Coracoid process transfer for anterior shoulder instability : a pectoralis minor sparing method

Abstract

The Latarjet procedure alters scapulothoracic motion by releasing the pectoralis minor insertion to the coracoid process and by changing the vector of the conjoint tendon. The purpose of this study is to evaluate the feasibility of retaining the pectoralis minor insertion and a part of the conjoint tendon on to the remainder of the coracoid, and to evaluate the efficiency of the procedure in avoiding scapular dyskinesis, without concessions to glenohumeral stability.

Since June 2017, a modification to the Latarjet pro- cedure has been used in the treatment of posttraumatic anterior shoulder instability. The pectoralis minor insertion and a part of the conjoint tendon is retained on its anatomical position, by harvesting only the lateral part of the coracoid. We retrospectively enrolled the first 9 consecutively treated shoulders with a minimum of 6 months follow up and recorded scapulothoracic position and scapulothoracic motion, patient satisfaction, Oxford score, and Short Form (SF)-36. All patients underwent a radiographic review at final follow up.

No scapular dyskinesis was observed at final follow- up. Radiographies consistently showed a bony spur at the original osteotomy site, suggesting a functional attachment of the pectoralis minor tendon to the scapula.

Harvesting only the lateral part of the coracoid is technically feasible, efficient in treating anterior shoulder instability and avoids scapular dyskinesis.

Level of evidence : Level IV, Retrospective Cohort study, Treatment study.