Abstract
Objectives:
The Latarjet procedure is commonly used in management of anterior shoulder instability with bipolar bone deficiency. Persistent off-track Hill-Sachs (HS) lesions after Latarjet procedure is associated with significantly higher rates of failure and recurrent instability. Preoperative prediction of which lesions will remain off-track is crucial for improving outcomes and decreasing failure rates. The purpose of this study was to determine if preoperative advanced imaging can predict coracoid graft size and conversion of off-track to on-track Hill-Sachs lesions in patients undergoing Latarjet procedures.
Methods:
Patients who underwent Latarjet procedure for shoulder instability at a single institution from 2012-2020 were evaluated. Inclusion criteria consisted of pre- and post-operative advanced imaging - computerized topography or magnetic resonance imaging. Glenoid diameter, HS interval (HSI), and coracoid length, depth, and height were measured on preoperative imaging. Glenoid track (GT), percent glenoid bone loss, predicted restoration of glenoid track, and the difference between HSI and GT (DHSI-GT) were calculated. These values were then compared with postoperative measurements of the glenoid diameter and coracoid graft width and height.
Results:
Seventeen patients with a mean age of 24.6 ± 8.6 years met inclusion criteria. The average glenoid bone loss preoperatively was 23.6 ± 7.3% and the average HSI was 27.2 ± 4.9mm. The Latarjet procedure was able to reconstruct 115.8 ± 7.6% of the native glenoid, and 103.8 ± 7.9% of the predicted diameter. Of the 15 patients that had off-track lesions preoperatively, 11 were successfully converted to on-track lesions (73.3%). The 4 lesions that remained off-track postoperatively had a significantly higher HSI (32.4 ± 2.4 mm vs. 25.6 ± 4.3 mm, p=0.002) and 3 of these had insufficient coracoid graft to convert to an on-track lesion based on the preoperative DHSI-GT values in comparison to coracoid graft size. Preoperative measurements accurately predicted postoperative glenoid track status 94.1% of cases.
Conclusions:
The Latarjet procedure was able to reconstruct 115.8 ± 7.6% of the native glenoid and converted 73.3% of off-track lesions to on-track lesions. The glenoid was reconstructed to 103.8 ± 7.9% of the predicted diameter. Preoperative advanced imaging measurements accurately predicted graft size, restoration of the glenoid track, and ability to convert off-track to on-track lesions.