Do the Traditional and Modified Latarjet Techniques Produce Equivalent Reconstruction Stability and Strength?

Abstract

Background:

The Latarjet procedure has been described as a reconstructive option for instability associated with substantial glenoid bone defects. A modification, termed the Congruent-Arc, is thought to improve glenoid reconstruction through better articular congruency and greater bone reconstitution. The strengths of these techniques, however, have not been reported.

Purpose/Hypothesis:

To compare the fixation stability, strength, glenoid vault load transfer, and joint contact between the Classic and Congruent-Arc techniques. The authors hypothesized that the Classic Latarjet would exhibit inferior joint contact characteristics while having greater stability and strength and more normal glenoid vault strain.

Study Design:

Controlled laboratory study.

Methods:

Sixteen shoulder specimens (8 pairs) were tested by loading the glenohumeral joint with the glenoid intact, following creation of a 25% anterior bone defect, and after random assignment to the Classic or Congruent-Arc Latarjet techniques. Specimens were mounted to a testing apparatus that allowed concentric, centralized loading and loading 30° anterior on the glenoid rim. Cyclic loading (100 cycles at 1 Hz) was applied with a staircase protocol (50, 100, 150, and 200 N). Graft interface displacement and glenoid load transfer, quantified in terms of strain, were recorded during loading. Contact was quantified during 50-N loading using a thin pressure sensor. After cyclic loading, specimens were loaded to failure, defined as 5 mm of graft interface displacement.

Results:

The 30° loading ≥100 N resulted in significantly greater graft displacement (P < .004) in the Congruent-Arc group as compared with the Classic (mean displacement range, 0.9-2.6 vs 0.1-0.5 mm, respectively). Failure testing yielded a significantly (P = .010) greater ultimate strength for the Classic (557 N) as compared with the Congruent-Arc (392 N). Load-transfer measurements demonstrated that neither technique’s glenoid vault strain values significantly differed from intact (P ≥ .076). Both techniques resulted in contact areas significantly less than intact (P < .035); however, the Congruent-Arc trended toward better contact characteristics (P = .074).

Conclusion:

The Congruent-Arc results in significantly poorer fixation stability as compared with the Classic technique but did more closely reproduce intact joint contact, which may yield more favorable long-term outcomes.

Clinical Relevance:

Care must be taken in balancing the consideration of initial fixation stability and joint contact for the Congruent-Arc and Classic Latarjet, as these factors have opposing implications for each of the 2 reconstructions’ outcomes.