of the study was to determine the biomechanical status of the different components of the Latarjet procedure. The anterior capsule reconstruction with the transferred coracoacromial ligament (CAL) and the necessity of an intact subscapularis tendon were of particular interest. We hypothesized that the anterior capsule reconstruction will have a significant effect and that the Latarjet procedure will lose its stabilizing effect if the subscapularis tendon is torn.

Methods

Stability testing of 12 human shoulder specimens was performed. After testing of the intact joint, a combined anterior glenoid and capsule defect was set arthroscopically. Then the Latarjet procedure was performed using an open approach and tested with and without loading of the conjoint tendons (10 N). Afterwards, the specimens were distributed into two groups and the Latarjet technique was reduced stepwise: dissection of the CAL, dissection of the conjoint tendons (group A); reduction of the coracoid segment, dissection of the subscapularis tendon (group B). Biomechanical testing was performed for each condition in two positions: 60° of glenohumeral abduction with neutral rotation and with 60° of external rotation; each with a passive humerus load of 30 N in the anterior, inferior and anteroinferior direction.

Results

The Latarjet technique with load applied to the conjoint tendons significantly reduced translation compared with the defect condition for all tested positions in all directions. In group A, the CAL-dissection led to a significant increase of anterior translation (+5.0 mm, p = 0.003) and inferior translation (+7.3 mm, p = 0.025) in neutral rotation and of anterior translation in 60° of external rotation (+4.4 mm, p = 0.034). In group B, the reduction of the coracoid bone down to the coracoid tip resulted in a significant increase of only the anterior translation in abduction and 60° of external rotation (+4.5 mm, p = 0.05). In contrast, the detachment of the subscapularis tendon led to a significant increase of translation in all testing positions except the inferior direction in the neutral rotation.

Conclusions

We found the anterior capsule reconstruction to represent a significant contribution to the stabilizing effect of the Latarjet procedure, whereas a deficiency of the subscapularis tendon eliminates its effect.

Clinical relevance

We recommend to perform the Latarjet technique with an anterior capsule reconstruction (e.g. CAL transfer) and with a transfer of the coracoid bone block rather than a transposition of the coracoid tip. Furthermore, we were able to show that an intact subscapularis tendon is a necessary prerequisite for a reliable stabilization.

Keywords

Shoulder instability Glenoid defect Latarjet procedure Capsuloplasty Bone block Subscapularis tendon tear 

