Division of Sports Medicine, Department of Orthopaedic Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Sports Medicine Institute, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Am J Sports Med. 2023 Jul;51(8):2023-2029. doi: 10.1177/03635465231174910. Epub 2023 May 30.
The amount of glenoid width that must be restored with a Latarjet procedure in order to reestablish glenohumeral stability has not been determined.
PURPOSE/HYPOTHESIS: The purpose of this article was to determine the percentage of glenoid width restoration necessary for glenohumeral stability after Latarjet by measuring anterior humeral head translation and force distribution on the coracoid graft. The hypothesis was that at least 100% of glenoid width restoration with Latarjet would be required to maintain glenohumeral stability.
Controlled laboratory study.
Nine cadaveric shoulders were prepared and mounted on an established shoulder simulator. A lesser tuberosity osteotomy (LTO) was performed to allow accurate removal of glenoid bone. Coracoid osteotomy was performed, and the coracoid graft was sized to a depth of 10 mm. Glenoid bone was sequentially removed, and Latarjet was performed using 2 screws to reestablish 110%, 100%, 90%, and 80% of native glenoid width. The graft was passed through a subscapularis muscle split, and the LTO was repaired. A motion tracking system recorded glenohumeral translations, and force distribution was recorded using a TekScan pressure sensor secured to the glenoid face and coracoid graft. Testing conditions included native; LTO; Bankart tear; and 110%, 100%, 90%, and 80% of glenoid width restoration with Latarjet. Glenohumeral translations were recorded while applying an anteroinferior load of 44 N at 90° of humerothoracic abduction and 0° or 45° of glenohumeral external rotation. Force distribution was recorded without an anteroinferior load.
Anterior humeral head translation progressively increased as the proportion of glenoid width restored decreased. A marked increase in anterior humeral head translation was found with 90% versus 100% glenoid width restoration (10.8 ± 3.0 vs 4.1 ± 2.6 mm, respectively; < .001). Greater glenoid bone loss also led to increased force on the coracoid graft relative to the native glenoid bone after Latarjet. A pronounced increase in force on the coracoid graft was seen with 90% versus 100% glenoid width restoration ( < .001).
Anterior humeral head translation and force distribution on the coracoid graft dramatically increased when <100% of the native glenoid width was restored with a Latarjet procedure.
If a Latarjet is unable to fully restore the native glenoid width, surgeons should consider alternative graft sources to minimize the risk of recurrent instability or coracoid overload.
为了重建盂肱关节稳定性，Latarjet 手术需要恢复多少肩胛盂宽度尚未确定。
目的/假设：本文的目的是通过测量肱骨头前向位移和喙突移植物上的力分布，确定 Latarjet 术后盂肱关节稳定性所需的肩胛盂宽度恢复百分比。假设是，至少需要 Latarjet 恢复 100%的肩胛盂宽度才能维持盂肱关节稳定性。
对照实验室研究。
准备 9 具尸体肩部并安装在已建立的肩部模拟器上。进行小结节截骨术 (LTO) 以准确去除肩胛盂骨。进行喙突截骨术，并将喙突移植物切至 10mm 深。依次去除肩胛盂骨，并用 2 枚螺钉进行 Latarjet 手术，以恢复 110%、100%、90%和 80%的原生肩胛盂宽度。将移植物穿过肩胛下肌劈开处，修复 LTO。运动跟踪系统记录盂肱关节的平移，使用固定在肩胛盂面和喙突移植物上的 TekScan 压力传感器记录力分布。测试条件包括：原生；LTO；Bankart 撕裂；以及 Latarjet 恢复 110%、100%、90%和 80%的肩胛盂宽度。在肱骨头外展 90°和外旋 0°或 45°时施加 44N 的前下负荷，记录盂肱关节的前向平移。不施加前下负荷记录力分布。
随着恢复的肩胛盂宽度比例的降低，肱骨头前向位移逐渐增加。与 100%的肩胛盂宽度恢复相比，90%的肩胛盂宽度恢复时发现盂肱关节的前向位移显著增加（分别为 10.8 ± 3.0mm 和 4.1 ± 2.6mm；<.001）。更大的肩胛盂骨丢失也导致 Latarjet 后移植物上的力相对于原生肩胛盂骨增加。与 100%的肩胛盂宽度恢复相比，90%的肩胛盂宽度恢复时移植物上的力显著增加（<.001）。
当 Latarjet 手术恢复的原生肩胛盂宽度<100%时，肱骨头前向位移和移植物上的力分布显著增加。
如果 Latarjet 无法完全恢复原生肩胛盂宽度，外科医生应考虑替代移植物来源，以最大程度地降低复发性不稳定或喙突过载的风险。
