Graft Condition, Position, and Reinjury Mechanisms in Competitive Rugby Players Experiencing Reinjury After Coracoid Transfer for Shoulder Dislocation
Takayuki Kawasaki, Takahiko Yoshimatsu, Yoshinori Hasegawa, Shogo Sobue, Yoshinori Gonda, Takefumi Kaketa, Yoshimasa Saigo, Yasutaka Yoshimura, Daichi Morikawa, Muneaki IshijimaBackground:
Although coracoid transfer is effective in collision athletes and has a low reinjury rate, few studies have focused on postoperative reinjury or revision surgeries in rugby cohorts.
Purpose:
To investigate the characteristics of reinjury in rugby players who underwent coracoid transfer for shoulder dislocations.
Study Design:
Case series; Level of evidence, 4.
Methods:
This study included 21 shoulders of 21 competitive male rugby players who experienced reinjury after coracoid transfer at the authors’ institute. Of these, 15 players underwent the Bristow procedure and 6 underwent the Latarjet procedure at the initial surgery. The primary analysis assessed the difference between each procedure regarding graft conditions before and after reinjury using computed tomography. Secondary analysis focused on comparing the mechanism of the initial injury with that of reinjury. In half of the players, arm position at the moment of reinjury was also evaluated using video footage.
Results:
Graft conditions varied before and after reinjury. In the Bristow patients (n = 15), graft failure occurred in 8 patients at reinjury, of whom 6 had achieved bone union before reinjury. In contrast, all 6 patients who had reinjury after Latarjet showed no graft failure at reinjury. The mechanism of initial shoulder dislocation was associated with tackles (16/21), whereas reinjury after coracoid transfer was more often associated with falls (10/21;
Conclusion:
In rugby players, reinjury after coracoid transfer can occur even when the graft has achieved bone union and sufficiently covers the glenoid bone defect. Among reinjured patients, the Bristow procedure tended to involve graft failure, whereas the Latarjet procedure maintained the graft intact, suggesting that the Latarjet may offer advantages in terms of graft strength and bone defect coverage in rugby players with shoulder instability. The mechanism of postoperative reinjury may partly differ from that of the initial dislocation, with significantly more cases occurring in a midrange shoulder position with the upper extremity hitting the ground.