Open Shoulder Repair of Osseous Glenoid Defects: Biomechanical Effectiveness of the Latarjet Procedure Versus a Contoured Structural Bone Graft

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Abstract

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° of abduction and by 374% at 60° of abduction. In comparison, the bone graft significantly reduced translation by 179% at 30° of abduction and by 159% at 60° of abduction. The effect of the bone graft was lowest in external rotation at 60° 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° 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° 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.

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