Investigating blood supply to the coracoid bone graft in latarjet procedures — a cadaveric study

Background: The Classic Latarjet Procedure (CLP) is a proven method for increasing anterior shoulder stability, where the posterior aspect of an osteotomized coracoid is fixed to the glenoid rim. De Beer’s Congruent-Arc Technique (CAT) is a recognized variation where the medial aspect of the coracoid is fixed to the glenoid. Consolidation of the coracoid graft depends on the compression achieved and the vascularity of the graft. Nonunion rates of 9.4% have been documented in the literature. Methods: Ethical approval was granted for our study by the medical school ethics board. Eight cadaveric shoulders were dissected using the standard deltopectoral approach. In each limb, the blood supply to the coracoid was identified, photographed, and protected. The coracoid process was osteotomized at its elbow and a bone transfer was performed. The effects on the coracoid blood supply of CLP vs CAT were noted. Results: In all cases, the blood supply to the coracoid process arose directly from the axillary artery, bifurcating close to the tip of the coracoid. CLP was performed with no disruption to the arterial supply of the coracoid or pectoralis minor. CAT was found to stretch the arterial supply in most specimens, potentially impacting blood supply to the coracoid. CAT also requires the sacrifice of the arterial branch to the insertion of the pectoralis minor. Conclusion: CLP appears less likely to stretch its arterial supply compared to CAT and allows retention of the arterial branch to pectoralis minor insertion. This has potential implications for graft union and recurrent shoulder instability.