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Introduction: Congruent arc Latarjet procedure involves rotating the coracoid process so that its inferior surface is flush with the glenoid face, owing to their matching radius of curvature (ROC). However, there has been no cadaveric study to actually measure and compare the ROC of coracoid with glenoid, especially in Indian population., Materials and Methods: 44 shoulders were dissected in 24 cadavers to measure usable length of coracoid process, width, height, ROC of coracoid and glenoid as well as ulnar length (as proxy of cadaver height). Critical coracoid height and length were estimated based on screw sizes of 2.7 mm, 3.5 mm, 4 mm and 4.5 mm, and pair concordance between height and length calculated. ROC of coracoid and glenoid were compared to measure extent of congruency., Results: The mean usable length of coracoid process, width and height at mid-point were 21.8 mm, 13.7 mm and 8.6 mm, respectively. Out of the different screw sizes, 2.7 mm screws were found safe in 82% shoulders. 24 coracoid-glenoid pairs fulfilled the operational definition (≤ 5 mm) of congruency while rest 20 were seemingly incongruent chiefly due to coracoid variations, with mean ROC difference 4.13 mm (95% CI 1.51-6.74 mm). The ulnar length was significantly smaller in the incongruent ROC group (p = 0.0002)., Conclusions: The available length as well as height of the transferred coracoid must be considered when deciding optimum diameter fixation screws in Latarjet procedure. Owing to smaller anatomic dimensions of coracoid in Indian population, 2.7-mm screws provide the safest fixation option. Also, the ROC of coracoid and glenoid does not match in substantial proportion of the cadavers. Pre-operative planning should include a CT-based assessment of glenoid and coracoid dimensions to decide the technique of Latarjet procedure and the optimum diameter fixation screws required.

Rationale: Coracoid processes (CPs) fracture with acromioclavicular (AC) joint dislocation are extremely rare. This combined injury has brought many challenges to surgeons, and the mechanism underlying the injury is still not fully understood. There is no clear consensus on its treatment., Patient Concerns: Here, we describe a CP fracture with AC joint dislocation in a middle-aged manual worker., Diagnosis: Radiographs showed a fracture of the base of the CP and a third-degree AC joint separation., Interventions: The patient was treated surgically with open reduction and internal fixation of the AC joint by LCP clavicle hook plate, and the CP was fixed with a 3.5 mm diameter cannulated screw., Outcomes: Three months after the operation, shoulder function was completely restored, and the affected shoulder had full mobility with no tenderness. Plain film radiography showed anatomical indications of the healing of these combined injuries., Lessons: Although AC joint dislocation with CP fractures is extremely rare in adults, it is important to remind and remember that this possibility exists. In unclear cases, special radiographic films and CT are necessary. Surgical treatment of AC joint dislocation with CP fractures can provide solid stability and restore normal shoulder function with an excellent prognosis.

