Anatomic study: suprascapular nerve safety zone in open Latarjet surgery

André Leonardo Nogueira Farias; Rômulo Brasil Filho; Antonio Carlos Tenor Júnior; Jorge Henrique Assunção; Caio Santos Checchia; Alexandre Lädermann; Eduardo Angeli Malavolta

Abstract

Background: Iatrogenic injury to the suprascapular nerve is a known complication of the Latarjet procedure. This cadaveric study aimed to define a reproducible anatomical safety zone for screw and Kirschner wire placement, a critical factor in avoiding nerve damage. It also assessed whether sex or anthropometric characteristics influence this risk.Hypothesis: The open Latarjet procedure, when performed with proper screw positioning, does not injure the suprascapular nerve.Methods: Twenty eight fresh-frozen adult cadaveric shoulders underwent simulated open Latarjet procedures using 2.0 mm Kirschner wires to represent screw trajectories. After graft fixation, posterior dissection enabled direct visualization and measurement of distances to the suprascapular nerve. The superior distance (SUP) was defined from the supraglenoid tubercle to the suprascapular notch; the posterior distance (POST), from the posterior glenoid rim at the 9 o’clock position to the spinoglenoid notch. Coracoid graft dimensions, insertion angles, and nerve injury rates were also recorded. Comparisons were made by sex and height, using t-tests, ANOVA, linear regression, and Pearson correlation (α = 0.05).Results: Males showed greater SUP (33.2 ± 6.3 mm vs. 28.1 ± 3.5 mm; p = 0.012) and POST (18.2 ± 3.9 mm vs. 15.3 ± 2.2 mm; p = 0.024) distances than females. Height correlated with POST distance (β = 18.76; p = 0.012). Nerve injuries occurred in 14% of superior and 7% of inferior wire placements, regardless of sex or height (p > 0.85).Conclusion: Screw angulation and graft positioning critically impact suprascapular nerve safety during the Latarjet procedure. Individualized planning is essential to reduce iatrogenic risk.What this study adds: This cadaveric study validates a reproducible posterior safety zone below the spinoglenoid notch during the open Latarjet procedure and highlights the importance of screw trajectory and inferomedial angulation in reducing suprascapular nerve injury risk.Implications for research, practice or policy: These findings may help surgeons optimize graft fixation and screw positioning during open Latarjet procedures, while supporting future anatomical and clinical studies aimed at improving neurovascular safety guidelines.Study Design: Cadaveric anatomical studyLevel of evidence: VKeywords: Glenohumeral instability; Complication; Cadaveric study; Deltopectoral approach; Innervation supraspinatus.https://doi.org/10.70885/hmsj.2026.05.002

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