Minimal adipose infiltration and good functionality of subscapularis after Latarjet using an inverted L-shaped tenotomy: results at minimum 10 years of follow-up

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Background: The Latarjet procedure is a well-established surgical technique for treating anterior shoulder instability. However, concerns remain regarding its long-term effects on subscapularis muscle integrity and glenohumeral joint health, particularly when using an inverted L-shaped tenotomy. This study aimed to evaluate subscapularis fatty infiltration and function, glenohumeral osteoarthritis, and bone graft osteointegration after a minimum 10-year follow-up. Methods: This prospective study included 32 patients who underwent the Latarjet procedure with an inverted L-shaped subscapularis tenotomy and single-screw coracoid fixation before January 2014. Functional outcomes were assessed using the Rowe and Constant Murley scores (CMS), subscapularis-specific strength testing, and internal rotation strength measured with a dynamometer. Magnetic resonance imaging was used to assess subscapularis fatty infiltration according to the Goutallier classification, while glenohumeral osteoarthritis was graded on X-ray using the Samilson-Prieto classification. Results: At final follow-up, 78.3% of patients achieved Rowe scores of good to excellent, and the mean Constant Murley scores was 94 ± 5.9. The mean subscapularis strength was 5 of 5 on the Medical Research Council scale in more than 90% of the patients, with an average internal rotation strength of 7.4 kg. Fatty infiltration of the subscapularis was classified as Goutallier grade 2 or 3 in 21.9% of cases. Glenohumeral osteoarthritis was identified in two-thirds of patients; however, 50% of these cases were classified as mild (grade 1). Complete graft osteointegration was observed in all cases. Conclusion: The Latarjet procedure with an inverted L-shaped subscapularis tenotomy provides satisfactory long-term clinical and radiological outcomes, with preservation of subscapularis function and limited fatty infiltration. These findings suggest that this approach represents a viable surgical option for anterior shoulder instability; however, no direct comparison was performed, and results should be interpreted in light of the study limitations.

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