Background: The pathophysiology of subscapularis (SS) lesions is still relatively unknown despite recent interest in predictive factors for SS tears. Our goal was to determine the influence of the coracoid morphology and humeral version on SS tears., Methods: This was a retrospective, controlled, single-blinded study. We analyzed 232 shoulders with SS lesions confirmed by magnetic resonance imaging. The coracoid proximal length, coracoid distal length (CLD), and coracoid total length were measured. The coracoid length ratio, coracoid angle (CA), and humeral version were also evaluated., Results: We found that greater humeral retroversion was progressively related to more serious SS injuries, with values of -28.6° ± 19.5° and -51.0° ± 11.1° in the normal SS group and tear group, respectively (P < .001). The same tendency was shown for the CA, with values of 123.8° ± 11.1° in the control group vs. 97.4° ± 10.1° in the tear group (P < .001). Greater CLD, coracoid total length, and coracoid length ratio were also associated with an increased risk of SS tears (P < .001). The CA and CLD represented the best predictors of SS tears, presenting areas under the receiver operating characteristic curve of 90.0% and 89.0%, respectively., Conclusions: This article is the first to study the influence of different parameters of the coracoid process morphology and humeral version on SS tears. We proved that humeral version and coracoid morphology were important risk factors for SS pathology and could accurately predict these lesions. Finally, our study was the first to create a classification system to divide coracoids according to their morphology and relative risk of associated SS tears., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Latarjet is one of the most common surgical procedure performed on patients with shoulder instability with osseous defects, some complications include coracoid bone graft osteolysis, osteoarthritis, graft detachment, and malpositioning were previously reported. Several studies investigated potential causes of graft osteolysis but still, it remains a crucial area of investigation. We aim to use finite element analysis to examine the potential correlations between three modes of fixation methods used in the Latarjet procedure (screw, wedge plate, and endobutton), and the coracoid graft osteolysis., Hypothesis: Finite element analysis tested the hypothesis that there is a linear relationship between the compression stress on graft which was generated by fixation methods used in the latarjet and the coracoid graft osteolysis., Material and Methods: Boundary conditions and inhomogeneous material properties were carefully assigned within the material of the scapula and coracoid interface. For the screw and wedge plate fixations, an applied torque in the range of 1-1.5Nm was used to characterize the surgeon's insertion torque during the surgical operation, while a 100N compressive force was selected for the endobutton fixation., Results: Relatively lesser stress magnitudes were observed with endobutton fixation method rather than screw and the wedge plate fixation. Statistical analyses revealed significant differences between the groups (p<0.05)., Discussion: Excessive compressive stresses within the coracoid graft regions may be responsible for osteolysis due to negative effects over biological factors such as blood flow. Our study emphasizes the importance of taking into account the fixation method while performing the Latarjet procedure. We concluded that the mode of fixation used within the Latarjet procedure has a correlation on the coracoid graft osteolysis., Level of Evidence: I., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: Although scapular morphology contributes to glenohumeral osteoarthritis and rotator cuff disease, its role in traumatic glenohumeral instability remains unknown. We hypothesized that coracoacromial and glenoid morphology would differ between healthy subjects and patients with recurrent traumatic anterior shoulder instability., Methods: Computed tomography scans of 31 cadaveric control scapulae and 54 scapulae of patients with recurrent traumatic anterior shoulder instability and Hill-Sachs lesions were 3-dimensionally reconstructed. Statistical shape modeling identified the modes of variation between the scapulae of both groups. Corresponding measurements quantified these modes in relation to the glenoid center (linear offset measures), defined by the best-fit circle of the inferior glenoid, or the glenoid center plane (angles), which bisects the glenoid longitudinally. Distances were normalized for glenoid size., Results: Compared with controls, the unstable coracoids were shorter (P = .004), with a more superior and medial offset of the tip (mean difference [MD], 7 and 3 mm, respectively; P < .001) and an origin closer to the 12-o'clock position (MD, 6°; P < .001). The unstable scapular spines originated closer to the 9-o'clock position (MD, 4°; P = .012), and the unstable acromions were more vertically oriented (MD, 6°; P < .001). The unstable glenoids had an increased height-width index (MD, 0.04; P = .021), had a flatter anterior-posterior radius of curvature (MD, 77 mm; P < .001), and were more anteriorly tilted (MD, 5°; P = .005)., Conclusions: Coracoacromial and glenoid anatomy differs between individuals with and without recurrent traumatic anterior shoulder instability. This pathologic anatomy is not addressed by current soft-tissue stabilization procedures and may contribute to instability recurrence., (Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to investigate the relationship between the bone length available for coracoid transfer without coracoclavicular ligament injury and the distance from the coracoid tip to the attachments of the coracoacromial ligament or pectoralis minor. We hypothesized that cadaver height and the soft tissue attachments on the coracoid process were predictive factors for sufficient bone length for coracoid transfer., Methods: This study included 28 shoulders from Japanese cadavers: 19 male and 9 female. The distance from the coracoid tip to the distal attachment of the coracoclavicular ligament and the anterior and posterior margins of the coracoacromial ligament or pectoralis minor on the coracoid process were measured., Results: The mean available length for coracoid transfer was 24.8 ± 3.4 mm. There was a significant difference in length between male and female subjects, being 26.0 ± 2.9 mm and 22.2 ± 3.0 mm, respectively (p = 0.004). High positive correlations were found between the length of the coracoid transfer and cadaver's height (r = 0.48, p = 0.009) and the distance from the coracoid tip to the anterior coracoacromial ligament attachment (r = 0.63, p < 0.001). The receiver operating characteristic curve area under the curve for cadaver height was 0.72 while that for distance from coracoid tip to anterior coracoacromial ligament was 0.88 when predicted for a sufficient length for coracoid transfer > 25 mm., Conclusions: Our findings will aid surgeons in preoperative planning and performing of osteotomy of the coracoid safely by predicting the available length of coracoid bone graft.

BACKGROUND There are few studies on distributions or morphological measurements for bony spurs form at the attachment points of the ligaments and tendons on the coracoid process. The aim of this study was to investigate their most common sites and morphological characteristics, and to propose possible reasons. MATERIAL AND METHODS Scapulae with bony spurs on the coracoid process were selected from 377 intact and dry Chinese scapulae. The distribution, height, and transverse and longitudinal diameter of the bony spurs were measured in each coracoid process. RESULTS We selected 71 scapulae, 36 left and 35 right, that had bony spurs, from 377 scapulae. The bony spurs were most commonly located at the attachment point of the superior transverse scapular ligament (STSL) (31, 23.66%), while the trapezoid ligament (TL) accounted for the smaller proportion (8, 6.11%). The TSL was the highest, with the minimum transverse and longitudinal diameter, while the TL had the greatest transverse and longitudinal diameters. Only the TSL and TL had a statistically significant difference between the left and the right bony spur regarding the longitudinal diameter (P<0.05). CONCLUSIONS Bony spurs are more likely to form at the attachment points of ligaments and tendons on the coracoid process, which has a greater risk of traction injuries or attachment points avulsion fractures.

