The Latarjet Procedure

When is the operation performed?

The operation is intended to treat recurrent dislocations. This condition is also called shoulder instability. In addition to repeated dislocation episodes, there is difficulty using the shoulder and difficulty doing sport or activities with the arm raised, for fear that the shoulder will dislocate.

In most cases, shoulder instability comes from a tear of a structure called the labrum. The damage is usually caused in the first dislocation; it does not heal and disrupts the shoulder's stabilizing mechanisms.

The only way to stabilize the shoulder and prevent dislocations is surgery.

Today it is standard to perform one of two operations to stabilize the shoulder:

• An operation to repair the torn labrum, called a "Bankart repair" (see the article on labral repair)
• An operation to reinforce the shoulder with bone – the "Latarjet" procedure

This article covers the Latarjet procedure.

In which cases is the operation performed?

The operation is intended to treat instability in the more complex cases where a labral repair is not enough, in situations of:

• significant damage to the glenoid bone, with missing bone at the front of the shoulder, usually the result of many dislocation episodes over time
• failure of a Bankart operation (stitching of the anterior labrum)
• other situations in which we would consider this type of operation: a combination of young age, recurrent dislocations, competitive sport or contact sport, and dislocations continuing over years.

What is the goal of the operation?

The goal is to treat the problem of instability, to prevent further dislocations of the shoulder, and to allow a return to normal activity.

What is done during the operation?

The operation is performed under general anesthesia with the addition of regional anesthesia.

Course of the operation

• The coracoid bone is detached at its base, together with the conjoint tendon attached to it.
• The subscapularis muscle (at the front of the shoulder) is split along its fibers.
• The bone, together with the conjoint tendon, is transferred through the subscapularis muscle.
• The coracoid is fixed with screws to the glenoid bone.

How does the operation stabilize the shoulder?

• In terms of bone, the joint surface is enlarged.
• In terms of the ligaments, the fact that the conjoint tendon passes over the lower part of the subscapularis muscle makes the muscle create an active barrier against dislocation when the arm is raised. In effect, it replaces the torn ligament (the labrum).

The operation can be performed open, through an incision about 8 cm long at the front of the shoulder, or with an arthroscopic technique.

My preference is to perform it with an arthroscopic technique.

What is the advantage of performing the operation arthroscopically?

With an arthroscopic technique it is possible to:

• minimize damage to the tissues
• examine the shoulder better before the repair (with the option of switching to a simpler operation during surgery, depending on the findings)
• repair additional injuries if there are any, such as rotator cuff tears
• achieve a better cosmetic result.

How long is the expected recovery after surgery?

Within two to three months most shoulder movements usually return, with good daily function (not including sport and physical work). A return to full activity is expected about 4–5 months from the time of surgery. The return to activity depends on daily physiotherapy to rehabilitate function.

The return to function is faster than after an operation to repair the labrum (Bankart repair). The reason recovery is faster with Latarjet is that recovery requires biological attachment of tissue. In Latarjet, bone is attached to bone, unlike the labral stitching operation, in which a ligament (the labrum) is attached to bone. Bone-to-bone attachment is faster, so the recovery period is also shorter.

At the end of the rehabilitation period, a return to full activity can be expected, including contact sports, martial arts and physical work.

Complications and risks

In this operation there is a risk of injury to the nerves in the area, so the surgeon must identify these nerves during the operation.

The chance of injury is very low – less than 5%. Even if there is an injury, it usually resolves.

When the operation is performed arthroscopically, it should be taken into account that, depending on the surgeon's skill, a problem during the operation may require switching to open surgery.