How does the Latarjet prevent dislocations?

The Latarjet stabilises the shoulder through three different mechanisms acting together: a bony block (the coracoid bone fixed to the front of the glenoid restores the bony arc), a sling effect (the conjoint tendon attached to the coracoid acts as a dynamic check rein in the abducted-and-externally-rotated position), and a capsular repair adding further static restraint.

What is the recurrence rate after Latarjet?

Recurrence rates after Latarjet are significantly lower than after labral repair alone. Long-term series report recurrent dislocation around 3 percent and recurrent instability symptoms without dislocation up to about 8 percent in well-selected patients. Latarjet is the procedure of choice when there is significant glenoid bone loss, an engaging Hill-Sachs lesion, or a previous labral repair has failed.

Will I lose any movement after Latarjet?

A small loss of end-range external rotation is common after Latarjet and usually does not affect function. Most patients regain full overhead movement and return to their previous level of activity. Stiffness in the early post-operative period is normal and resolves with physiotherapy.

Procedure

Latarjet Procedure

A bone-block stabilisation procedure for complex shoulder instability. The coracoid process is transferred with its attached conjoint tendon to the front of the glenoid and fixed with two screws. Dr Piper trained on both the open and arthroscopic techniques with Dr Laurent Lafosse in Annecy, and performs both techniques in his Sydney practice.

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History

A French procedure with a long track record

The Latarjet procedure was developed in France by Michel Latarjet and has been used for management of complex shoulder instability for decades. Rather than repairing the torn labrum, the procedure transfers a piece of bone (the coracoid process) onto the front of the glenoid and fixes it in place with screws. The bone block and its attached tendon prevent the shoulder from dislocating, taking over the function the labrum can no longer perform on its own.

Dr Laurent Lafosse later pioneered an arthroscopic version of the Latarjet. Dr Piper trained on both the open and arthroscopic techniques during his fellowship in Annecy in 2009 to 2010. He performs both techniques in his Sydney practice. The open approach gives reliable, reproducible exposure for accurate graft positioning and fixation, which is the most important factor in the long-term success of the procedure; the arthroscopic version is available for patients who prefer it.

Indications

When the Latarjet is the right operation

The Latarjet is used in situations where a labral repair alone has too high a risk of re-dislocation. Common indications include:

Glenoid bone loss. A significant fracture or progressive wearing-down of the front rim of the glenoid removes the bony ledge the labrum needs to anchor onto. Repairing the labrum to a deficient rim is unreliable.
Engaging Hill-Sachs lesion. An indentation in the back of the humeral head, caused by repeated dislocations, that catches on the front of the glenoid in functional positions.
Failed previous stabilisation surgery. Recurrent instability after a labral repair or other stabilisation.
Chronic or recurrent instability. Multiple dislocations over time, particularly in younger patients with high functional demand.
High-risk activity profile. Contact and collision sport, military service, occupational demands that put repeated high loads through the shoulder.
Hyperlaxity with instability. Some patients with generalised ligamentous laxity have a higher recurrence risk after labral repair alone.

The decision between an arthroscopic labral repair and an open Latarjet is made after a full assessment that includes examination, x-rays, MRI, and (for bone loss assessment) a CT scan. Dr Piper will explain why one operation is being recommended over the other in the consultation.

How it works

The triple-block effect

The Latarjet stabilises the shoulder through three different mechanisms acting together. The combination is why the procedure is effective in shoulders where soft-tissue repair alone is not.

Bone block. The coracoid bone is fixed to the front of the glenoid, restoring the bony arc that prevents the humeral head from sliding forward.
Sling effect. The conjoint tendon attached to the coracoid swings across the front of the shoulder when the arm is in the abducted and externally rotated position. The tendon acts as a dynamic check rein against dislocation in the most vulnerable arm position.
Capsular repair. The joint capsule is repaired to the stump of the coracoacromial ligament, which adds further static restraint to the joint.

The procedure

What happens in the operating theatre

The procedure is performed under general anaesthetic, usually with a regional nerve block to help with post-operative pain control. The patient is positioned in a beach-chair position, and the operative arm is prepped and draped free.

