This is a case series from Burkhart and De Beer evaluating the open modified Latarjet in patients with anteroinferior instability plus significant bone loss. Bone loss was defined as an inverted-pear glenoid (≥25% inferior glenoid width loss) or an engaging Hill-Sachs lesion. It asks whether coracoid transfer can restore stability where soft-tissue repair reliably fails.
When you assess anterior instability, quantify glenoid bone loss before committing to a soft-tissue repair. Once loss reaches the inverted-pear threshold (≥25% of inferior glenoid width) or a Hill-Sachs lesion engages at 90/90, a Bankart repair alone fails in this series at 67%, while the Latarjet fails at about 5%.
The mechanical reason matters for boards: in a deficient glenoid, off-axis loads fall on soft tissue and tear the repair, whereas the coracoid graft extends the bony arc so bone resists the load. Patte's triple effect (bone, conjoined tendon sling, capsular repair) is the classic testable framework.
Graft position is the surgeon-controlled variable: too lateral causes arthritis, too medial causes recurrence, and keeping the graft extra-articular protects the humeral cartilage. Remember this is Level IV evidence from two expert surgeons with only 47 of 102 examined in person, so treat the numbers as a best-case benchmark rather than a universal rate.
This is a case series from Burkhart and De Beer evaluating the open modified Latarjet in patients with anteroinferior instability plus significant bone loss. Bone loss was defined as an inverted-pear glenoid (≥25% inferior glenoid width loss) or an engaging Hill-Sachs lesion. It asks whether coracoid transfer can restore stability where soft-tissue repair reliably fails.
When you assess anterior instability, quantify glenoid bone loss before committing to a soft-tissue repair. Once loss reaches the inverted-pear threshold (≥25% of inferior glenoid width) or a Hill-Sachs lesion engages at 90/90, a Bankart repair alone fails in this series at 67%, while the Latarjet fails at about 5%.
The mechanical reason matters for boards: in a deficient glenoid, off-axis loads fall on soft tissue and tear the repair, whereas the coracoid graft extends the bony arc so bone resists the load. Patte's triple effect (bone, conjoined tendon sling, capsular repair) is the classic testable framework.
Graft position is the surgeon-controlled variable: too lateral causes arthritis, too medial causes recurrence, and keeping the graft extra-articular protects the humeral cartilage. Remember this is Level IV evidence from two expert surgeons with only 47 of 102 examined in person, so treat the numbers as a best-case benchmark rather than a universal rate.