Boden Stephanie A, Godshaw Brian M, Hughes Jonathan D, Musahl Volker, Lin Albert, Lesniak Bryson P
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Ochsner Sports Medicine Institute, New Orleans, LA, USA.
JSES Int. 2024 Jun 1;9(1):1-5. doi: 10.1016/j.jseint.2024.05.012. eCollection 2025 Jan.
Glenoid bone grafting procedures are often utilized to address glenoid bone loss in patients with recurrent shoulder instability. The purpose of this study was to determine if preoperative advanced imaging can accurately predict coracoid graft size and conversion of off-track to on-track Hill-Sachs lesions in patients undergoing Latarjet procedures.
Patients who underwent Latarjet procedure for shoulder instability at a single institution from 2012 to 2020 with preoperative and postoperative advanced shoulder imaging (computerized tomography or magnetic resonance imaging scans) were retrospectively reviewed. Glenoid diameter, Hill-Sachs interval (HSI), and measurements of the coracoid length, depth, and height were measured on preoperative imaging. Glenoid track (GT), percent glenoid bone loss, predicted restoration of GT, and the difference between HSI and GT (ΔHSI-GT) were calculated.
Seventeen patients with a mean age of 25 ± 9 years met inclusion criteria. Average glenoid bone loss preoperatively was 24 ± 7% and average HSI was 27 ± 5mm. The Latarjet procedure reconstructed 116 ± 8% of the native glenoid, and 104 ± 8% of the predicted diameter. Of the 15 patients that had off-track lesions preoperatively, 11 were successfully converted to on-track lesions (73%). The 4 persistent off-track lesions had a significantly higher HSI (32 ± 2 mm vs. 26 ± 4 mm, = .002). Preoperative measurements accurately predicted postoperative GT status in 94% of cases. At a mean follow-up of 2 years, there was no significant difference in recurrence rate or rate of revision stabilization procedures between patients with on-track versus persistent off-track humeral lesions.
Preoperative advanced imaging measurements can accurately predict whether an off-track Hill-Sachs can be converted to on-track after Latarjet procedure, further enhancing shoulder stability.
盂骨移植手术常用于治疗复发性肩关节不稳患者的盂骨缺损。本研究的目的是确定术前的先进影像学检查能否准确预测接受Latarjet手术患者的喙突移植骨大小以及非轨迹性Hill-Sachs损伤向轨迹性损伤的转变。
回顾性分析2012年至2020年在单一机构接受Latarjet手术治疗肩关节不稳且术前行肩关节先进影像学检查（计算机断层扫描或磁共振成像扫描）的患者。在术前影像学检查上测量盂骨直径、Hill-Sachs间距（HSI）以及喙突长度、深度和高度。计算盂骨轨迹（GT）、盂骨骨缺损百分比、预测的GT恢复情况以及HSI与GT之间的差值（ΔHSI-GT）。
17例平均年龄为25±9岁的患者符合纳入标准。术前平均盂骨骨缺损为24±7%，平均HSI为27±5mm。Latarjet手术重建了116±8%的天然盂骨以及104±8%的预测直径。术前有15例非轨迹性损伤患者，其中11例成功转变为轨迹性损伤（73%）。4例持续性非轨迹性损伤患者的HSI显著更高（32±2mm对26±4mm，P = 0.002）。术前测量在94%的病例中准确预测了术后GT状态。平均随访2年时，轨迹性与持续性非轨迹性肱骨损伤患者之间的复发率或翻修稳定手术率无显著差异。
术前先进影像学测量能够准确预测Latarjet手术后非轨迹性Hill-Sachs损伤能否转变为轨迹性损伤，进一步增强肩关节稳定性。
