Clin Orthop Surg.  2016 Mar;8(1):84-91. 10.4055/cios.2016.8.1.84.

Biomechanical Comparison of the Latarjet Procedure with and without Capsular Repair

• Kleiner MT
• Payne WB
• McGarry MH
• Tibone JE
• Lee TQ

• KMID: 2363950
• DOI: http://doi.org/10.4055/cios.2016.8.1.84

Abstract

BACKGROUND
The purpose of this study was to determine if capsular repair used in conjunction with the Latarjet procedure results in significant alterations in glenohumeral rotational range of motion and translation.
METHODS
Glenohumeral rotational range of motion and translation were measured in eight cadaveric shoulders in 90degrees of abduction in both the scapular and coronal planes under the following four conditions: intact glenoid, 20% bony Bankart lesion, modified Latarjet without capsular repair, and modified Latarjet with capsular repair.
RESULTS
Creation of a 20% bony Bankart lesion led to significant increases in anterior and inferior glenohumeral translation and rotational range of motion (p < 0.005). The Latarjet procedure restored anterior and inferior stability compared to the bony Bankart condition. It also led to significant increases in glenohumeral internal and external rotational range of motion relative to both the intact and bony Bankart conditions (p < 0.05). The capsular repair from the coracoacromial ligament stump to the native capsule did not significantly affect translations relative to the Latarjet condition; however it did cause a significant decrease in external rotation in both the scapular and coronal planes (p < 0.005).
CONCLUSIONS
The Latarjet procedure is effective in restoring anteroinferior glenohumeral stability. The addition of a capsular repair does not result in significant added stability; however, it does appear to have the effect of restricting glenohumeral external rotational range of motion relative to the Latarjet procedure performed without capsular repair.

Keyword

Shoulder; Instability; Bone loss; Dislocation

MeSH Terms

Biomechanical Phenomena/*physiology
Female
Humans
Humerus/physiology/surgery
Male
Middle Aged
Range of Motion, Articular/*physiology
Scapula/physiology/surgery
Shoulder Joint/*physiology/*surgery

Figure

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  Fig. 1 Photograph of a right shoulder mounted on the custom testing system at 60° of glenohumeral abduction.

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  Fig. 2 Rotational range of motion in the coronal plane for external rotation, internal rotation and total range of motion for all four conditions tested (p < 0.05). ER: external rotation, IR: internal rotation. *vs. intact. †vs. bony Bankart. ‡vs. Latarjet.

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  Fig. 3 Rotational range of motion in the scapular plane for external rotation, internal rotation and total range of motion for all four conditions tested (p < 0.05). ER: external rotation, IR: internal rotation. *vs. intact. †vs. bony Bankart. ‡vs. Latarjet.

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  Fig. 4 Anterior glenohumeral translation for 20, 30, and 40 N loads in the scapular plane (p < 0.05). *vs. intact. †vs. bony Bankart.

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  Fig. 5 Inferior glenohumeral translation for 20, 30, and 40 N loads in the scapular plane (p < 0.05). *vs. intact. †vs. bony Bankart.

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  Fig. 6 Anterior glenohumeral translation for 20, 30, and 40 N loads in the coronal plane (p < 0.05). *vs. intact. †vs. bony Bankart.

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  Fig. 7 Inferior glenohumeral translation for 20, 30, and 40 N loads in the coronal plane (p < 0.05). *vs. intact. †vs. bony Bankart.

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  Fig. 8 Change in anteroposterior humeral head apex position in the scapular plane compared with the intact position throughout the range of motion from maximum internal rotation (Max IR) to maximum external rotation (Max ER) (p < 0.05). *vs. intact. †vs. bony Bankart.

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  Fig. 9 Change in anteroposterior humeral head apex position in the coronal plane compared with the intact position throughout the range of motion from maximum internal rotation (Max IR) to maximum external rotation (Max ER) (p < 0.05). *vs. intact. †vs. bony Bankart.

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