Open shoulder repair of osseous glenoid defects: biomechanical effectiveness of the Latarjet procedure versus a contoured structural bone graft.

摘要

BACKGROUND: To address glenoid bone deficiency, 2 competing surgical approaches are currently recommended: transplantation of a structural bone graft or the coracoid transfer according to Latarjet. Nonetheless, no clear advantages for either procedure are evident. HYPOTHESIS: The Latarjet procedure will provide an equivalent beneficial effect on glenohumeral stability as the placement of an intra-articular bone graft. STUDY DESIGN: Controlled laboratory study. METHODS: Stability testing of 8 cadaveric shoulders was performed in a dynamic shoulder simulator under 4 different conditions: (1) anteroinferior capsulotomy, (2) anteroinferior glenoid defect, (3) transplantation of a contoured bone graft, and (4) Latarjet procedure. Translational movement of the humeral head in response to a load of 25 N was evaluated in the anterior and anteroinferior directions. RESULTS: The Latarjet procedure significantly reduced translation by 354% relative to the glenoid defect condition at 30 degrees of abduction and by374% at 60 degrees of abduction. In comparison, the bone graft significantly reduced translation by 179% at 30 degrees of abduction and by 159% at 60 degrees of abduction. The effect of the bone graft was lowest in external rotation at 60 degrees of abduction where a decrease of translation of 133% was observed. Comparing both reconstruction techniques, the Latarjet procedure resulted in significantly less anterior and anteroinferior translation at 60 degrees of abduction. CONCLUSION: Biomechanically, the Latarjet procedure outperforms the bone graft in reducing translation in anteroinferior glenoid bone defects. The advantage of the Latarjet procedure is particularly evident at 60 degrees of glenohumeral abduction. CLINICAL RELEVANCE: On the basis of the results of this biomechanical study, the authors recommend the Latarjet procedure for restoring stability in shoulders with a significant glenoid bone defect.