Arthroscopic Coracoid Transfer in the Treatment of Recurrent Shoulder Instability: A Systematic Review of Early Results

Purpose: Systematic review of the literature to characterize safety profile and complication rates associated with arthroscopic coracoid transfer procedures. Methods: We conducted a combined search of Medline, EMBASE, and the CINAHL databases from 1985 to November 2012. Articles were selected and data extracted according to standard criteria. Results: Only 3 studies met the inclusion criteria, and these originated from the pioneers of this technique. These studies described the results of 172 arthroscopic coracoid transfer procedures with an overall complication rate of 19.8% +/- 5.6%. Conversion to open surgery was necessary in 6/172 (3.5%) patients. Repeated surgery was described in 5/172 (2.9% +/- 2.5%) cases, all for screw removal. The overall rate of recurrent instability was 3/172 cases (1.7% +/- 2%). Hardware-related complications occurred in 4/172 patients (2.3% +/- 2.3%). Coracoid grafts failed to unite in 14/172 patients (8.1% +/- 4.1%); graft osteolysis was seen in 7/172 patients (4.1% +/- 2.6%). The coracoid graft fractured in 2/172 cases (1.2% +/- 1.6%); one of these occurred intraoperatively and one occurred early postoperatively. There was one transient nerve palsy (0.6% +/- 1.1%). Conclusions: Results of arthroscopic coracoid transfer surgery for anterior shoulder instability are sparse, with the available studies originating from the pioneers of this technique. Early results suggest that arthroscopic coracoid transfer is a technically feasible procedure that is able to restore shoulder stability. However, this technique seems to be associated with a high complication rate and a steep learning curve. Results from the wider orthopaedic shoulder arthroscopic community are awaited. Extensive cadaveric training and experience with the open technique is recommended before performing the arthroscopic procedure. Level of Evidence: Systematic review of Level IV studies.