Repairing the capsule to the transferred coracoid preserves external rotation in the modified latarjet procedure

Yoshiaki Itoigawa, Alexander W. Hooke, John W. Sperling, Scott P. Steinmann, Kristin D Zhao, Nobuyuki Yamamoto, Eiji Itoi, Kai Nan An

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

Background: It is not clear whether the anterior capsule should be repaired to the coracoid process or to the native glenoid during the modified Latarjet procedure. We investigated joint stability and range of motion of the shoulder after the modified Latarjet procedure with both of these methods of capsular repair. Methods: Eighteen fresh-frozen cadaveric shoulders were used. After a Bankart lesion and 6-mm glenoid defect were created, the coracoid process was transferred to the glenoid and fixed with screws. The anterior capsule was repaired either to the coracoid process (coracoid group) or to the native glenoid (glenoid group). The ranges of internal and external axial rotation were measured with the arm at 0° and 60° of glenohumeral abduction. The range of motion was measured with a constant torque of 200 N-mm. Joint stability was measured using a custom stability testing device. The stability ratio in the anterior-posterior direction was measured with the arm at maximal external rotation and neutral rotation. Results: The range of external rotation was greater at both 0° and 60° of abduction in the coracoid group compared with the glenoid group (p < 0.05). The range of internal rotation was not significantly different between groups. The end-range stability ratiowas not significantly different between groups, but themid-range stability ratio was significantly greater in the glenoid group. Conclusions: Because the difference in the mid-range stability may not be clinically relevant, we recommend repairing the capsule to the coracoid, as that preserves the range of motion in external rotation. Clinical Relevance: Repairing the capsule to the transferred coracoid during the modified Latarjet procedure appears to be beneficial to avoid the limited range of motion in external rotation, but the direct contact of the humeral head and the transferred coracoidmight confer a risk of osteoarthritis. Long-termconsequences in the clinical setting need to be clarified.

Original languageEnglish (US)
Pages (from-to)1484-1489
Number of pages6
JournalJournal of Bone and Joint Surgery - American Volume
Volume98
Issue number17
DOIs
StatePublished - 2016

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Capsules
Articular Range of Motion
Arm
Humeral Head
Bursitis
Torque
Osteoarthritis
Joints
Equipment and Supplies
Coracoid Process

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Orthopedics and Sports Medicine

Cite this

Repairing the capsule to the transferred coracoid preserves external rotation in the modified latarjet procedure. / Itoigawa, Yoshiaki; Hooke, Alexander W.; Sperling, John W.; Steinmann, Scott P.; Zhao, Kristin D; Yamamoto, Nobuyuki; Itoi, Eiji; An, Kai Nan.

In: Journal of Bone and Joint Surgery - American Volume, Vol. 98, No. 17, 2016, p. 1484-1489.

Research output: Contribution to journalReview article

Itoigawa, Yoshiaki ; Hooke, Alexander W. ; Sperling, John W. ; Steinmann, Scott P. ; Zhao, Kristin D ; Yamamoto, Nobuyuki ; Itoi, Eiji ; An, Kai Nan. / Repairing the capsule to the transferred coracoid preserves external rotation in the modified latarjet procedure. In: Journal of Bone and Joint Surgery - American Volume. 2016 ; Vol. 98, No. 17. pp. 1484-1489.
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abstract = "Background: It is not clear whether the anterior capsule should be repaired to the coracoid process or to the native glenoid during the modified Latarjet procedure. We investigated joint stability and range of motion of the shoulder after the modified Latarjet procedure with both of these methods of capsular repair. Methods: Eighteen fresh-frozen cadaveric shoulders were used. After a Bankart lesion and 6-mm glenoid defect were created, the coracoid process was transferred to the glenoid and fixed with screws. The anterior capsule was repaired either to the coracoid process (coracoid group) or to the native glenoid (glenoid group). The ranges of internal and external axial rotation were measured with the arm at 0° and 60° of glenohumeral abduction. The range of motion was measured with a constant torque of 200 N-mm. Joint stability was measured using a custom stability testing device. The stability ratio in the anterior-posterior direction was measured with the arm at maximal external rotation and neutral rotation. Results: The range of external rotation was greater at both 0° and 60° of abduction in the coracoid group compared with the glenoid group (p < 0.05). The range of internal rotation was not significantly different between groups. The end-range stability ratiowas not significantly different between groups, but themid-range stability ratio was significantly greater in the glenoid group. Conclusions: Because the difference in the mid-range stability may not be clinically relevant, we recommend repairing the capsule to the coracoid, as that preserves the range of motion in external rotation. Clinical Relevance: Repairing the capsule to the transferred coracoid during the modified Latarjet procedure appears to be beneficial to avoid the limited range of motion in external rotation, but the direct contact of the humeral head and the transferred coracoidmight confer a risk of osteoarthritis. Long-termconsequences in the clinical setting need to be clarified.",
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T1 - Repairing the capsule to the transferred coracoid preserves external rotation in the modified latarjet procedure

