Summary

A reduction in nerve injury following Latarjet.

Abstract

Purpose

Neurological dysfunction following the open Latarjet procedure is a known complication, and while the reported clinical incidence is variable a prior neuromonitoring study demonstrated a significant incidence of nerve dysfunction during surgery, presumably from nerve stretch. The purpose of this study was to determine if a nerve stretch-reduction protocol, developed as a result of our prior neuromonitoring study, reduced the incidence of neurological injury following the open Latarjet procedure.

Methods

A non-randomized study was performed in which we compared a cohort of 38 patients (Group 1) who underwent surgery prior to our neuromonitoring study, to a cohort of 48 patients (Group 2) who underwent surgery after this study. In the second group, we implemented a nerve stretch-reduction protocol based on our neuromonitoring study. All patients were followed postoperatively with careful evaluation of sensory and motor function of the nerves of the upper extremity. Patients were followed for at least 3 months or until documented resolution of any nerve dysfunction. Range of motion, radiographs and strength were documented.

Results

There were no significant demographic differences between the two groups. In Group 1 there were two recurrent instabilities and seven nerve injuries, of which all but two recovered. In Group 2 there were three patients with recurrent instability and three nerve injuries of which all but one recovered. The overall incidence of nerve injury was 18.4% in Group 1 vs 6.3% in Group 2; however, the incidence of permanent motor dysfunction was 5.3% in Group 1 vs 2.1% in Group 2. These differences were not significant probably due to the small number of patients in each group.

Conclusions

We observed a trend in reduction of nerve injury with the implementation of nerve stretch-reduction protocol with the open Latarjet procedure; however, we could not demonstrate statistical significance. We believe that this trend represents an important finding and that modification of surgical technique can reduce the incidence of nerve injury with the Latarjet procedure.