Distal Clavicle Autograft Versus Traditional and Congruent Arc Latarjet Procedures: A Comparison of Surface Area and Glenoid Apposition With 3-Dimensional Computed Tomography and 3-Dimensional Magnetic Resonance Imaging

Abstract

Background:

Limited studies have compared graft-glenoid apposition and glenoid augmentation area between the Latarjet procedure and distal clavicle graft in glenohumeral stabilization. Additionally, preoperative planning is typically performed using computed tomography (CT), and few studies have used 3-dimensional (3D) magnetic resonance imaging (MRI) reformations to assess graft dimensions.

Purpose:

The purpose of this study was 2-fold: (1) to compare bony apposition, glenoid augmentation, and graft width among coracoid and distal clavicle bony augmentation techniques and (2) to determine the viability of 3D MRI to assess bone graft dimensions.

Study Design:

Controlled laboratory study.

Methods:

A total of 24 patients with recurrent glenohumeral instability and bone loss were included in this study. 3D CT and 3D MRI reformations were utilized to measure pertinent dimensions for 5 orientations of coracoid and distal clavicle autografts: (1) standard Latarjet procedure (SLJ), (2) congruent arc Latarjet procedure (CLJ), (3) distal clavicle attached by its posterior surface (DCP), (4) distal clavicle attached by its inferior surface (DCI), and (5) distal clavicle attached by its resected end (DCR). Glenoid augmentation was defined as the graft surface area contributing to the glenoid. Bone-on-bone apposition was defined as the graft-glenoid contact area for bone healing potential, and graft width was pertinent for fixation technique. Glenoid bone loss ranged from 0% to 34%. Paired t tests were used to compare graft sizes between patients and compare 3D CT versus 3D MRI measurements.

Results:

The CLJ had the largest graft surface area (mean, 318.41 ± 74.44 mm²), while the SLJ displayed the most bone-on-bone apposition (mean, 318.41 ± 74.44 mm²). The DCI had the largest graft width (mean, 20.62 ± 3.93 mm). Paired t tests revealed no significant differences between the Latarjet techniques, whereas distal clavicle grafts varied significantly with orientation. All 3D CT and 3D MRI measurements were within 1 mm of each other, and only 2 demonstrated a statistically significant difference (coracoid width: 13.03 vs 13.98 mm, respectively [P = .010]; distal clavicle thickness: 9.69 vs 10.77 mm, respectively [P = .002]). 3D CT and 3D MRI measurements demonstrated a strong positive correlation (r > 0.6 and P < .001 for all dimensions).

Conclusion:

Glenoid augmentation, bony apposition, and graft width varied with coracoid or distal clavicle graft type and orientation. Differences between 3D CT and 3D MRI were small and likely not clinically significant.

Clinical Relevance:

3D MRI is a viable method for preoperative planning and graft selection in glenoid bone loss.

Keywords

shoulder instability autograft distal clavicle Latarjet 3D MRI 3D CT

Get full access to this article

View all access options for this article.

References

Armitage

Elkinson

Giles

Athwal

. An anatomic, computed tomographic assessment of the coracoid process with special reference to the congruent-arc Latarjet procedure. Arthroscopy. 2011;27(11):1485-1489.

Arner

Ruzbarsky

Midtgaard

, et al. Defining critical glenoid bone loss in posterior shoulder capsulolabral repair. Am J Sports Med. 2021;49(8):2013-2019.

Avramidis

Kokkineli

Trellopoulos

, et al. Excellent clinical and radiological midterm outcomes for the management of recurrent anterior shoulder instability by all-arthroscopic modified Eden-Hybinette procedure using iliac crest autograft and double-pair button fixation system: 3-year clinical case series with no loss to follow-up. Arthroscopy. 2021;37(3):795-803.

Baudi

Rebuzzi

Matino

Catani

. Imaging of the unstable shoulder. Open Orthop J. 2017;11:882-896.

Calvo

Itoi

Landreau

, et al. Anterior and posterior glenoid bone augmentation options for shoulder instability: state of the art. J ISAKOS. 2021;6(5):308-317.

Cohen

. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. L. Erlbaum Associates; 1988.

Domos

Lunini

Walch

. Contraindications and complications of the Latarjet procedure. Shoulder Elbow. 2018;10(1):15-24.

Dumont

Vopat

Parada

, et al. Traditional versus congruent arc Latarjet technique: effect on surface area for union and bone width surrounding screws. Arthroscopy. 2017;33(5):946-952.

Gyftopoulos

Yemin

Mulholland

, et al. 3DMR osseous reconstructions of the shoulder using a gradient-echo based two-point Dixon reconstruction: a feasibility study. Skeletal Radiol. 2013;42(3):347-352.

10.

