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Reconstruction of the coracoacromial ligament during a modified Latarjet procedure: a case series.

Aurich M, Hofmann GO, Gras F - BMC Musculoskelet Disord (2015)

Bottom Line: The coracoacromial ligament (CAL) is an important restraint to superior shoulder translation.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Trauma Surgery, Sana Kliniken Leipziger Land, Sana Klinikum Borna, Rudolf-Virchow-Str. 2, 04552, Borna, Germany. kontakt@matthias-aurich.de.

ABSTRACT

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus

Tip of Coracoid Process (CP, beige) with Attached Structures. Depiction (a) and illustration (b). The bone cut marked as an inverted L (black lines) (b). The L-shaped incision (c) and the cut creating the coracoid bone block (d) with the conjoined tendon attached (white). Note that the PMM (blue) is attached to the medial one-third of the CP. The CAL (yellow) is secured with a Vicryl™ suture
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Fig3: Tip of Coracoid Process (CP, beige) with Attached Structures. Depiction (a) and illustration (b). The bone cut marked as an inverted L (black lines) (b). The L-shaped incision (c) and the cut creating the coracoid bone block (d) with the conjoined tendon attached (white). Note that the PMM (blue) is attached to the medial one-third of the CP. The CAL (yellow) is secured with a Vicryl™ suture

Mentions: After skin incision and identification of the deltopectoral interval, the cephalic vein is protected laterally with the self-retractor. The clavipectoral fascia is now visible. The CP is the central landmark, from which the coracoclavicular ligaments (CCLs) and the CAL extend cranially and laterally, respectively. Two important muscular insertions, the pectoralis minor muscle (PMM) and the conjoined tendon, extend medially and caudally, respectively (Fig. 3a, b). In the interval between the PMM and conjoined tendon, the musculocutaneous nerve can be identified and must be protected. Next, an L-shaped incision of the periosteum of the coracoid process is made with the electric knife. This is important for cutting the coracoid bone block. It is necessary to leave about one-third of the CP intact medially, so that the insertion of the PMM is protected (Fig. 3c, d). Before the bone block (lateral two-thirds of the CP) is cut with a small oscillating saw, the periosteal layer must be prepared carefully to enhance the CAL and obtain maximal length. The CAL (with the periosteal insertion) is then secured with a Vicryl™ (Ethicon, Inc., Somerville, NJ, USA) suture (Fig. 3c, d).Fig. 3


Reconstruction of the coracoacromial ligament during a modified Latarjet procedure: a case series.

Aurich M, Hofmann GO, Gras F - BMC Musculoskelet Disord (2015)

Tip of Coracoid Process (CP, beige) with Attached Structures. Depiction (a) and illustration (b). The bone cut marked as an inverted L (black lines) (b). The L-shaped incision (c) and the cut creating the coracoid bone block (d) with the conjoined tendon attached (white). Note that the PMM (blue) is attached to the medial one-third of the CP. The CAL (yellow) is secured with a Vicryl™ suture
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4559879&req=5

Fig3: Tip of Coracoid Process (CP, beige) with Attached Structures. Depiction (a) and illustration (b). The bone cut marked as an inverted L (black lines) (b). The L-shaped incision (c) and the cut creating the coracoid bone block (d) with the conjoined tendon attached (white). Note that the PMM (blue) is attached to the medial one-third of the CP. The CAL (yellow) is secured with a Vicryl™ suture
Mentions: After skin incision and identification of the deltopectoral interval, the cephalic vein is protected laterally with the self-retractor. The clavipectoral fascia is now visible. The CP is the central landmark, from which the coracoclavicular ligaments (CCLs) and the CAL extend cranially and laterally, respectively. Two important muscular insertions, the pectoralis minor muscle (PMM) and the conjoined tendon, extend medially and caudally, respectively (Fig. 3a, b). In the interval between the PMM and conjoined tendon, the musculocutaneous nerve can be identified and must be protected. Next, an L-shaped incision of the periosteum of the coracoid process is made with the electric knife. This is important for cutting the coracoid bone block. It is necessary to leave about one-third of the CP intact medially, so that the insertion of the PMM is protected (Fig. 3c, d). Before the bone block (lateral two-thirds of the CP) is cut with a small oscillating saw, the periosteal layer must be prepared carefully to enhance the CAL and obtain maximal length. The CAL (with the periosteal insertion) is then secured with a Vicryl™ (Ethicon, Inc., Somerville, NJ, USA) suture (Fig. 3c, d).Fig. 3

Bottom Line: The coracoacromial ligament (CAL) is an important restraint to superior shoulder translation.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Trauma Surgery, Sana Kliniken Leipziger Land, Sana Klinikum Borna, Rudolf-Virchow-Str. 2, 04552, Borna, Germany. kontakt@matthias-aurich.de.

ABSTRACT

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus