title: Predictive Surgical Reasons for Failure After Coracoid Process Transfers.
abstract: BACKGROUND
  Recurrent anterior shoulder instability after coracoid process transfers may be caused by trauma, sports injury, or technical failure of the index procedure. Surgical techniques vary with regard to graft orientation and positioning and number of screws utilized for fixation.
  
  
  OBJECTIVE
  To identify surgical and patient-related factors associated with failure, defined as the need for revision surgery. We hypothesized that failures will occur more commonly with single-screw fixation and graft malposition.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Eighty-three patients (mean age, 24 years) who underwent an Eden-Hybinette operation as a revision procedure for recurrent anterior instability after primary coracoid process transfer between 1977 and 2010 were retrospectively reviewed. Preoperative medical records were queried for demographic data, failure event, and physical examination. Two fellowship-trained shoulder surgeons reviewed radiographs to identify for graft positioning, nonunion, and hardware failure. Descriptive analysis was used to assess reasons for failure.
  
  
  RESULTS
  Seventy-five percent of patients sustained a redislocation event after primary coracoid process transfer. Revisions were performed on average 50.3 months after the index procedure, most commonly on males, with two-thirds of recurrent instability occurring during sports. Among all patients, single-screw methods for fixation and inferior graft malposition during index bone block transfer were the most common. Hardware failure and graft nonunion were more frequent with the single-screw technique.
  
  
  CONCLUSIONS
  In our series, recurrent anterior shoulder instability after primary coracoid process transfer was more likely to occur during sports in young, male patients. The most common technical errors leading to revision were placing the graft inferior to the 5-o'clock position on the glenoid face or relying on single-screw fixation.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Gasbarro
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Juan Marcelo
authors.initials: JM
authors.lastname: Giugale
authors.affiliation: Centre Orthopédique Santy, Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Walch
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Lin
keywords: Bristow; Latarjet; instability; recurrent; shoulder