Format

Send to

Choose Destination
Orthop J Sports Med. 2017 Oct 20;5(10):2325967117734218. doi: 10.1177/2325967117734218. eCollection 2017 Oct.

Can a Drill Guide Improve the Coracoid Graft Placement During the Latarjet Procedure? A Prospective Comparative Study With the Freehand Technique.

Author information

1
Centre Ostéo-\Articulaire Cèdres, Grenoble, France.
2
Générale de Santé, Hôpital privé Jean Mermoz; Centre Orthopédique Santy, Lyon, France.
3
Clinique Générale, Annecy, France.

Abstract

Background:

One of the factors that can affect the success of the Latarjet procedure is accurate coracoid graft (CG) placement.

Hypothesis:

The use of a guide can improve placement of the CG and screw positioning in the sagittal and axial planes as compared with the classic open ("freehand") technique.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

A total of 49 patients who underwent a Latarjet procedure for the treatment of recurrent anterior shoulder instability were prospectively included; the procedure was performed with the freehand technique in 22 patients (group 1) and with use of a parallel drill guide during screw placement in 27 patients (group 2). All patients underwent a postoperative computed tomography scan with the same established protocol. The scans were used to evaluate and compare the position of the CG in the sagittal and axial planes, the direction of the screws (α angle), and overall contact of the graft with the anterior surface of the glenoid after the 2 surgical techniques.

Results:

The CG was placed >60% below the native glenoid equator in 23 patients (85.2%) in group 2, compared with 14 patients (63.6%) in group 1 (P = .004). In the axial plane, the position of the CG in group 2 patients was more accurate (85.2% and 88.9% flush) at the inferior and middle quartiles of the glenoid surface (P = .012 and .009), respectively. Moreover, with the freehand technique (group 1), the graft was in a more lateral position in the inferior and middle quartiles (P = .012 and .009, respectively). No differences were found between groups 1 and 2 regarding the mean α angle of the superior (9° ± 4.14° vs 11° ± 6.3°, P = .232) and inferior (9.5° ± 6° vs 10° ± 7.5°, P = .629) screws. However, the mean contact angle (angle between the posterior coracoid and the anterior glenoid surface) with the freehand technique (3.8° ± 6.8°) was better than that of the guide (8.55° ± 8°) (P = .05).

Conclusion:

Compared with the classic freehand operative technique, the parallel drill guide can ensure more accurate placement of the CG in the axial and sagittal planes, although with inferior bone contact.

KEYWORDS:

Latarjet; coracoid graft position; parallel drill guide; shoulder instability

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: J.B. is a consultant for Arthrex. L.N. is a consultant for Arthrex and Wright Medical and receives royalties from Wright Medical. L.L. receives royalties from DePuy Mitek/Synthes. G.W. is a consultant for and receives royalties from Wright Medical and receives equity from Imascap.

Supplemental Content

Full text links

Icon for PubMed Central
Loading ...
Support Center