AU - Itoigawa, Yoshiaki

AU - Hooke, Alexander W.

AU - Sperling, John W.

AU - Steinmann, Scott P.

AU - Zhao, Kristin D

AU - Yamamoto, Nobuyuki

AU - Itoi, Eiji

AU - An, Kai Nan

PY - 2016

Y1 - 2016

N2 - Background: It is not clear whether the anterior capsule should be repaired to the coracoid process or to the native glenoid during the modified Latarjet procedure. We investigated joint stability and range of motion of the shoulder after the modified Latarjet procedure with both of these methods of capsular repair. Methods: Eighteen fresh-frozen cadaveric shoulders were used. After a Bankart lesion and 6-mm glenoid defect were created, the coracoid process was transferred to the glenoid and fixed with screws. The anterior capsule was repaired either to the coracoid process (coracoid group) or to the native glenoid (glenoid group). The ranges of internal and external axial rotation were measured with the arm at 0° and 60° of glenohumeral abduction. The range of motion was measured with a constant torque of 200 N-mm. Joint stability was measured using a custom stability testing device. The stability ratio in the anterior-posterior direction was measured with the arm at maximal external rotation and neutral rotation. Results: The range of external rotation was greater at both 0° and 60° of abduction in the coracoid group compared with the glenoid group (p < 0.05). The range of internal rotation was not significantly different between groups. The end-range stability ratiowas not significantly different between groups, but themid-range stability ratio was significantly greater in the glenoid group. Conclusions: Because the difference in the mid-range stability may not be clinically relevant, we recommend repairing the capsule to the coracoid, as that preserves the range of motion in external rotation. Clinical Relevance: Repairing the capsule to the transferred coracoid during the modified Latarjet procedure appears to be beneficial to avoid the limited range of motion in external rotation, but the direct contact of the humeral head and the transferred coracoidmight confer a risk of osteoarthritis. Long-termconsequences in the clinical setting need to be clarified.

AB - Background: It is not clear whether the anterior capsule should be repaired to the coracoid process or to the native glenoid during the modified Latarjet procedure. We investigated joint stability and range of motion of the shoulder after the modified Latarjet procedure with both of these methods of capsular repair. Methods: Eighteen fresh-frozen cadaveric shoulders were used. After a Bankart lesion and 6-mm glenoid defect were created, the coracoid process was transferred to the glenoid and fixed with screws. The anterior capsule was repaired either to the coracoid process (coracoid group) or to the native glenoid (glenoid group). The ranges of internal and external axial rotation were measured with the arm at 0° and 60° of glenohumeral abduction. The range of motion was measured with a constant torque of 200 N-mm. Joint stability was measured using a custom stability testing device. The stability ratio in the anterior-posterior direction was measured with the arm at maximal external rotation and neutral rotation. Results: The range of external rotation was greater at both 0° and 60° of abduction in the coracoid group compared with the glenoid group (p < 0.05). The range of internal rotation was not significantly different between groups. The end-range stability ratiowas not significantly different between groups, but themid-range stability ratio was significantly greater in the glenoid group. Conclusions: Because the difference in the mid-range stability may not be clinically relevant, we recommend repairing the capsule to the coracoid, as that preserves the range of motion in external rotation. Clinical Relevance: Repairing the capsule to the transferred coracoid during the modified Latarjet procedure appears to be beneficial to avoid the limited range of motion in external rotation, but the direct contact of the humeral head and the transferred coracoidmight confer a risk of osteoarthritis. Long-termconsequences in the clinical setting need to be clarified.

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