Hudson

Pinto

Brabston

, et al. Distal clavicle autograft for anterior-inferior glenoid augmentation: a comparative cadaveric anatomic study. Shoulder Elbow. 2020;12(6):404-413.

11.

Kwapisz

Fitzpatrick

Cook

Athwal

Tokish

. Distal clavicular osteochondral autograft augmentation for glenoid bone loss: a comparison of radius of restoration versus Latarjet graft. Am J Sports Med. 2018;46(5):1046-1052.

12.

Lamplot

Brusalis

Apostolakos

, et al. Computed tomography-based preoperative planning provides a pathology and morphology-specific approach to glenohumeral instability with bone loss. Arthroscopy. 2021;37(6):1757-1766.e2.

13.

Larouche

Knowles

Ferreira

Tokish

Athwal

. Osteoarticular distal clavicle autograft for the management of instability-related glenoid bone loss: an anatomic and cadaveric study. J Shoulder Elbow Surg. 2020;29(8):1615-1620.

14.

Lau

Hutyra

Gonzalez

, et al. Surgical treatment for recurrent shoulder instability: factors influencing surgeon decision making. J Shoulder Elbow Surg. 2021;30(3):e85-e102.

15.

Burkhart

Parten

. Surgery about the coracoid: neurovascular structures at risk. Arthroscopy. 2004;20(6):591-595.

16.

Longo

Loppini

Rizzello

, et al. Latarjet, Bristow, and Eden-Hybinette procedures for anterior shoulder dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy. 2014;30(9):1184-1211.

17.

Mengers

SRP

Knapik

Kaufman

, et al. Clinical outcomes of the traditional Latarjet versus the congruent arc modification for the treatment of recurrent anterior shoulder instability: a meta-analysis. Orthop J Sports Med. 2021;9(10):23259671211030204.

18.

Noonan

Hollister

Sekiya

Bedi

. Comparison of reconstructive procedures for glenoid bone loss associated with recurrent anterior shoulder instability. J Shoulder Elbow Surg. 2014;23(8):1113-1119.

19.

Petersen

Bernard

Langdale

Belkoff

. Autologous distal clavicle versus autologous coracoid bone grafts for restoration of anterior-inferior glenoid bone loss: a biomechanical comparison. J Shoulder Elbow Surg. 2016;25(6):960-966.

20.

Rossi

Tanoira

De Cicco

Ranalletta

. Traditional versus congruent-arc Latarjet anatomic and biomechanical perspective. EFORT Open Rev. 2021;6(4):280-287.

21.

Saccomanno

Ieso

CDE

Milano

. Acromioclavicular joint instability: anatomy, biomechanics and evaluation. Joints. 2014;2(2):87-92.

22.

Schmid

Farshad

Catanzaro

Gerber

. The Latarjet procedure for the treatment of recurrence of anterior instability of the shoulder after operative repair: a retrospective case series of forty-nine consecutive patients. J Bone Joint Surg Am. 2012;94(11):e75.

23.

Shaha

Cook

Song

, et al. Redefining “critical” bone loss in shoulder instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med. 2015;43(7):1719-1725.

24.

Stillwater

Koenig

Maycher

Davidson

3D-MR

. 3D-CT of the shoulder in patients with glenohumeral instability. Skeletal Radiol. 2017;46(3):325-331.

25.

Taylor

Schrumpf

Shea

Kelly

2nd . Distal clavicle autograft augmentation for glenoid bone loss in revision shoulder arthroplasty: results and technique. J Shoulder Elbow Surg. 2020;29(10):e386-e393.

26.

Tokish

Fitzpatrick

Cook

Mallon

. Arthroscopic distal clavicular autograft for treating shoulder instability with glenoid bone loss. Arthrosc Tech. 2014;3(4):e475-481.

27.

Vezeridis

. Editorial commentary. Arthroscopic shoulder instability surgery and glenoid bone loss: a paradigm shift? Arthroscopy. 2021;37(3):804-805.

28.

Weber

Bolia

Horn

, et al. Glenoid bone loss in shoulder instability: superiority of three-dimensional computed tomography over two-dimensional magnetic resonance imaging using established methodology. Clin Orthop Surg. 2021;13(2):223-228.

29.

Wong

King

Boyd

Mitchell

Coady

. Radiographic analysis of glenoid size and shape after arthroscopic coracoid autograft versus distal tibial allograft in the treatment of anterior shoulder instability. Am J Sports Med. 2018;46(11):2717-2724.

30.

Zhu

Jiang

. Coracoid bone graft resorption after Latarjet procedure is underestimated: a new classification system and a clinical review with computed tomography evaluation. J Shoulder Elbow Surg. 2015;24(11):1782-1788.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.12 MB