An assessment of the clinical relevance of coracoid graft osteolysis following the Latarjet procedure: a clinical and radiological review

BackgroundThe Latarjet procedure was developed for the treatment of anterior shoulder instability in young, high-demand patients with attritional glenoid bone loss, whose risk of re-dislocation following primary dislocation may exceed 90%. Coracoid graft osteolysis and prominent screws are commonly observed late in postoperative CT scans, but the clinical relevance of osteolysis in the overall Latarjet cohort is undetermined. We aimed to evaluate clinical and radiological outcomes in patients who underwent the Latarjet procedure, and to determine if severe coracoid graft osteolysis compromised clinical outcomes.MethodsThis was a retrospective analysis of patients who underwent the open Latarjet procedure. Patients were invited via an e-questionnaire that contained a Western Ontario Shoulder Instability Index (WOSI), and queried about re-dislocation and re-operation since index surgery. Preoperative glenoid bone loss was calculated on CT using the best-fit circle method. Osteolysis was graded (0, screw head buried in graft; 1, screw head exposed; 2, threads exposed; 3, complete resorption/severe osteolysis) at the level of the proximal and distal screws respectively on axial CT scans performed ≥12 months postoperatively.ResultsBetween 2011-2022, a single surgeon performed 442 Latarjet procedures. 158 patients responded to the questionnaire at median(IQR) 44(27-70) months postoperatively, among whom the median(IQR) WOSI score was 352(142-666) points (0=best, 2100=worst). Recurrent anterior instability occurred in 3/158 (2%) patients. One patient required reoperation for this indication. Among patients who had CT scans ≥12 months postoperatively (median(IQR) 40(29-69) months), one patient developed severe osteolysis around both screws (WOSI=90), 17/62 (27%) patients developed severe osteolysis around one screw, all of which were proximal (median(IQR) WOSI=235(135-644)), and 44/62 (71%) patients did not develop severe osteolysis around either screw (median(IQR) WOSI=487(177-815)). There were no statistically significant differences in WOSI scores between groups based on the presence of severe osteolysis.ConclusionThe Latarjet is reliable procedure that has a low rate of re-dislocation and re-operation. Severe coracoid graft osteolysis occurs with time, and always affects the proximal graft first. The presence of severe osteolysis did not compromise clinical outcomes.