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Review
. 2022 Jan 25;10(1):23259671211068371.
doi: 10.1177/23259671211068371. eCollection 2022 Jan.

Intra-articular Versus Extra-articular Coracoid Grafts: A Systematic Review of Capsular Repair Techniques During the Latarjet Procedure

Hytham S Salem  1 , Alexander L Vasconcellos  2 , Oliver C Sax  1 , Kent C Doan  2 , Matthew T Provencher  3 , Anthony A Romeo  4 , Kevin B Freedman  5 , Rachel M Frank  2
Affiliations
Review

Intra-articular Versus Extra-articular Coracoid Grafts: A Systematic Review of Capsular Repair Techniques During the Latarjet Procedure

Hytham S Salem et al. Orthop J Sports Med. .

Abstract

Background: Various methods exist for managing the joint capsule during the Latarjet procedure. Repairing the capsule to the native glenoid rim results in an extra-articular bone block, while repairing it to the remnant coracoacromial ligament stump of the coracoid graft renders it intra-articular. The technique that optimizes patient outcomes is not well defined.

Purpose: To compare the outcomes of intra-articular and extra-articular bone block techniques for the Latarjet procedure.

Study design: Systematic review; Level of evidence, 4.

Methods: Using PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines, we queried the PubMed, EMBASE, and the Cochrane Library for all studies reporting outcomes of the Latarjet procedure with a clearly defined method of capsular repair that rendered the coracoid graft intra-articular or extra-articular. The included levels of evidence and degree of heterogeneity in this study precluded meta-analysis. Outcomes of interest included preoperative variables, surgical technique, rehabilitation protocols, functional outcome assessments, recurrent instability, range of motion, and radiographic findings.

Results: A total of 16 studies including 816 patients were included. A total of 8 studies employed an intra-articular bone block in 338 patients, while the other 8 employed an extra-articular technique in 478 patients. There was variation among studies in reference to baseline patient characteristics, surgical techniques, rehabilitation, methods for assessing patient outcomes, and follow-up times. Rates of postoperative instability were reported in 8 intra-articular (0%, 0%, 2.1%, 2.7%, 3.2%, 5%, 5.4%, 5.9%) and 7 extra-articular (0%, 0%, 1.2%, 2%, 3.9%, 6.3%, 14%) bone block studies. Postoperative osteoarthritis or progression of preoperative osteoarthritis was reported in 5 intra-articular bone block studies (0%, 5.6%, 23.5%, 23.5%, 25%) and 4 extra-articular bone block studies (0%, 1.9%, 5.2%, 8.6%).

Conclusion: Varying capsular repair methods appeared to provide similar outcomes regarding stability. There was an apparent trend toward higher rates of post-traumatic arthritis among studies in which an intra-articular bone block technique was employed; however, it is possible that this was influenced by substantially different follow-up times between groups and other various sources of heterogeneity among the included studies. There were no studies in the literature directly comparing intra-articular and extra-articular bone block techniques. Large-scale randomized controlled trials or comparative studies are needed to draw stronger conclusions comparing the 2 techniques.

Keywords: Latarjet; glenoid reconstruction; osteoarthritis; shoulder instability.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: K.C.D. has received education payments from Gemini Mountain. M.T.P. has received research support from Arthrex, consulting fees from Arthrex and JRF (Allosource), nonconsulting fees from Arthrex and Flexion, and royalties from Arthrex and Arthrosurface. A.A.R. has received research support, consulting fees, nonconsulting fees, and royalties from Arthrex. K.B.F. has received education payments from Liberty Surgical, consulting fees from DePuy/Medical Device Business Services and Vericel, and nonconsulting fees from Aastrom Biosciences and Vericel. R.M.F. has received research support from Arthrex, education payments from Gemini Mountain and Smith & Nephew, consulting fees from Arthrex and JRF (Allosource), and nonconsulting fees from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) flowchart describing the process for selecting studies included in the review.
Figure 2.
Figure 2.
Illustration demonstrating the intra-articular bone block technique with the medial capsule sutured to the remnant coracoacromial ligament stump of the bone graft. (Reprinted with permission from Mizuno N, Denard PJ, Raiss P, Melis B, Walch G. Long-term results of the Latarjet procedure for anterior instability of the shoulder. J Shoulder Elbow Surg. 2014;23(11):1691-1699.)
Figure 3.
Figure 3.
(A) Bone block preparation showing (B) 2 transosseous U-suture formations for capsular fixation. Unlike other capsular-coracoid repair techniques, (C) the method employed by Bouju et al yields (D) an extra-articular bone block. The dotted line refers to the articular surface of the glenoid. (Reprinted with permission from Bouju Y, Gadea F, Stanovici J, Moubarak H, Favard L. Shoulder stabilization by modified Latarjet-Patte procedure: results at a minimum 10 years’ follow-up, and role in the prevention of osteoarthritis. Orthop Traumatol Surg Res. 2014;100(4)(suppl):S213-218.)
Figure 4.
Figure 4.
Postoperative rehabilitation. *After clinical and radiographic evaluation showed satisfactory healing of the coracoid graft. **When full ROM was restored and no apprehension detected. ***Delayed until 1 year postoperatively if bone graft did not show radiographic consolidation at 6 months. ADL, activities of daily living; ER, external rotation; FF, forward flexion; NR, not reported; ROM, range of motion.
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