title: Open shoulder repair of osseous glenoid defects: biomechanical effectiveness of the Latarjet procedure versus a contoured structural bone graft.
abstract: BACKGROUND
  To address glenoid bone deficiency, 2 competing surgical approaches are currently recommended: transplantation of a structural bone graft or the coracoid transfer according to Latarjet. Nonetheless, no clear advantages for either procedure are evident.
  
  
  OBJECTIVE
  The Latarjet procedure will provide an equivalent beneficial effect on glenohumeral stability as the placement of an intra-articular bone graft.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Stability testing of 8 cadaveric shoulders was performed in a dynamic shoulder simulator under 4 different conditions: (1) anteroinferior capsulotomy, (2) anteroinferior glenoid defect, (3) transplantation of a contoured bone graft, and (4) Latarjet procedure. Translational movement of the humeral head in response to a load of 25 N was evaluated in the anterior and anteroinferior directions.
  
  
  RESULTS
  The Latarjet procedure significantly reduced translation by 354% relative to the glenoid defect condition at 30 degrees of abduction and by 374% at 60 degrees of abduction. In comparison, the bone graft significantly reduced translation by 179% at 30 degrees of abduction and by 159% at 60 degrees of abduction. The effect of the bone graft was lowest in external rotation at 60 degrees of abduction where a decrease of translation of 133% was observed. Comparing both reconstruction techniques, the Latarjet procedure resulted in significantly less anterior and anteroinferior translation at 60 degrees of abduction.
  
  
  CONCLUSIONS
  Biomechanically, the Latarjet procedure outperforms the bone graft in reducing translation in anteroinferior glenoid bone defects. The advantage of the Latarjet procedure is particularly evident at 60 degrees of glenohumeral abduction.
  
  
  CONCLUSIONS
  On the basis of the results of this biomechanical study, the authors recommend the Latarjet procedure for restoring stability in shoulders with a significant glenoid bone defect.
authors.affiliation: Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany. mathias.wellmann@annastift.de
authors.forename: Mathias
authors.initials: M
authors.lastname: Wellmann
authors.forename: Wolf
authors.initials: W
authors.lastname: Petersen
authors.forename: Thore
authors.initials: T
authors.lastname: Zantop
authors.forename: Mirco
authors.initials: M
authors.lastname: Herbort
authors.forename: Philipp
authors.initials: P
authors.lastname: Kobbe
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Raschke
authors.forename: Christof
authors.initials: C
authors.lastname: Hurschler
mesh_terms: D000368:Aged; D001178:Arthroplasty / Q000379:methods; D001696:Biomechanical Phenomena; D016025:Bone Transplantation / Q000379:methods*; D002102:Cadaver; D006801:Humans; D007593:Joint Instability; D008875:Middle Aged; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*