Neurological Anatomy Applied to the Deltopectoral Surgical Approach: Safety Parameters in the Latarjet Procedure

Objective  The present study aims to identify neurological safety parameters for performing the Latarjet procedure via the deltopectoral approach in a cross-sectional and prospective analysis of fresh cadavers. Methods  We dissected 12 shoulders from cadavers in good condition with no history of previous surgery or musculoskeletal dysfunction. Their mean age, height, weight, and body mass index (BMI) were the following: 75.33 (41-97) years, 168.81 (149-186) cm, 60.35 (26-77) kg, and 21.38 (11.71-34.22) kg/m ² , respectively. We identified the anatomical landmark of the deltopectoral approach (medial glenoid rim, MGR) and measured its distance from the axillary, musculocutaneous, and subscapular nerves. Results  We obtained the following measurements in neutral rotation and 40° external rotation, respectively: distance from the MGR to the axillary nerve (AN), 2.87 cm and 2.58 cm ( p  = 0.29); distance from the MGR to the musculocutaneous nerve (MCN), 2.70 cm and 2.54 cm ( p  = 0.36); distance from the MGR to the upper subscapular nerve (USSN), 3.83 cm and 4.00 cm ( p  = 0.30); distance from the MGR to the middle subscapular nerve (MSSN), 3.50 cm and 3.50 cm ( p  = 1.00); and distance from the MGR to the lower subscapular nerve (LSSN), 3.00 cm and 2.83 cm ( p  = 0.36). Conclusion  The deltopectoral approach is safe. However, in the Latarjet procedure, subscapularis muscle splitting and coracoid graft fixation require attention and caution due to the small distance to the adjacent nerves. These precautions can avoid major postoperative complications.