[Treatment of chronic anterior shoulder instability using a coracoid bone block (Latarjet procedure): 74 cases]

Results of the Latarjet procedure for chronic anterior shoulder instability using a coracoid block are known in terms of recurrence, but not in terms of apprehension. We studied a prospective consecutive series of shoulders treated with the Latarjet method in order to determine whether patients forget their shoulder or whether they are still bothered, particularly during sports activities.

The series included 74 patients with chronic anterior shoulder instability treated with a coracoid block according to the Latarjet procedure. Sixty-nine were available for review and 66 had complete radiographic explorations (93.2%). The Duplay score was used to classify sports activities. Mean age was 26.5 years; 90% of the patients practiced sports. The surgical procedure was performed by the same operator for 78% of patients. The Duplay score and the Constant score were determined and standard x-rays (four views) were obtained. Statistical analysis was performed with the chi-square test. Multivariate analysis was then applied to the subpopulation presenting persistent apprehension.

Follow-up was at least 24 months, average follow-up 50 months. Four patients presented secondary dislocation and two subluxation; 85% of patients were satisfied, 6% were hesitant and 9% were dissatisfied. The Duplay score was: excellent (18.8%), good (49.9%), fair (20.2%) and poor (10.1%). External elbow rotation (RE1) was limited by 17.69 degrees compared with the other side. Eighty-seven percent of patients resumed their sports activity five months postoperatively on average; 34% presented persistent apprehension. This subpopulation was examined separately. Multivariate analysis demonstrated two significantly independent factors of persistent apprehension: recovery of RE1 at 30 days postop, and total recovery of R1 at last follow-up. The radiographies demonstrated degenerative lesions in 10.6% of patients.

The satisfaction rate of 85% and the 9% failure rate are similar to earlier reports. Our series was however exceptional in terms of an unusually high rate of persistent apprehension. Statistical analysis did not demonstrate a significant link between the presence of hyperlaxity and persistent apprehension. Nevertheless, in patients with hyperlaxity associated with chronic anterior shoulder instability, we associate Latarjet coracoid block with Neer capsuloplasty.