A survey of the variety of Latarjet procedure techniques as used by Orthopedic Surgeons in Thailand

Abstract

Context: The Latarjet procedure can have several variations in operative technique, and in many aspects follows the preferences of the individual surgeon. We aimed to survey these diverse techniques in the context of indication, surgical approach, sub-scapularis management, instruments for graft fixation as well as techniques for capsular repair.

Objective: To survey the variety of Latarjet procedure operating techniques among sport medicine surgeons in Thailand.

Methods: A cross-sectional descriptive sample survey in which a questionnaire was sent to current members of the Sports Medicine Subspecialty, totaling 475 individuals, via email of Thai Orthopedics Society for Sport Medicine (TOSSM). The 11-item questionnaire was developed based on a review of literature and research. The content validity (IOC) was evaluated by three
experts. The IOC for each item was ≥ 0.5. The inclusion criteria for the sample were that the participant must be a specialist and a member of TOSSM. The exclusion criterion was that the participant have never performed the Latarjet procedure. The results were analyzed using descriptive statistics.

Results: A total of 94 specialists responded to the survey, and 80 specialists who had
undergone the Latarjet procedure were included in the sample. It was found that 80% of surgeons performed the Latarjet procedures using a criteria of glenoid bone loss greater than 20% on non-athlete patients. In contrast, for athletes, 16.25% and 35% of the sample used criteria of glenoid bone loss greater than 13.5% and 15%, respectively. Regarding the surgical approach, 81.25% of the sample underwent surgery using the Delto-pectoral approach, and only one surgeon had arthroscopic surgery. For the management of the subscapularis, 75% of the sample underwent subscapularis splitting. The most commonly used method for fixation was the classical technique, applied in 61.25% of the cases, with screws used for all fixations. In terms of capsular management, 40% of the cases involved suturing the capsule to the coracoid
process, 32.5% sutured to the glenoid, and 27.5% did not undergo any suturing.

Conclusions: The Latarjet procedure performed by specialists is indicated based on the necessity for post-surgical shoulder joint function. In non-athlete patients, the procedure is typically recommended when there is more than 20% glenoid bone loss, while for athletes, the threshold is lowered to 13.5% and 15%, respectively. Regarding surgical technique, the Delto-pectoral approach is the most commonly used, accounting for 81% of cases. For muscle
management, the splitting technique is preferred. Bone fixation is generally performed using the classical technique The capsular repair is more frequently performed than not, with a ratio of 72.5% to 27.5% in favor of suturing the capsule.