Radiographic measurement of the coracoid process and its suitability for the Latarjet procedure in patients of Thai ethnicity
Keywords:
Coracoid process, Latarjet procedure, Coracoid anatomy, Thai population, Congruence arch procedureAbstract
Context: The Latarjet procedure is a technique that affixes a coracoid graft with the glenoid. The procedure is recommended for patients with shoulder instability and glenoid bone loss. The size of the coracoid graft influences the success rate of the procedure.
Objective: To measure the coracoid size from a CT scan, to compare the coracoid size based on the patient’s ethnicity and to evaluate the patient’s suitability for the Latarjet procedure (i.e., according to safe zone parameters).
Methods: This retrospective study included participants aged 18 years and above, who’ve had CT scans of their shoulders at Burapha University Hospital between 1st January 2013 to 31st January 2023. The CT scans allowed the length and width of the coracoid to be analyzed. The coracoid length was measured on an axial oblique plane which was truly parallel to the coracoid process, as determined with 3D MPR. We used descriptive statistics in terms of average and frequency to present the result of the study.
Results: There were 35 shoulders included in this study – 18 males and 17 females. The average height of the female participants was 155.76+6.03 cm; male participants was 170.11+8.66 cm. The average coracoid length was 26.90+3.43 mm – with males at 28.86+3.05 mm and females at 24.84 + 2.52 mm. The width of the coracoid at the front and back were 9.34+1.66 and 11.83+2.36 mm, respectively. When divided by sex, the male coracoid size was bigger. The average upfront dimension in males was 10.36+1.31 mm, and in females was 8.26+1.26 mm. The back dimension in males was 13.03+1.91 mm, and 10.55+2.14 mm in females. Compared with other ethnicities, our results revealed an overall smaller size of the coracoid process. The distance from the insertion of the CC ligament to the distal tip (known as the “safe distance” for the Latarjet procedure – between the implant used and the coracoid osteotomy point) should be at least equal to the diameter of the implant. The safe distance for the Latarjet procedure achieved in females was 5.90% of the participants (1/17) for a 4.50 mm-sized screw, 52.90%
(9/17) for a 3.50 mm-sized screw, 64.70% (11/17) for a 3.75 mm-sized screw, and 88% (15/17) for a 2.80 mm-sized button. In males, the safe zone was achieved in 44.40% (8/18) of patients for a 4.50 mm-sized screws, 88.90% (16/18) for a 3.50 mm-sized screw, 94.40% for a 3.75 mmseized screws, and 100% (18/18) for a 2.80 mm-sized button.
Conclusions: Coracoid sizes in the Thai population are smaller compared to other ethinicities, especially in females of short stature. The prospective surgeon should be aware when performing the Lartajet procedure on this kind of patient.
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