This prospective CT study of 26 patients is the first to quantify where and how much coracoid graft resorbs after the Latarjet procedure. Using an 8-zone measurement system, the authors mapped osteolysis at 3 days and again at a mean of 17.5 months postoperatively. The central question: does graft resorption correlate with clinical failure?
When you see near-complete resorption of the proximal coracoid graft on a postoperative CT, do not panic. This paper establishes that proximal superficial osteolysis exceeding 90% is normal after Latarjet, and the clinically relevant zone — distal deep. Is the one to scrutinize.
The practical rule: evaluate the distal deep zones on follow-up CT. These are the zones in contact with the glenoid bed, and their preservation (or loss) is what determines whether a bone-block effect exists at all.
This paper also reframes why the Latarjet works. In patients without significant glenoid bone loss, the sling effect of the conjoined tendon across the anteroinferior capsule in abduction/external rotation likely matters more than the bone block. Reserve concern about graft osteolysis for patients who had substantial preoperative bone loss, where the bone-block effect is genuinely load-bearing.
The authors cannot confirm a correlation between osteolysis and failure here because no failures occurred. A limitation worth knowing for boards and clinical reasoning alike.
This prospective CT study of 26 patients is the first to quantify where and how much coracoid graft resorbs after the Latarjet procedure. Using an 8-zone measurement system, the authors mapped osteolysis at 3 days and again at a mean of 17.5 months postoperatively. The central question: does graft resorption correlate with clinical failure?
When you see near-complete resorption of the proximal coracoid graft on a postoperative CT, do not panic. This paper establishes that proximal superficial osteolysis exceeding 90% is normal after Latarjet, and the clinically relevant zone — distal deep. Is the one to scrutinize.
The practical rule: evaluate the distal deep zones on follow-up CT. These are the zones in contact with the glenoid bed, and their preservation (or loss) is what determines whether a bone-block effect exists at all.
This paper also reframes why the Latarjet works. In patients without significant glenoid bone loss, the sling effect of the conjoined tendon across the anteroinferior capsule in abduction/external rotation likely matters more than the bone block. Reserve concern about graft osteolysis for patients who had substantial preoperative bone loss, where the bone-block effect is genuinely load-bearing.
The authors cannot confirm a correlation between osteolysis and failure here because no failures occurred. A limitation worth knowing for boards and clinical reasoning alike.