What is the Latarjet Procedure?

The Latarjet procedure is a surgical technique used to treat shoulder instability, particularly in cases of recurrent shoulder dislocations caused by a loss of bone in the glenoid (the socket of the shoulder joint). It involves transferring a piece of bone, along with its attached tendon, from the coracoid process (a small hook-like bone on the scapula) to the front of the glenoid to restore stability to the shoulder joint.

This procedure is most commonly performed when other treatments, such as arthroscopic stabilization, have failed or when significant bone loss is present.

Why is the Latarjet Procedure Performed?

The Latarjet procedure is indicated for patients with:

1. Recurrent Shoulder Dislocations: Often due to structural issues like bone loss in the glenoid or damage to the humeral head.
2. Significant Glenoid Bone Loss: Typically caused by repeated shoulder dislocations or trauma.
3. Engaging Hill-Sachs Lesion: A large defect in the back of the humeral head that engages with the edge of the glenoid, leading to instability.
4. Failed Previous Stabilization Surgery: When other procedures, like arthroscopic Bankart repair, have not resolved instability.

Anatomy and Mechanism

The stability of the shoulder joint depends on the balance between the glenoid and the humeral head. When part of the glenoid is missing or damaged (e.g., due to trauma), the humeral head can easily slip out, leading to instability or dislocations.

The Latarjet procedure achieves stability in two ways:

1. Bony Augmentation: The coracoid process is transferred to the glenoid, restoring the bone structure of the socket.
2. Dynamic Sling Effect: The attached muscles and ligaments from the coracoid process create a “sling” that holds the humeral head in place during movement.

The Procedure

The Latarjet procedure is typically performed as an open surgery (through a larger incision), although minimally invasive arthroscopic techniques are becoming more common.

Steps

1. Incision: An incision is made on the front of the shoulder to expose the joint.
2. Coracoid Harvesting: A portion of the coracoid process, along with its attached tendon (conjoined tendon), is cut.
3. Transfer to Glenoid: The harvested bone is transferred to the front of the glenoid.
4. Fixation: Screws are used to secure the coracoid bone to the glenoid.
5. Closure: The surgical site is closed, and a dressing is applied.

Benefits of the Latarjet Procedure

• Restores Bone Loss: Addresses structural deficiencies in the glenoid.
• Prevents Future Dislocations: Significantly reduces the risk of recurrent instability.
• Dynamic Stability: The sling effect provides additional soft-tissue support during shoulder movement.
• Durable: High success rates and long-lasting stability.

Recovery and Rehabilitation

Post-Surgery Recovery

• Immobilization: The shoulder is placed in a sling for 4-6 weeks to protect the repair.
• Pain Management: Medications and ice packs are used to control post-operative pain.

Physical Therapy

Rehabilitation progresses through three phases:

1. Phase 1 (0-6 weeks):
   • Passive range of motion exercises to prevent stiffness.
   • No active shoulder use.
2. Phase 2 (6-12 weeks):
   • Gradual introduction of active range of motion.
   • Begin light strengthening exercises.
3. Phase 3 (3-6 months):
   • Advanced strengthening.
   • Return to full activities, including sports, typically at 6 months.

Potential Risks and Complications

While the Latarjet procedure has a high success rate, potential risks include:

• Infection: Rare but possible.
• Nerve Injury: The axillary or musculocutaneous nerves may be injured during the procedure.
• Hardware Complications: Screws used for fixation may cause irritation or loosening.
• Arthritis: Over time, the shoulder joint may develop arthritis.
• Loss of Range of Motion: Some patients may experience stiffness.

Success Rates

Studies report success rates of over 90% for restoring shoulder stability and preventing further dislocations. Patients with significant bone loss or previous failed surgeries often achieve excellent outcomes with this procedure.

Latarjet vs. Other Procedures

Feature	Latarjet Procedure	Bankart Repair
Indication	Bone loss, failed repairs	Labrum tears or soft tissue issues
Method	Bone transfer	Soft-tissue repair
Recovery Time	4-6 months	4-6 months
Success in Severe Cases	High	Lower for bone loss cases

Who is a Candidate?

The Latarjet procedure is ideal for:

• Patients with recurrent shoulder dislocations due to significant bone loss.
• Athletes or laborers who require a stable and strong shoulder.
• Individuals who have failed previous surgeries like Bankart repair.

Conclusion

The Latarjet procedure is a highly effective surgical option for addressing complex shoulder instability, especially when caused by glenoid bone loss. It provides both structural and dynamic stability, making it particularly beneficial for active individuals or those with recurrent dislocations. Consulting with an experienced orthopedic surgeon can help determine if this procedure is the best fit for your needs.