Alternative Management of the Capsule in the Bristow-Latarjet Procedure

Abstract

The Bristow-Latarjet procedure is considered the current gold standard for the management of anterior glenohumeral joint instability in which significant glenoid bone loss is present, and numerous techniques have been proposed for capsular management after the bony augmentation component of the procedure. These techniques for capsular management include excision of the capsule and labrum, 2-flap elevation, T-capsulotomy, or an L-shaped incision into the capsule. Capsular management during open shoulder procedures may vary among surgeons and may or may not include capsulolabral repair after the Bristow-Latarjet procedure. The purpose of this Technical Note was to illustrate an alternative approach to capsular management, focusing on the elevation of the capsulolabral complex as a sleeve along with augmentation using the coracoacromial ligament during the Bristow-Latarjet procedure in patients with anterior glenohumeral instability. The proposed technique provides the benefit of improvement in visualization to more reliably identify the ideal location for bone block placement and allows for the surgeon to perform a large inferior-to-superior capsular shift to prevent inferior subluxation or instability.

Capsulolabral Reconstruction During the Open Latarjet Procedure

“… 13 However, no article has described the reduction of the humeral head while tightening the knots during the capsule reconstruction. 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 The reconstruction of both labral and anterior capsular structures has been described with the arthroscopic Latarjet technique 20 , 21 but rarely in the open procedure. 22 This Technical Note aims to describe our preferred surgical technique of capsulolabral management during open Latarjet procedure.…”