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A cadaveric morphometric analysis of coracoid process with reference to the Latarjet procedure using the “congruent arc technique”

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Congruent arc Latarjet procedure involves rotating the coracoid process so that its inferior surface is flush with the glenoid face, owing to their matching radius of curvature (ROC). However, there has been no cadaveric study to actually measure and compare the ROC of coracoid with glenoid, especially in Indian population.

Materials and methods

44 shoulders were dissected in 24 cadavers to measure usable length of coracoid process, width, height, ROC of coracoid and glenoid as well as ulnar length (as proxy of cadaver height). Critical coracoid height and length were estimated based on screw sizes of 2.7 mm, 3.5 mm, 4 mm and 4.5 mm, and pair concordance between height and length calculated. ROC of coracoid and glenoid were compared to measure extent of congruency.

Results

The mean usable length of coracoid process, width and height at mid-point were 21.8 mm, 13.7 mm and 8.6 mm, respectively. Out of the different screw sizes, 2.7 mm screws were found safe in 82% shoulders. 24 coracoid–glenoid pairs fulfilled the operational definition (≤ 5 mm) of congruency while rest 20 were seemingly incongruent chiefly due to coracoid variations, with mean ROC difference 4.13 mm (95% CI 1.51–6.74 mm). The ulnar length was significantly smaller in the incongruent ROC group (p = 0.0002).

Conclusions

The available length as well as height of the transferred coracoid must be considered when deciding optimum diameter fixation screws in Latarjet procedure. Owing to smaller anatomic dimensions of coracoid in Indian population, 2.7-mm screws provide the safest fixation option. Also, the ROC of coracoid and glenoid does not match in substantial proportion of the cadavers. Pre-operative planning should include a CT-based assessment of glenoid and coracoid dimensions to decide the technique of Latarjet procedure and the optimum diameter fixation screws required.

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Funding

No financial support was provided for this study. This study was carried out at AIIMS Bhopal, India.

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Authors and Affiliations

  1. Department of Trauma and Emergency (Orthopaedics), All India Institute of Medical Sciences, Bhopal, India

    Manoj Nagar

  2. Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, India

    Vivek Tiwari

  3. Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India

    Ankur Joshi

  4. Department of Anatomy, All India Institute of Medical Sciences, Bhopal, India

    Mohtashim Ahmed & Manmohan Patel

Authors
  1. Manoj Nagar
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  2. Vivek Tiwari
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  3. Ankur Joshi
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Correspondence to Vivek Tiwari.

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Conflict of interest

Manoj Nagar, Vivek Tiwari, Ankur Joshi, Mohtashim Ahmed and Manmohan Patel declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (include name of committee + reference number) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Institutional Human Ethics Committee, AIIMS Bhopal Study Number: IM0174.

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Nagar, M., Tiwari, V., Joshi, A. et al. A cadaveric morphometric analysis of coracoid process with reference to the Latarjet procedure using the “congruent arc technique”. Arch Orthop Trauma Surg 140, 1993–2001 (2020). https://doi.org/10.1007/s00402-020-03579-0

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  • DOI: https://doi.org/10.1007/s00402-020-03579-0

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