References

  1. 1.
    Boileau P, Mercier N, Old J (2010) Arthroscopic Bankart-Bristow-Latarjet (2B3) Procedure: How to Do It and Tricks To Make it Easier and Safe. Orthop Clin North Am 41(3):381–392PubMedCrossRefGoogle Scholar
  2. 2.
    Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Neyton L (2006) Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am 88(8):1755–1763PubMedCrossRefGoogle Scholar
  3. 3.
    Burkhart SS, De Beer JF (2000) Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 16(7):677–694PubMedCrossRefGoogle Scholar
  4. 4.
    Collin P, Rochcongar P, Thomazeau H (2007) Treatment of chronic anterior shoulder instability using a coracoid bone block (Latarjet procedure): 74 cases. Rev Chir Orthop Reparatrice Appar Mot 93(2):126–132PubMedCrossRefGoogle Scholar
  5. 5.
    Debski RE, Wong EK, Woo SL, Sakane M, Fu FH, Warner JJ (1999) In situ force distribution in the glenohumeral joint capsule during anterior-posterior loading. J Orthop Res 17(5):769–776PubMedCrossRefGoogle Scholar
  6. 6.
    Di Giacomo G, Costantini A, de GN, De VA, Lin BK, Francone M et al (2011) Coracoid graft osteolysis after the Latarjet procedure for anteroinferior shoulder instability: a computed tomography scan study of twenty-six patients. J Shoulder Elbow SurgGoogle Scholar
  7. 7.
    Ghodadra N, Gupta A, Romeo AA, Bach BR Jr, Verma N, Shewman E et al (2010) Normalization of glenohumeral articular contact pressures after Latarjet or iliac crest bone-grafting. J Bone Joint Surg Am 92(6):1478–1489PubMedCrossRefGoogle Scholar
  8. 8.
    Habermeyer P, Gleyze P, Rickert M (1999) Evolution of lesions of the labrum-ligament complex in posttraumatic anterior shoulder instability: a prospective study. J Shoulder Elbow Surg 8(1):66–74PubMedCrossRefGoogle Scholar
  9. 9.
    Hintermann B, Gachter A (1995) Arthroscopic findings after shoulder dislocation. Am J Sports Med 23(5):545–551PubMedCrossRefGoogle Scholar
  10. 10.
    Hovelius LK, Sandstrom BC, Rosmark DL, Saebo M, Sundgren KH, Malmqvist BG (2001) Long-term results with the Bankart and Bristow-Latarjet procedures: recurrent shoulder instability and arthropathy. J Shoulder Elbow Surg 10(5):445–452PubMedCrossRefGoogle Scholar
  11. 11.
    Jiang LS, Cui YM, Zhou ZD, Dai LY (2007) Stabilizing effect of the transferred conjoined tendon on shoulder stability. Knee Surg Sports Traumatol Arthrosc 15(6):800–805PubMedCrossRefGoogle Scholar
  12. 12.
    Lafosse L, Boyle S (2010) Arthroscopic Latarjet procedure. J Shoulder Elbow Surg 19(2 Suppl):2–12PubMedCrossRefGoogle Scholar
  13. 13.
    Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R, Kochhar T (2007) The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy 23(11):1242–1245PubMedGoogle Scholar
  14. 14.
    Latarjet M (1958) Technic of coracoid preglenoid arthroereisis in the treatment of recurrent dislocation of the shoulder. Lyon Chir 54(4):604–607PubMedGoogle Scholar
  15. 15.
    Loew M, Thomsen M, Rickert M, Simank HG (2001) Injury pattern in shoulder dislocation in the elderly patient. Unfallchirurg 104(2):115–118PubMedCrossRefGoogle Scholar
  16. 16.
    Mihata T, Lee Y, McGarry MH, Abe M, Lee TQ (2004) Excessive humeral external rotation results in increased shoulder laxity. Am J Sports Med 32(5):1278–1285PubMedCrossRefGoogle Scholar
  17. 17.
    Neviaser RJ, Neviaser TJ (1995) Recurrent instability of the shoulder after age 40. J Shoulder Elbow Surg 4(6):416–418PubMedCrossRefGoogle Scholar
  18. 18.
    Nourissat G, Nedellec G, O‘Sullivan NA, Debet-Mejean A, Dumontier C, Sautet A et al (2006) Mini-open arthroscopically assisted Bristow-Latarjet procedure for the treatment of patients with anterior shoulder instability: a cadaver study. Arthroscopy 22(10):1113–1118PubMedCrossRefGoogle Scholar
  19. 19.
    Saito H, Itoi E, Sugaya H, Minagawa H, Yamamoto N, Tuoheti Y (2005) Location of the glenoid defect in shoulders with recurrent anterior dislocation. Am J Sports Med 33(6):889–893PubMedCrossRefGoogle Scholar
  20. 20.
    Takase K, Yamamoto K (2005) Intraarticular lesions in traumatic anterior shoulder instability: a study based on the results of diagnostic imaging. Acta Orthop 76(6):854–857PubMedCrossRefGoogle Scholar
  21. 21.
    Tauber M, Resch H, Forstner R, Raffl M, Schauer J (2004) Reasons for failure after surgical repair of anterior shoulder instability. J Shoulder Elbow Surg 13(3):279–285PubMedCrossRefGoogle Scholar
  22. 22.
    Urayama M, Itoi E, Sashi R, Minagawa H, Sato K (2003) Capsular elongation in shoulders with recurrent anterior dislocation. Quantitative assessment with magnetic resonance arthrography. Am J Sports Med 31(1):64–67PubMedGoogle Scholar
  23. 23.
    Walch G, Boileau P (1997) Rotator cuff tears associated with anterior instability. In: Warner J, Ianotti J, Gerber C (eds) Complex and revision problems in shoulder surgery. Lippincott-Raven, Philadelphia, pp 65–70Google Scholar
  24. 24.
    Warner JJ, Deng XH, Warren RF, Torzilli PA (1992) Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint. Am J Sports Med 20(6):675–685PubMedCrossRefGoogle Scholar
  25. 25.
    Wellmann M, Petersen W, Zantop T, Herbort M, Kobbe P, Raschke MJ et al (2009) Open shoulder repair of osseous glenoid defects: biomechanical effectiveness of the Latarjet procedure versus a contoured structural bone graft. Am J Sports Med 37(1):87–94PubMedCrossRefGoogle Scholar
  26. 26.
    Yiannakopoulos CK, Mataragas E, Antonogiannakis E (2007) A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy 23(9):985–990PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • M. Wellmann
    • 1
    Email author
  • H. de Ferrari
    • 1
  • T. Smith
    • 1
  • W. Petersen
    • 1
  • C. H. Siebert
    • 1
  • J. D. Agneskirchner
    • 1
  • C. Hurschler
    • 1
  1. 1.Department of Orthopaedic SurgeryHannover Medical SchoolHannoverGermany

Personalised recommendations