Does the Arthroscopic Latarjet Procedure Effectively Correct "Off-Track" Hill-Sachs Lesions?
BACKGROUND
The glenoid track concept describes the dynamic interaction of bipolar bone loss in anterior glenohumeral instability. Initial studies have successfully demonstrated this concept's application in clinical populations. In clinical practice, the Latarjet procedure is commonly the preferred treatment in addressing "off-track" Hill-Sachs lesions. The effectiveness of this procedure in restoring such lesions to an "on-track" state, however, has not yet been evaluated or described in the literature.


HYPOTHESIS
The Latarjet procedure would transform "off-track" Hill-Sachs lesions to "on-track" lesions. Lesions would remain "on-track" during follow-up, despite glenoid remodeling.


STUDY DESIGN
Case series; Level of evidence, 4.


METHODS
Patients with "off-track" Hill-Sachs lesions treated with the arthroscopic Latarjet procedure between March 2013 and May 2014 were included. Glenoid track and coracoid graft contact surface area measurements using 3-dimensional computed tomography (3D-CT) were performed preoperatively and at 6-week, 6-month, and at least 12-month (final) follow-up. The mean final follow-up was 23 months. The glenoid diameter, as a percentage of the native glenoid, was also calculated from this imaging.


RESULTS
Twenty-six patients met the inclusion criteria. 3D-CT scans were available for all patients preoperatively and postoperatively, with 21 patients (81%) undergoing 6-month follow-up CT and 19 patients (73%) undergoing final follow-up CT. Hill-Sachs lesions remained "on-track" at all follow-up time points. The mean glenoid diameter changed significantly from 84.6% preoperatively to 122.8% at 6 weeks ( P < .001) and from 120.5% at 6 months to 113.9% at final follow-up ( P = .005). This was also reflected in significant remodeling seen in the coracoid graft articular contact area (6 weeks to 6 months, P = .024; 6 months to final follow-up, P = .002). This persisting glenoid arc enlargement at final follow-up avoided "off-track" Hill-Sachs lesions in 6 of 19 patients (32%), which would otherwise have occurred had the coracoid graft remodeled to native glenoid dimensions.


CONCLUSION
The Latarjet procedure provides an effective treatment for "off-track" engaging Hill-Sachs lesions, despite an evident glenoid remodeling process. At a mean of 23 months postoperatively, a mean persisting enlargement of the glenoid arc of 14% beyond native dimensions remained, avoiding a recurrent "off-track" lesion in 32% of patients, which would otherwise have occurred with complete remodeling.
['Plath|Johannes E|JE|', 'Henderson|Daniel J H|DJH|', 'Coquay|Julien|J|', 'Dück|Klaus|K|', 'Haeni|David|D|', 'Lafosse|Laurent|L|']
D000293:Adolescent D000328:Adult D001178:Arthroplasty D000070896:Bankart Lesions D005260:Female D006801:Humans D007593:Joint Instability D008297:Male D008875:Middle Aged D011184:Postoperative Period D012540:Scapula D012783:Shoulder Dislocation D012785:Shoulder Joint D014057:Tomography, X-Ray Computed D016896:Treatment Outcome D055815:Young Adult
Latarjet glenoid track glenoid remodeling “off-track” lesion