Comparison of Coracoid Graft Position and Fixation in the Open Versus Arthroscopic Latarjet Techniques: A Cadaveric Study.

Abstract

Background: Since the description of the arthroscopic Latarjet technique, discussion about the superiority of the open or arthroscopic procedure has arisen. The appropriate placement of the coracoid graft (CG) on the anterior glenoid neck was reported to be the most important step of the Latarjet procedure. Purpose: To verify if there are differences in the parameters that may affect the final position and fixation of CG obtained from the open and arthroscopic Latarjet techniques. Study Design: Controlled laboratory study. Methods: Twenty fresh-frozen human paired cadaveric shoulder specimens were randomly distributed in 2 surgery groups (open group [OG] and arthroscopic group [AG]) with 10 specimens in each. Two surgeons, each with experience performing open and arthroscopic Latarjet techniques, executed these procedures in each of the respective groups[AQ: 2]. After surgery, a computerized tomography scan was performed. The surgical time, the position of each CG, a series of variables that might affect the CG fixation, and the level of the subscapularis split were evaluated. Results: The mean surgical time was significantly higher in the AG (mean, 26 minutes for OG and 57 minutes for AG). Three intraoperative complications (30%) were identified in the AG, consisting of graft fractures. The CG was determined to be in an optimal cranial-caudal position in 90% of specimens of the OG and 44% of the AG [AQ: 3](Fisher, P = .057). In both groups, the CG was placed in an optimal medial-lateral position in all specimens. In the OG, the degree of parallelism between the major axes of the glenoid surface and CG was significantly greater than in the AG (mean, 3.88 for OG and 15.18 for AG). No significant differences were observed in superior and inferior screw orientation between the groups. In the longitudinal and transversal directions, significant differences were found in the centering of the superior screw, being closer to the ideal point in the OG than in the AG[AQ: 4]. The location where the longitudinal subscapularis split was performed was significantly higher in the AG. Conclusion: The open Latarjet technique requires less surgical time; presents a lower number of intraoperative complications; and allows more adequate placement of the CG, better centering of the screws, and a subscapularis split closer to the ideal position.