Limits...
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

Fixation of the Coracoid Bone Block (a, b). Note that the PMM (blue illustration) is still attached to the coracoid stump. Closure of the capsule (c, d). The CAL (yellow illustration) is secured with a strong Vicryl™ suture
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig7: Fixation of the Coracoid Bone Block (a, b). Note that the PMM (blue illustration) is still attached to the coracoid stump. Closure of the capsule (c, d). The CAL (yellow illustration) is secured with a strong Vicryl™ suture

Mentions: In the next step, a horizontal split of the subscapularis muscle is performed longitudinally along the muscle fibers at the level of the equator of the glenoid (Fig. 5). The joint capsule is incised in an inverted L with the long arm parallel to the glenoid rim. The short arm of the L is directed laterally at the level of the equator (Fig. 5b). This is important for capsular plication after the coracoid bone block has been fixed to the glenoid (Figs. 6 and 7). For stable bony fixation, the periosteum at the anterior glenoid vault needs to be removed and the cortical bone slightly abraded; e.g., with a small burr.Fig. 5


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

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

Fixation of the Coracoid Bone Block (a, b). Note that the PMM (blue illustration) is still attached to the coracoid stump. Closure of the capsule (c, d). The CAL (yellow illustration) is secured with a strong Vicryl™ suture
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig7: Fixation of the Coracoid Bone Block (a, b). Note that the PMM (blue illustration) is still attached to the coracoid stump. Closure of the capsule (c, d). The CAL (yellow illustration) is secured with a strong Vicryl™ suture
Mentions: In the next step, a horizontal split of the subscapularis muscle is performed longitudinally along the muscle fibers at the level of the equator of the glenoid (Fig. 5). The joint capsule is incised in an inverted L with the long arm parallel to the glenoid rim. The short arm of the L is directed laterally at the level of the equator (Fig. 5b). This is important for capsular plication after the coracoid bone block has been fixed to the glenoid (Figs. 6 and 7). For stable bony fixation, the periosteum at the anterior glenoid vault needs to be removed and the cortical bone slightly abraded; e.g., with a small burr.Fig. 5

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