Objective: To identify factors that influence shoulder balance and to determine whether a model can be made to predict shoulder balance after corrective surgery., Methods: This is a retrospective study in which we examined the records of with adolescent idiopathic scoliosis (AIS) patients who underwent single posterior spinal correction and fusion using all pedicle screws with derotation in our institution between January 2008 and June 2010. For the radiographic outcome measurement, we measured the preoperative lumbar curve, the main thoracic curve, and their difference (L&#95;TH&#95;D), and the degree of correction of the lumbar curve, the main thoracic curve, and their difference (c&#95;L&#95;TH&#95;D) to evaluate their influence on postoperative shoulder balance. The preoperative flexibility of the proximal non-fusion curve on the immediate postoperative tilt of the upper endplate of the uppermost vertebra of fusion segments (Up&#95;FuS) was used to evaluate and predict the shoulder balance at follow-up., Results: For patients who had shoulder balance at follow-up, the average balance time was 7.1 months, and in most of them, balance was detected within 12 months. The main thoracic curve has the greatest influence on preoperative shoulder tilt and correction of the main thoracic curve has the greatest influence on the postoperative alteration in shoulder balance. To evaluate the influence on the preoperative shoulder tilt, the lumbar curve must be larger than the main thoracic curve both pre operatively and postoperatively. If the preoperative flexibility of the proximal non-fusion curve on the immediate postoperative Up&#95;FuS includes the horizontal line (With Horizontal group), shoulder balance can be ensured. The postoperative Up&#95;FuS can be evaluated based on the preoperative Up&#95;FuS and the degree of correction of the lumbar and main thoracic curves., Conclusion: Shoulder balance can be ensured in patients in the With Horizontal group after surgery. If the preoperative Up&#95;FuS and the degree of correction of the main thoracic curve and the lumbar curve are considered in the preoperative plan, the desired postoperative Up&#95;FuS can be achieved, ensuring shoulder balance at follow-up., (© 2018 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)

Rationale: We report a rare case of hepatocellular carcinoma (HCC) with metastases to the mandible and coracoid process of scapula without evidence of lung involvement., Patients Concerns: The patient was diagnosed with HCC, presented 5 months later with right lower tooth pain, swelling over the right mandible area and right shoulder pain., Diagnoses: Histopathological examination of mandible showed findings suggestive of metastatic HCC. Magnetic resonance imaging (MRI) of the right shoulder revealed findings of irregular enhancing lesion at the right coracoid process causing erosion of the coracoid process., Interventions: Patient was subsequently referred for palliative medicine care., Outcomes: He received adequate analgesia., Lessons: Oral cavity and scapula metastases from HCC are very rare. Most oral metastases are associated with lung metastases, and they possibly occur by hematogenous route. In our case, the possible pathway of metastasis is an anastomotic network of paravertebral veins that bypasses the pulmonary, inferior caval, and portal venous circulations.

Background: Recurrent glenohumeral instability is often a result of underlying bony defects in the glenoid and/or humeral head. Anterior glenoid augmentation with a coracoid bone block (ie, Latarjet procedure) has been recommended for glenoid bone loss in the face of recurrent instability. However, no study has investigated the effect of Latarjet augmentation in the setting of both glenoid and humeral head defects (Hill-Sachs defects)., Purpose: To evaluate the glenohumeral kinematics of the Latarjet procedure in the presence of combined bony defects., Study Design: Controlled laboratory study., Methods: Eighteen fresh-frozen cadaveric specimens void of all surrounding soft tissue were tested at all combinations of glenohumeral abduction (ABD) angles of 20°, 40°, and 60° and 3 external rotation (ER) levels of 0°, 40°, and 80°. Each experiment comprised anterior dislocation by translating the glenoid under a 50-N medial load applied on the humerus, simulating the static load of soft tissue. The primary outcome measurement was defined as the percentage of intact translation (normalized distance to dislocation). Specimens were tested in an intact condition (no defect), with different combinations of defects, and with Latarjet augmentation. The Latarjet procedure was performed for 20% and 30% glenoid defects by transferring the specimen's coracoid process anterior to the glenoid so that it was flush with the articulating surface., Results: Results depended on the position of the arm. At 20° of ABD and 0° of ER, a 20% glenoid defect decreased the percentage of intact translation regardless of the humeral head defect size (P ≤ .0001). In this same setting, Latarjet reconstruction restored translation to dislocation greater than the native intact joint for all sizes of humeral head defects. At 60° of ABD and 80° of ER, a 20% glenoid defect led to an overall decrease in translation to dislocation with increasing humeral head defects. While Latarjet augmentation resulted in increased translation to dislocation for all humeral head defect sizes, it was not able to restore translation greater than the native intact joint for large humeral head defects (31% and 44%); the normalized percentages of intact translation to dislocation were 65% and 30%, respectively., Conclusion: These results demonstrate that some degree of translation can be regained for combined bony glenoid and humeral head defects with the Latarjet procedure. However, for humeral defects larger than 31%, the rotational effect of the humeral head defect led to persistent decreased translation and to dislocation despite glenoid augmentation. Thus, directly addressing the humeral defect to restore the articular surface should be considered in these cases., Clinical Relevance: This study provides a critical value limit for combined anterior glenoid bone loss and humeral head defects. While this is a biomechanical study, the results indicate that in patients with humeral head defects greater than 31%, additional humeral-sided surgery may be needed., (© 2016 The Author(s).)