2025 ISAKOS Biennial Congress ePoster
Distance To Dislocation And Recurrent Shoulder Instability After Latarjet
Scott Feeley, MD, Bethesda, MD UNITED STATES
Aidan McQuade, MS, Bethesda, Maryland UNITED STATES
Benjamin Hoyt, MD, Chicago, IL UNITED STATES
Conor McCarthy, MD, Bethesda, MD UNITED STATES
Daniel Lawrence Rodkey, MD, Bethesda, Maryland UNITED STATES
Kelly Kilcoyne, MD, Bethesda, MD UNITED STATES
Jon F. Dickens, MD, Bethesda, MD UNITED STATES
Walter Reed National Military Medical Center, Bethesda, MD, UNITED STATES
FDA Status Not Applicable
Summary
In patients undergoing primary Latarjet, postoperative DTD was associated with recurrent instability and only found with postoperative DTD <8.5mm.
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Abstract
OBJECTIVES: There is conflicting evidence on the distance to dislocation (DTD) for Hill-Sachs lesions and its impact on stability. While the Latarjet procedure reconstructs large glenoid defects and decreases the DTD, its impact has not been evaluated across DTD values. Therefore, our aim was to determine the relationship between DTD and recurrent shoulder instability after Latarjet.
Methods
We retrospectively analyzed open Latarjet procedures in the military from 2010-2018. We excluded patients without computed tomography (CT) or two year follow-up. We included both primary and revision Latarjets, but all were the index bone block procedure. Preoperative CT was analyzed for DTD and coracoid thickness to calculate the postoperative DTD. On postoperative CT, we classified graft resorption. Risk factors for the primary outcome of recurrent instability were assessed with multivariate analysis. A receiver operating characteristic curve determined the predictive value of DTD for recurrent instability.
Results
We analyzed 78 Latarjet procedures: 31 primaries and 47 revisions, which differed by GBL, DTD, and presence of off-track lesions. The overall cohort had median age 24.0 years (IQR 21.6-29.3), GBL 22.6% (IQR 17.4-28.0), and follow-up 6.4 years (IQR 4.1-9.4). Graft thickness was 11.4 ± 1.6mm. Preoperative DTD of 2.6 ± 8.1mm improved to 13.9 ± 8.7mm postoperatively (p<0.0001). There were 26 near-track and 30 off-track lesions preoperatively. After Latarjet, 1/30 off-track lesions remained off-track.
Overall, 20 patients (25.6%) had recurrent instability. Preoperative DTD was not associated with recurrent instability in revision Latarjet (p=0.409) and did not reach statistical significance in primary Latarjet (p=0.053). Postoperative DTD was associated with recurrence in primary (p=0.009) but not revision Latarjet (p=0.438). For primary Latarjet, postoperative DTD <8.5mm was 100% sensitive and 58.3% specific for recurrent instability. On multivariate analysis of recurrent instability when considering age, sex, DTD, resorption, primary vs. revision, follow-up, and GBL, no factor reached statistical significance.
Conclusion
In patients undergoing primary Latarjet, postoperative DTD was associated with recurrent instability and only found with postoperative DTD <8.5mm.