Predictors of coracoid graft osteolysis after the Latarjet procedure: A systematic review

Background Coracoid graft osteolysis is a known complication following the Latarjet procedure and may influence postoperative shoulder stability. While prior studies have reported variable rates of graft osteolysis, the risk factors that influence this process are not well defined. Therefore, the purpose of this systematic review was to investigate the risk factors associated with coracoid graft osteolysis after the Latarjet procedure. We hypothesized that the location of coracoid graft placement on the glenoid would influence graft osteolysis. Methods This review followed PRISMA guidelines to query the Medline, Embase, and Cochrane online databases. Eligible studies included prospective or retrospective clinical studies, including cohort studies, comparative studies, and case series, reporting postoperative graft osteolysis assessed by computerized tomography (CT) after the Latarjet procedure. A qualitative analysis was performed. Results Fifteen studies met the criteria to be included in this review, encompassing 963 patients. Of the four studies that assessed open vs arthroscopic Latarjet, open Latarjet was associated with increased rates of graft osteolysis in 3 of the 4 of studies (214 of 262 patients). There was an inverse relationship found between preoperative glenoid bone loss and graft osteolysis in 3 of 6 studies (256 of 382 patients), and there were no relationships observed between graft osteolysis and graft position, fixation type, or patient demographics. One of six studies that assessed osteolysis impact on clinical outcomes found lower Walch-Duplay scores as well as recurrent instability, while all other studies found no relationships noted between graft osteolysis and patient-reported outcome measures (PROMs), range of motion, or strength. Discussion and conclusion Coracoid graft osteolysis after the Latarjet procedure appears to be influenced by surgical technique (open vs arthroscopic) and preoperative glenoid bone loss, with the arthroscopic technique and increased preoperative glenoid bone loss showing reduced graft osteolysis in some studies. However, most studies demonstrated no significant association between graft osteolysis and clinical outcomes, with contrary findings limited to small, underpowered cohorts. Level of Evidence IV