These authors reviewed the Latarjet practice of a highly experienced shoulder surgeon, including 38 patients (group 1) who underwent surgery before neuromonitoring study and 48 patients (group 2) who underwent surgery with neuromonitoring.
In group 1, there were 7 nerve injuries, of which all but 2 recovered. In group 2, there were 3 nerve injuries, of which all but 1 recovered. The overall incidence of nerve injury was 18.4% (group 1) vs. 6.3% (group 2); however, the incidence of permanent motor dysfunction was 5.3% (group 1) vs. 2.1% (group 2).
Thus overall 12% of patients experienced nerve injuries and 3.5% of these did not recover.
Thus overall 12% of patients experienced nerve injuries and 3.5% of these did not recover.
The supra scapular nerve was injured in 2, the axillary in 6, the musculocutaneous (MCN) in 3 and the radial in one. For the nerve injuries that were not permanent, recovery took from 2 to 9 months.
In one patient the EMG demonstrated severe axillary nerve dysfunction and MCN dysfunction. Required open nerve release of his axillary and MCNs MCN resolved, axillary permanent (mild deltoid weakness at 11 months).
In another with EMG confirmation, resection of axillary nerve neuroma was performed with end-to-end motor nerve transfer of radial nerve medial triceps to axillary motor nerve (12.6 months post-op). Moderate recovery with mild deltoid weakness at 12 months after nerve transfer.
In another with EMG confirmation, revision reconstruction was performed with iliac crest bone graft and suprascapular nerve decompression (28 months).
In another with EMG confirmation, there was mild permanent deltoid weakness and numbness (lost to follow-up at 15 months).
In another with EMG confirmation, resection of axillary nerve neuroma was performed with end-to-end motor nerve transfer of radial nerve medial triceps to axillary motor nerve (12.6 months post-op). Moderate recovery with mild deltoid weakness at 12 months after nerve transfer.
In another with EMG confirmation, revision reconstruction was performed with iliac crest bone graft and suprascapular nerve decompression (28 months).
In another with EMG confirmation, there was mild permanent deltoid weakness and numbness (lost to follow-up at 15 months).
The authors identified certain risk factors for nerve injury:
Comment: This report clearly documents the risk of serious nerve injury with the Latarjet procedure, even when it is performed by expert hands. Recovery, if it occurred, required many months. When recovery did not occur, major reconstructive procedures were considered.
This information is useful in surgical decision making and in preoperative discussions with patients considering this procedure.
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