Complications associated with open coracoid transfer procedures for shoulder instability

J Shoulder Elbow Surg. 2012 Aug;21(8):1110-9. doi: 10.1016/j.jse.2012.02.008. Epub 2012 May 18.


Background: Interest has been maintained in the use of coracoid transfer procedures for recurrent shoulder instability despite the significant potential for serious complications. A comprehensive systematic review of the literature was performed to quantify and characterize the complication rate associated with these procedures to better inform practicing surgeons and their patients.

Materials and methods: Medline, Excerpta Medica Database (EMBASE), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched for therapeutic studies published between 1985 and 2011. Data regarding complications was extracted from selected articles in a standardized manner. Complication rates were determined and expressed as percentages with 95% confidence intervals.

Results: Included were 30 studies describing the results of 1658 coracoid transfer procedures. Repeat surgery was documented in 4.9% ± 1.0% of cases. Recurrent instability occurred in 6.0% ± 1.2%. Hardware complications occurred in 6.5% ± 1.3%. Collectively, the rate of graft nonunion, fibrous union, or postoperative graft migration was 10.1% ± 1.6%; graft osteolysis occurred in 1.6% ± 0.7%. There was a 1.2% ± 0.8% rate of nerve palsy. Surgical site infection occurred in 1.5% ± 0.7%. Intraoperative fractures occurred in 1.1 ± 0.6%.

Conclusion: Coracoid transfers for shoulder instability can improve shoulder stability with acceptable recurrence rates. They are challenging procedures associated with a broad range and significant incidence of complications. A detailed appreciation of anatomy and meticulous attention to technical detail, particularly graft placement, is key to reducing complications. These procedures may be best indicated in the setting of glenoid or humeral bony deficiency, although efficacy over open capsular procedures remains equivocal.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Arthroplasty / adverse effects
  • Arthroplasty / methods*
  • Bone Transplantation / adverse effects
  • Bone Transplantation / methods
  • Female
  • Fractures, Bone / diagnostic imaging*
  • Fractures, Bone / physiopathology
  • Graft Rejection
  • Humans
  • Intraoperative Complications / diagnostic imaging*
  • Intraoperative Complications / surgery
  • Joint Instability / diagnostic imaging
  • Joint Instability / surgery*
  • Male
  • Postoperative Complications / epidemiology
  • Postoperative Complications / physiopathology
  • Prognosis
  • Radiography
  • Range of Motion, Articular / physiology
  • Recurrence
  • Reoperation
  • Risk Assessment
  • Scapula / surgery
  • Scapula / transplantation*
  • Shoulder Dislocation / diagnostic imaging
  • Shoulder Dislocation / surgery*
  • Treatment Outcome