Division of Sports Medicine, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A.
Sports Medicine Institute, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A.
Arthroscopy. 2021 Jun;37(6):1757-1766.e2. doi: 10.1016/j.arthro.2021.01.021. Epub 2021 Jan 27.
To use computed tomography (CT) to determine a reproducible method of coracoid measurement to compare the ability of the classic Latarjet technique and the congruent arc modification (CAM) to restore native glenoid diameter and to develop a preoperative planning algorithm for glenoid restoration with a goal of achieving an on-track shoulder.
Coracoid dimensions were measured on multiplanar reconstructed shoulder CT scans of patients aged 18 to 45 years obtained between December 1, 2019, and March 13, 2020. Patients were excluded if CT demonstrated osteophyte formation, glenoid dysplasia, coracoid fracture, or tumor. The proportion of glenoid diameter able to be restored using classic Latarjet technique and CAM were calculated. A treatment algorithm was proposed considering the amount of bone loss present and coracoid dimensions.
Coracoid dimensions of 117 consecutive patients were measured and varied considerably (length: 17.5-31.8 mm, width: 9.1-20.5 mm, thickness: 6.1-15.7 mm). While most patients had harvestable coracoid length ≥20 mm (male: 96.3% vs female: 94.4%, P = .65), only 27.8% of female patients had coracoid thickness ≥10 mm. When comparing Latarjet techniques, there was no difference in the proportion of patients in whom 30% glenoid diameter could be fully restored, but CAM was able to restore at least 35% in more male and female patients (98.8% vs 79.0% and 100% vs 61.1%, respectively, P = .00001). Intra- and inter-rater reliability was excellent ( intraclass correlation coefficient ≥0.950 for all dimensions).
We describe a reliable method of measuring coracoid dimensions for preoperative planning of glenoid restoration. The classic Latarjet technique reliably restores the glenoid anteroposterior diameter with bone loss of up to 30%. The majority of female patients have coracoid thickness <10 mm, which may increase the risk of graft fracture when using CAM. The decision to use the classic Latarjet technique or CAM considers each individual's glenoid and coracoid dimensions with a goal of achieving an on-track shoulder.
Our reliable method of coracoid measurement demonstrated the differing abilities of the classic Latarjet and CAM to restore the native glenoid diameter. An evidence-based algorithm using these measurements was developed to assist in preoperative planning for glenohumeral instability in the setting of bone loss, with a goal of achieving an on-track shoulder. Alternative techniques may be considered if an on-track shoulder cannot be achieved with Latarjet.
利用计算机断层扫描（CT）确定一种可重复的喙突测量方法，比较经典的 Latarjet 技术和一致弧形改良（CAM）修复技术恢复原生肩盂直径的能力，并开发一种术前规划算法，以实现理想的肩盂复位。
在 2019 年 12 月 1 日至 2020 年 3 月 13 日期间，对 18 至 45 岁的患者进行多平面重建的肩部 CT 扫描，以测量喙突的尺寸。如果 CT 显示骨赘形成、肩盂发育不良、喙突骨折或肿瘤，则排除患者。计算使用经典 Latarjet 技术和 CAM 能够修复的肩盂直径比例。根据存在的骨质丢失量和喙突尺寸提出了一种治疗算法。
测量了 117 例连续患者的喙突尺寸，差异较大（长度：17.5-31.8mm，宽度：9.1-20.5mm，厚度：6.1-15.7mm）。尽管大多数男性患者（96.3%）和女性患者（94.4%）都有可采集的长度≥20mm 的喙突（P=0.65），但只有 27.8%的女性患者喙突厚度≥10mm。在比较 Latarjet 技术时，两种技术修复 30%肩盂直径的患者比例没有差异，但 CAM 技术能使更多的男性和女性患者的肩盂至少恢复 35%（98.8%比 79.0%和 100%比 61.1%，P=0.00001）。组内和组间的可靠性都很好（所有尺寸的组内相关系数≥0.950）。
我们描述了一种可靠的方法，用于测量喙突尺寸，以便在术前规划肩盂修复。经典的 Latarjet 技术可以可靠地恢复肩盂前后直径，骨质丢失可达 30%。大多数女性患者的喙突厚度<10mm，这可能会增加使用 CAM 时移植物骨折的风险。经典 Latarjet 技术或 CAM 的选择取决于每位患者的肩盂和喙突尺寸，以实现理想的肩部复位。
我们可靠的喙突测量方法显示了经典 Latarjet 和 CAM 修复技术恢复原生肩盂直径的不同能力。根据这些测量值开发了一种基于证据的算法，以协助在骨丢失的情况下进行肩锁关节不稳定的术前规划，目标是实现理想的肩锁关节复位。如果不能通过 Latarjet 实现理想的肩锁关节复位，可以考虑使用其他技术。
