Latarjet Procedure: Restoring Shoulder Stability

Introduction

The Latarjet procedure is a surgical treatment for recurrent shoulder dislocations, especially in patients with significant bone loss at the front of the shoulder socket (glenoid). Originally described by French surgeon Michel Latarjet in 1954, this procedure has evolved over the decades and is now considered one of the most reliable techniques for restoring shoulder stability in active patients.

It works through what’s known as the “triple blocking” mechanism:

1. Bony augmentation: A piece of bone (the coracoid process) is transferred to enlarge the front part of the glenoid.
2. Dynamic sling effect: The attached tendons (conjoined tendon) act like a sling to stabilize the shoulder during movement.
3. Soft tissue reinforcement: The coracoid and its tendons reinforce the front capsule of the shoulder, especially when it’s been weakened by injury or previous surgery.

While traditionally performed as an open surgery, the arthroscopic (minimally invasive) Latarjet has gained popularity due to faster recovery, better visualization, and reduced scarring, although it remains technically challenging.

When Is the Latarjet Procedure Recommended?

The Latarjet is commonly used when:

• Glenoid bone loss exceeds 20%, which limits the success of traditional soft tissue repairs like the Bankart procedure.
• There is recurrent shoulder instability, especially in contact athletes.
• Previous surgeries (e.g., Bankart repair) have failed.
• The shoulder joint is unstable in patients with seizure disorders or poor-quality anterior soft tissues.

Clinical studies have shown that athletes and patients with significant bone loss benefit more from Latarjet than other procedures. In fact, in certain patients, it is even considered as a primary (first-choice) surgery due to its stability and lower recurrence rates.

Planning for Surgery

Accurate preoperative imaging, such as 3D CT scans, is critical. These scans help determine:

• The size and angle of the coracoid graft.
• The amount of bone loss in the glenoid.
• The proper length and placement of surgical screws.

Without this level of planning, the risk of improper screw placement or graft misalignment increases, which could compromise outcomes.

Fixation Techniques

Two main methods exist to secure the bone graft:

1. Screw fixation (most common and biomechanically stronger).
2. Cortical button fixation, a newer technique that avoids metal screws but may have slightly higher rates of recurrence.

Studies show that while screw fixation provides better initial stability, it may cause discomfort or require removal due to hardware irritation. Cortical buttons avoid this but require more precision during surgery.

Surgical Technique: Step-by-Step

1. Positioning and Portals

The patient is placed in a beach chair position, and six small arthroscopic portals are created around the shoulder. These allow for viewing and working inside the joint with minimal disruption.

2. Preparing the Glenoid

The surgeon clears damaged tissue and reshapes the anterior glenoid (front of the socket) to receive the graft. This step is crucial to ensure the graft will sit flush and heal properly.

3. Harvesting the Coracoid

The coracoid process, a small bony projection from the shoulder blade, is carefully detached. All surrounding soft tissue is cleared, and the undersurface is smoothed to encourage healing once fixed to the glenoid.

4. Osteotomy and Drilling

Holes are drilled into the coracoid for screw placement, and a specialized guide helps align them perfectly. The bone is then cut cleanly using an osteotome.

5. Subscapularis Split

The subscapularis muscle is gently split to create a passage for the bone graft. Care is taken to protect nerves, especially the axillary and musculocutaneous nerves, which are nearby.

6. Graft Placement

The coracoid graft is passed through the split muscle and fixed to the glenoid using cannulated screws. The goal is to compress the graft tightly and ensure it sits in line with the joint surface, avoiding overhang or underhang.

Comparing Surgical Options

Latarjet vs. Bankart Repair

While Bankart repair (a soft tissue surgery) is suitable for many patients, it has higher recurrence rates in those with bone loss or who play contact sports. The Latarjet procedure is preferred when:

• There’s significant bone loss.
• The patient is at high risk of reinjury.
• A prior Bankart has failed.

Meta-analyses show Latarjet leads to fewer redislocations and lower revision rates, though it carries a slightly higher short-term risk of infection.

Arthroscopic vs. Open Latarjet

Arthroscopic Latarjet offers:

• Smaller incisions
• Faster recovery
• Better visualization inside the joint

However, it requires advanced technical skills. Open surgery remains a solid alternative, especially when soft tissue reconstruction is also needed.

Biomechanical studies show similar stability between both approaches, though capsule reconstruction is easier in open surgery.

Results and Recovery

Clinical outcomes of arthroscopic Latarjet have been excellent:

• High bone union rates (95–98%)
• Low recurrence of dislocation
• Fast return to sports and daily activities

Some studies even suggest less pain and better function postoperatively compared to traditional methods.

Potential Risks

Complications, while relatively uncommon, can include:

• Graft fracture or failure to heal (non-union)
• Screw irritation or migration
• Nerve injury
• Infection

The total complication rate is approximately 6–7%, which is comparable to open techniques. With increasing experience, complication rates have declined, especially as surgeons become more adept with arthroscopic techniques.

Conclusion

The Latarjet procedure—especially via the arthroscopic route—offers a powerful solution for patients suffering from chronic anterior shoulder instability with or without bone loss. It has proven superior in many clinical settings, particularly for contact athletes and patients with failed prior surgeries.