Latarjet Reconstruction for Chronic Dislocation
What is the Latarjet reconstruction?
The Latarjet procedure is generally considered a salvage procedure for patients that have substantial bone loss and have failed prior instability repairs of the shoulder. Initially described in Lyon, France, by the French surgeon of the same name(1), the procedure calls for replacing bone to the front of the glenoid socket with the coracoid process, which is a finger-like projection of hard bone that has muscle attachments on the shoulder blade.
Although several modifications to the original description have been made, the Latarjet procedure imparts a high degree of stability to a dislocating shoulder for reasons that relate to the bone as well as to the soft tissue. The coracoid bone graft that is fixated with screws increases the bony surface area of the glenoid and recruits one of the rotator cuff tendons (called the subscapularis) into becoming a “sling” which pulls and keeps the ball in the appropriate position when the arm is raised overhead. Repair of the joint capsule to the coracoid bone graft is considered the last component of the procedure which also improves stability.
While used routinely in France, the utilization of the Latarjet is uncommon in the United States as arthroscopic technique and instrumentation has improved over the last couple decades. However, there are a cohort of patients that have failed prior surgery and continue with disabling symptoms of instability (such as dislocations happening at night with little or no injury) that are good candidates for the Latarjet procedure. These patients generally have substantial bone loss in the glenoid, where greater than 25-30% of the glenoid bone is deficient, as well as large engaging Hill-Sachs lesions. These patients are at high risk of failure with revision arthroscopic procedures.
Revision arthroscopy with repair of the labrum and remplissage (or “fill in”) of the infraspinatus into the Hill-Sachs lesion is the primary alternative to the Latarjet procedure. Arthroscopic repair and remplissage can sometimes be offered even to patients with substantial glenoid bone loss, pending symptoms and risk factors(2).
Compared with arthroscopic surgery, the Latarjet reconstruction is more invasive and has a more unforgiving complication profile compared with arthroscopic revision repair and remplissage(2). Graft lysis, neurologic injury, and long term shoulder arthritis are all potential complications and need to be carefully considered in the selection of patients for the Latarjet procedure(3). Avoidance of the complications can be achieved by meticulous surgical technique by an experienced shoulder surgeon such as Dr. Obermeyer.
Shoulder surgeon Dr. Obermeyer has trained in Lyon, France, where the Latarjet procedure was first described, and has learned the nuance of the procedure by Dr. Gilles Walch, a French shoulder surgeon who is considered by many to be an international expert in the Latarjet procedure. The Latarjet procedure is technically challenging, with an exposure of the glenoid bone requiring a split in the subscapularis tendon (instead of cutting it), and therefore requires a surgeon experienced in open and revision shoulder surgery.
The Latarjet procedure is performed through a 4 to 5 inch incision in the front of the shoulder and takes 1 to 2 hours to perform. A general anesthetic is administered as well as a numbing block placed prior to the surgery. Patients leave the facility the same day, shower a few days after the procedure, and wear a sling for 6 weeks. Full activities are resumed between 6 and 12 weeks after surgery and full sporting activity is permitted around 5 to 6 months after the procedure.
References:
- LATARJET M. Treatment of recurrent dislocation of the shoulder. Lyon Chir. 1954 Nov-Dec;49(8):994-7. English. PMID: 13234709.
- Hurley ET, Toale JP, Davey MS, Colasanti CA, Pauzenberger L, Strauss EJ, Mullett H. Remplissage for anterior shoulder instability with Hill-Sachs lesions: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2020 Dec;29(12):2487-2494. doi: 10.1016/j.jse.2020.06.021. Epub 2020 Jul 7. PMID: 32650087.
- Domos P, Lunini E, Walch G. Contraindications and complications of the Latarjet procedure. Shoulder Elbow. 2018 Jan;10(1):15-24. doi: 10.1177/1758573217728716. Epub 2017 Sep 11. PMID: 29276533; PMCID: PMC5734530.
At a Glance
Dr. Thomas Obermeyer
- 15+ years of training and experience treating complex shoulder and sports medicine conditions
- Expert subspecialized and board-certified orthopedic care
- Award-winning outstanding patient satisfaction scores
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