Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss

Abstract

Anterior glenohumeral instability is a common clinical entity, particularly among young athletic patient populations. Nonoperative management and arthroscopic treatment of glenohumeral instability have been associated with high rates of recurrence, particularly in the setting of glenohumeral osseous defects. Coracoid transfer, particularly the Latarjet procedure, has become the treatment of choice for recurrent anterior glenohumeral instability in the setting of osseous deficiencies greater than 20% to 30% of the glenoid surface area and may also be considered for the primary treatment of recurrent instability in the high-risk contact athlete, even in the setting of limited osseous deficiency. The following Technical Note provides a diagnostic approach for suspected glenohumeral instability, as well as a detailed description of the congruent-arc Latarjet procedure, performed with a deltoid split, with its postoperative management.

Biomechanical Comparison of Screw Fixation Versus a Cortical Button and Self-tensioning Suture for the Latarjet Procedure

“…Clinically, anterior shoulder stabilization procedures are normally performed in younger male patients. 4 , 13 , 22 , 25 Bone quality may have influenced load to failure because it has been shown that bone density decreases over time. 3 We tried to mitigate this limitation by using paired male shoulders so that both fixation techniques were applied to specimens of similar bone quality.…”

“…A subscapularis split was created sharply along its fibers from the insertion of the subscapularis tendon to the musculotendinous junction to facilitate exposure of the glenoid. 22 The subscapularis split was performed to replicate the clinical setting as much as possible. To simulate a glenoid defect of critical size for anterior instability, 32 , 33 a 6-mm defect was planned and measured from the 3-o’clock position of the glenoid, and a cut was made parallel to the long axis of the glenoid with an oscillating saw.…”

“…For both groups, the subscapularis split was then repaired in a standard fashion using nonabsorbable sutures to model a standard Latarjet procedure. 22 …”

Arthroscopic Management and Radiographic Interpretation of an Everted Bony Bankart Lesion

“…In patients that have between 12.5% and 25% bone loss, fragment reduction and fixation is recommended. Alternative techniques using bone grafts, such as the Latarjet and Bristow procedures, are generally reserved for bone loss exceeding 20–30% [ 7 , 8 ]. We felt that in our case, with a fragment that was over 1 cm long and approximately 20% of the anterior-posterior width of the glenoid, surgical stabilization was the best treatment option.…”

Alternative Management of the Capsule in the Bristow-Latarjet Procedure

“…Most discussions and studies of the Bristow-Latarjet procedure focus on the coracoid transfer; however, many forms of capsulotomy have been reported to uncover the glenohumeral joint. 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 11, 12, 13. Capsular management during open shoulder procedures may vary among surgeons and may or may not include capsulolabral repair after the Bristow-Latarjet procedure 14, 15.…”