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      Going in for latarjet surgery
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      TOPIC: Going in for latarjet surgery

      Re: Going in for latarjet surgery 3 years, 2 months ago #29678

      • riderk
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      Everyone has a valuable experience to share, good and not so good. But the important thing to remember is that everyone has their own valid experience. Statistics and studies are great, until you are the outlier.
      I wonder if any other major joints have such non-anatomical procedures done like the reverse replacement or even latarjet. Academically, I "get" the purpose of the reverse, but for an active person? Or the latarjet - what is the purpose of the coracoid in the normal anatomy? I have it staring at me in the mirror due to atrophy - why is it there and why don't we need it? Why is it OK to turn a joint upside down and inside out? So far, the proponents of the reverse expect the patients to die before they complain, which is why it is only suggested for those over 70.

      Yeah yeah, i ask too many questions!

      Re: Going in for latarjet surgery 3 years, 2 months ago #29681

      • LorenzoSC
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      Hi riderk,
      you said it, I don't think such an invasive procedure like the reverse is suited for an active person, even in terms of purpose. I guess its aim is to cut down pain in seriously arthritic shoulders with minimal improvement in ROM as an additional benefit. The case of young people with seriously impaired shoulders due to trauma is border-line for current ortho practice, as for now.
      The Latarjet is kinda different, because it usually works quite good even for top-level athletes. Of course no one is the same and there are possible terrible outcomes for it either.
      What's the gist of shattering a piece of body to heal another part? I don't know, maybe maximum gain with minimum effort? I have a split coracoid and, btw, half a patellar tendon with boney incisions for ACL purpose in my knee, both of them feels weird to say the least but their sacrifice restored proper function to otherwise damaged joints. I guess I'm lucky I'm full into statistics for both surgeries, had been a couple of standard deviations outside, everything would have been different!
      "Subice te rationi, si tibi subicere vis omnia."

      Re: Going in for latarjet surgery 3 years, 2 months ago #29682

      • riderk
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      I understand the latarjet is very successful and it makes sense mechanically. What I do not understand it the purpose of the coracoid in its natural position.

      As for the reverse, well, no one here cares except me. I heard one surgeon say that his first thought when he sees a candidate for reverse is, will I be able to revise this?

      Re: Going in for latarjet surgery 3 years, 2 months ago #29683

      • LorenzoSC
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      [quote="riderk" post=29682]I understand the latarjet is very successful and it makes sense mechanically. What I do not understand it the purpose of the coracoid in its natural position.

      I think its evolutional function was that of attaching bicep short head and pectoralis minor, force lines for those tendons follow its shape quite good. Just my 2 cents...
      "Subice te rationi, si tibi subicere vis omnia."

      Re: Going in for latarjet surgery 3 years, 2 months ago #29690

      • ljansen
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      in terms of normal anatomic function of the coracoid...given it's shape/location, it's basically an anchor point for various ligaments and muscultendinous structures. Ligamentous structures attaching to the coracoid are the coracoacromial, coracohumeral and coracoclavicular ligaments with all of the coracoid attachments of these ligaments being on the superior (lateral superior for coracohumeral, medial superior for coracoclavicular). These all serve a purpose for static suspension of the of the shoulder complex by placing an upward line of force (direction of force) to the shoulder. The coracoacromial and coracohumeral ligaments also serve as a superior barrier to the glenohumeral joint in preventing superior dislocation of the humeral head.

      The inferior portion of the coracoid serves as attachment and provides a lever anchor for muscuotendinous structures. The pec minor (which suspends ribs 2-4...i think, I don't remember exactly how many ribs it attaches to) is the first thing to be removed during latarjet and most times is not re-attached. the short head of the biceps and coracobrachialis attach to the inferior lateral portion of the coracoid and are those anchors necessary for lever movements of shoulder flexion and also elbow flexion with regards to the biceps.

      The biceps and coracobrachialis attachments remain untouched during the latarjet but one has to wonder if the length/tension of those muscles is affected when they are moved inferiorly to the new attachment at the inferior glenoid...especially for those who have previously also had a biceps tenodesis or tenotomy. Studies have shown there is no significant change to this relationship, but those studies were on cadaver shoulders tested by being anchored to 2x4's, so functionally speaking, I guess we have to take that with a grain of salt. I think the biggest issues are with the ligaments and I think the functions of those ligaments are gravely overlooked y surgeons. By removing those superior ligaments, and removing the superior barriers you risk superior migration of the humeral head and people do age, and I'd be curious to know long term studies on the cuff after latarjet after years of motion with a humeral head's constant pressure and impingement on the cuff. I have only seen longterm studies for latarjet focusing on joint/OA and stability. So while the coracoid itself may just be a piece of bone sacrificed for the stability of the shoulder, I think the attachments are important and I'm learning this after having most of them removed. My coracoacromial ligament is now part of my anterior inferior shoulder capsule used to reinforce.

      I dunno, most people do well after surgeries like the latarjet and unfortunately there are some outliers and anatomy is not textbook a lot of times, so predicting how someone might do after any type of surgery is impossible. So we all must weigh the possible risks with the benefits, nothing in life is a guarantee, but all anyone can do is take one day at a time, life is not something that can be rushed through and either is rehab from shoulder surgery. Here is a functional shoulder anatomy .pdf for anyone that is interested in learning more about the structures that surround the most complex joint in the body


      File Attachment:

      File Name: shoulderanatomy.pdf
      File Size: 3,999 KB
      R. Shoulder Capsular Shift - Sept. 03
      L. Shoulder Bankart/SLAP/Capsular Shift/Rotator interval & SS repair - Jan. 05
      L. Shoulder MUA/adhesion release - Jan. 06
      L. Shoulder SAD/Bursectomy - Sept. 07
      L. Shoulder Biceps Tenodesis - Mar. 09
      L. Shoulder Open Latarjet & Arthroscopy - Nov. 24, 2011
      L. Shoulder Capsular Release/SAD - June 11, 2012
      L. Shoulder Capsular Release/Screw Removal/Biceps Tenotomy - Mar. 22, 2013
      L. Shoulder Arthroscopic Latarjet Screw Removal, Interval Repair, Axillary Neurolysis, Debridement
      Last Edit: 3 years, 2 months ago by ljansen.

      Re: Going in for latarjet surgery 3 years, 2 months ago #29691

      • riderk
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      Exactly.

      I just purchased a lecture entitled "Reverse shoulder arthroplasty: instrument of the devil?" My kind of talk...
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