The authors declare that they have no competing interests.
MA designed the study protocol, developed the surgical technique, and drafted the manuscript. GH was involved in the coordination of the study and manuscript preparation. FG was involved in the surgery and data analysis. All authors read and approved the final manuscript.
The coracoacromial ligament (CAL) is an important restraint to superior shoulder translation. CAL release with the Latarjet procedure leads to increased superior humeral translation. Therefore, a surgical technique was developed to reconstruct the CAL during a modified Latarjet procedure.
Between May 2010 and July 2011, six patients (five were male, one was female; age 23–41 years) with chronic post-traumatic anterior shoulder instability were treated surgically with a modified congruent-arc Latarjet procedure (modLAT) with additional reconstruction of the CAL using a newly developed procedure, the pectoralis minor fascia flap (PMFF). Clinical follow-up was performed for up to 36 months, and patients were evaluated using a Rowe score.
All six patients experienced chronic, post-traumatic anterior shoulder instability and had experienced multiple re-dislocations after initial treatment. The preoperative assessment showed a defect of the anterior glenoid in three cases, and the mean Rowe score was 16.67 (5–25). Open modLAT with PMFF resulted in a stable shoulder function with no re-dislocations. The Rowe score increased from 77.5 (65–90) at 12 weeks to 95 (90–100) at 12 months and plateaued thereafter. Operative duration was 95 min (78–112 min), and there were no intra- or postoperative complications. All patients returned to their preoperative sports activity, three at the same level.
The PMFF is a safe technique for reconstruction of the CAL during a modLAT procedure. Patients had improved shoulder function and no re-dislocations after the surgery.
Lee TQ, Black AD, Tibone JE, McMahon PJ. Release of the coracoacromial ligament can lead to glenohumeral laxity: a biomechanical study. J Shoulder Elb Surg. 2001;10:68–72. CrossRef
Wiley AM. Superior humeral dislocation. A complication following decompression and debridement for rotator cuff tears. Clin Orthop Relat Res. 1991;263:135–41. PubMed
Denard PJ, Bahney TJ, Kirby SB, Orfaly RM. Contact pressure and glenohumeral translation following subacromial decompression: How much is enough? Orthopedics. 2010;33:805. PubMed
Degen RM, Giles JW, Boons HW, Litchfield RB, Johnson JA, Athwal GS. A biomechanical assessment of superior shoulder translation after reconstruction of anterior glenoid bone defects: the Latarjet procedure versus allograft reconstruction. Int J Shoulder Surg. 2013;7(1):7–13. CrossRefPubMedPubMedCentral
Latarjet M. Treatment of recurrent dislocation of the shoulder. Lyon Chir. 1954;49(8):994–7. PubMed
Young AA, Maia R, Berhouet J, Walch G. Open Latarjet procedure for management of bone loss in anterior instability of the glenohumeral joint. J Shoulder Elbow Surg. 2011;20:61–9. CrossRef
Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am. 1978;60(1):1–16. PubMed
Helfet AJ. Coracoid transplantation for recurring dislocation of the shoulder. J Bone Joint Surg (Br). 1958;40:198–202.
Walch G, Neyret P, Charret P, Pietropaoli H, DeJour H. L’opération de Trillat pour luxation récidivante antérieure de l’épaule. Résultats à long terme de 250 cas avec un recul moyen de 11,3 ans. Lyon Chir. 1989;85:25–31.
Barry TP, Lombardo SJ, Kerlan RK, Jobe FW, Carter VS, Shields Jr CL, et al. The coracoid transfer for recurrent anterior instability of the shoulder in adolescents. J Bone Joint Surg Am. 1985;67:383–7. PubMed
Lombardo SJ, Kerlan RK, Jobe FW, Carter VS, Blazina ME, Shields Jr CL. The modified Bristow procedure for recurrent dislocation of the shoulder. J Bone Joint Surg Am. 1976;58:256–61. PubMed
de Waal MJ, Ooms AJ, van Rens TJ. A comparison of the results of the Bristow-Latarjet procedure and the Bankart/Putti-Platt operation for recurrent anterior dislocation of the shoulder. Acta Orthop Belg. 1985;51:831–42.
- Reconstruction of the coracoacromial ligament during a modified Latarjet procedure: a case series
Gunther O. Hofmann
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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