Accurate Placement of the Coracoid Graft in Latarjet Procedure: Use of Drill Guide Vs Conventional Free Hand Technique: Comparative Cross-Sectional Study.

Abstract

Background: The Latarjet procedure is a widely known surgical procedure that is utilized in management of recurrent shoulder instability especially where there is significant glenoid bone deficiency of more than 25 %. Location of the coracoid graft is one of the most significant factors for patients’ overall results. This work aims at determining accuracy of placing coracoid grafts in patients using a drill guide and the free-hand methods.

Objectives: the present work aims at comparing the effectiveness of drill guide in coracoid graft positioning in the Technique of Latarjet procedure with the traditional free-hand technique.

Study design: Analytical cross section design

Place and duration of study. From Jan 2019 to June 2021MTI, LRH Peshawar

 Methods: 50 patients who had recurrent shoulder instability were retrieved from hospital computer record. All the preoperative details and post operative details were recorded. All those patients who had been operated since January 2019 till august 2021 were included and we got a total of 50 patients. Patients were then divided into two groups. Group A had all those patients who had been operated for recurrent dislocation shoulder and stabilized by Latarjet procedure in which coracoid graft had been fixed by conventional free hand technique , and we got a total number of 30 patients. Group B had all patients in whom graft fixation had been done using Drill guide and we had 20 patients. From the record, the time of surgery retrieved and recorded. Graft positioning was used as the criteria to evaluate the accuracy using postoperative x-ray and CT scans. Post-surgery complications and the clinical and functional outcome of patient at 3months after surgerywere noted and recorded.

 Results: We had a total of50 patients.Mean age was 29. 7 years (standard deviation was 4. 1). In the same study, it was clearly determined that, in the drill guide group B, grafts placed were 93% optimally placed within 2mm to the ideal location, as compared to the free-hand group where only 75% of the grafts were optimally placed (p < 0. 01). The free hand group A had 0. 82% of added complications while the drill guide group recorded only 0. 46% (P < 0. 05), Mean operating time of the drill guide group B was 50(SD = 10) while the free hand group A mean operating time was 65mins (SD = 10). Complications were 5% for group B and were 15% for free hand group B. Functional outcome and stability scores were comparable in both and shoulder  were stable in both groups

Conclusion: This recent study of comparing the use of the drill as a reference point in positioning the coracoid graft in Latarjet procedure with the free-hand method showed that the present technique was accurate, reproducible ,less likely to cause complications and required shorter time to perform the operation. These results imply that, in some way, the utilization of the drill guide may enhance the results of surgeries that are carried out for shoulder instability.