2021 ISAKOS Biennial Congress ePoster
Latarjet Vs Coracoid Free Graft For The Treatment Of Glenohumeral Anterior Instability In Patients Older Than 40 Years
Peter Domos, MD, FRCS(Tr&Orth), London UNITED KINGDOM
Mikaël Chelli, MD, Nice FRANCE
Gilles Walch, MD, Lyon FRANCE
Santy Orthopedic Center and Royal Free London NHS Trust, Lyon and London, UNITED KINGDOM
FDA Status Cleared
Open Latarjet or coracoid free graft procedures can have comparable good clinical outcomes but the return to sport level is lower and these patients may have increased rate of apprehension and post-operative osteoarthritis in the coracoid free graft group due to the lack of the dynamic sling effect.
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The open Latarjet surgery is an established treatment but there is limited literature regarding the outcomes of this procedure in older patients. In this study, we compared the outcomes of patients older than 40-years-old who underwent open Latarjet procedure with those who underwent open coracoid free graft procedure without the advantage of the dynamic sling effect by the conjoint tendon.
68 patients were included in this study with a mean age at surgery of 43 years (40 – 58): 40 patients in the Latarjet group (LAT) and 28 in the coracoid free graft (CFG). Clinical outcomes were assessed by Walch-Duplay, Rowe and Constant scores, Subjective Shoulder Value. Radiographs were reviewed for osteoarthritis (OA), complications.
At a mean follow up of 11 years (4 – 27 years), we did not observe any statistically significant differences in the overall range of motion, functional scores, recurrent instability and complications, reoperation rates between the 2 groups. However, we recorded some clinically important differences including: better external rotation (p=0.073), less subjective apprehension/microinstability (p=0.106) especially if associated large/deep Hill Sachs lesions was present (p=0.052) and higher return to sport level (p=0.057) with open Latarjet. LAT group had also lower overall and graft-related complication rates with approximately 40% less patients developed (p=0.195) and/or progressed (p=0.299) with OA postoperatively, which can be important in older patients.
Both open Latarjet and coracoid free graft procedures can have equivalent satisfactory clinical and functional outcomes, with no significant difference in the rate of recurrent instability. The dynamic sling effect needs further clinical assessment as it can provide potentially less subjective apprehension/microinstability rate leading to better return to sport level and less postoperative OA.