The Pectoralis Minor–Repairing Latarjet: A Modified Technique to Prevent Postoperative Scapular Dyskinesis After the Latarjet Procedure

Abstract

Background:

Latarjet is the gold standard procedure for treating anterior shoulder instability associated with significant bone loss. However, concerns arise regarding associated anatomic and mechanical changes, including release of the pectoralis minor tendon and alteration of the conjoint tendon vector. Recent studies have investigated alterations in scapular position and motion after Latarjet, with conflicting findings.

Purpose:

To evaluate the clinical outcomes and scapular position and motion in patients treated with the pectoralis minor–repairing Latarjet (PMRL) compared with traditional Latarjet (TL) after midterm follow-up.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

A case-control study included 41 consecutive patients (27 men and 14 women; mean age, 37.4 years; mean body mass index, 26.4) with anterior recurrent shoulder instability. Patients underwent TL (21 patients) or PMRL (20 patients). Clinical evaluation, including Western Ontario Shoulder Instability Index (WOSI), Rowe score, and Subjective Shoulder Value (SSV), was performed preoperatively and at various postoperative intervals. Scapular position and motion were assessed using established protocols. Statistical analyses were conducted.

Results:

The mean follow-up was 34 months. No significant differences were observed in surgical time, clinical scores, or patient satisfaction between groups. Recurrence of dislocation occurred in 1 TL patient and persistent apprehension in 1 PMRL patient. Postoperative hematoma occurred in 1 TL patient. The rate of return to preoperative sport activity for the TL and PMRL groups was 93% and 95%, respectively (P > .05). Scapular dyskinesis occurred in 5 TL patients (25%) and 0 PMRL patients; in all cases, a type III dyskinesis was present. Four of 5 cases resolved with 6 months of a specific rehabilitation protocol. A significance difference was found between patients with and without dyskinesis, according to the WOSI, Rowe score, and SSV (P < .05). Scapular malposition was observed in 2 TL patients with dyskinesis.

Conclusion:

The study confirmed that postoperative scapular dyskinesis occurred frequently (25%) after the Latarjet procedure. A simple modification of the original technique, which consists of repairing the pectoralis minor to the coracoid stump, prevented the risk of postoperative dyskinesis, maintaining the stabilizing benefits of the TL procedure.