A relatively short incision is made along the deltopectoral interval at the front of the shoulder. The coracoid process is identified and separated from its bony origin with its conjoint tendon attached. The coracoid is prepared with two drill holes for the fixation screws.

The subscapularis muscle is split horizontally, exposing the joint capsule. The capsule is opened, and the front rim of the glenoid is exposed and prepared. The coracoid bone block is then fixed to the front of the glenoid with two screws, with care taken to position the graft flush with the joint surface and not overhanging into the joint.

The capsule is repaired and the subscapularis split is closed. The wound is closed in layers. A sling is applied at the end of the procedure.

Operative time is typically 60 to 90 minutes. Most patients stay one night.

Recovery

What recovery looks like

A sling is worn for the first four weeks after surgery. Gentle passive movement is started in the first week or two under physiotherapy guidance.

Active movement out of the sling progresses over weeks four to eight, with strengthening introduced from around week eight. Most patients are back to driving by six weeks once out of the sling and with safe two-handed control of the steering wheel. Office work is usually possible within two to three weeks, depending on whether the affected arm is the dominant arm.

Return to non-contact sport is usually possible by three to four months. Return to contact and collision sport is typically at four to six months, after the bone block is well-healed (checked with CT scan) and strength has returned.

Complications and risks

What can go wrong

The Latarjet is more complex than a soft-tissue stabilisation, and the risks are correspondingly higher. The trade-off is a much lower risk of re-dislocation in the right patient. Complications may require further surgery. Dr Piper will discuss the specific risks for each patient in consultation. The general risks include (but are not limited to):

Recurrence. Lower than after labral repair alone, but not zero. Long-term series report recurrent dislocation around 3 percent and recurrent instability symptoms without dislocation up to about 8 percent in well-selected patients.
Loss of external rotation. A small loss of end-range external rotation is common and usually does not affect function.
Nerve injury. The musculocutaneous nerve and the axillary nerve are close to the operative field. Stretch injuries are uncommon and usually recover.
Complex regional pain syndrome (CRPS). A rare condition that causes pain and stiffness in the hand.
Hardware problems. Screw breakage, screw loosening, or graft non-union can occur. Symptomatic hardware can be removed once the bone block is well-healed.
Graft fracture. Usually as a result of another injury, graft fracture may require revision surgery.
Bone block resorption. The graft can lose volume over time. In most cases this does not cause symptoms.
Infection. Uncommon but serious. Open surgery has a slightly higher infection rate than arthroscopic stabilisation.
Stiffness. A period of stiffness after sling removal is normal and resolves with physiotherapy.
Anaesthetic complications. Discussed separately with the anaesthetist before surgery.

FAQ

Frequently asked questions

Should I have the Latarjet open or arthroscopic?: Dr Piper trained on both the open and arthroscopic Latarjet techniques during his fellowship in Annecy with Dr Laurent Lafosse, who pioneered the arthroscopic version, and performs both in his Sydney practice. The open approach gives reliable, reproducible exposure for accurate graft positioning and fixation, which is the most important factor in the long-term success of the procedure. The arthroscopic version is available for patients who prefer it. The choice is made with you in consultation.
How does the Latarjet prevent dislocations?: The Latarjet stabilises the shoulder through three different mechanisms acting together: a bony block (the coracoid bone fixed to the front of the glenoid restores the bony arc), a sling effect (the conjoint tendon attached to the coracoid acts as a dynamic check rein in the abducted-and-externally-rotated position), and a capsular repair adding further static restraint.
How long is recovery from a Latarjet procedure?: A sling is worn for four weeks. Active movement progresses over weeks four to eight, with strengthening from around week eight. Most patients are back to driving by six weeks once out of the sling and with safe two-handed control of the steering wheel. Return to non-contact sport is usually possible by three to four months. Return to contact and collision sport is typically four to six months, once the bone block is well-healed (checked with CT scan).
What is the recurrence rate after Latarjet?: Recurrence rates after Latarjet are significantly lower than after labral repair alone. Long-term series report recurrent dislocation around 3 percent and recurrent instability symptoms without dislocation up to about 8 percent in well-selected patients. Latarjet is the procedure of choice when there is significant glenoid bone loss, an engaging Hill-Sachs lesion, or a previous labral repair has failed.
Will I lose any movement after Latarjet?: A small loss of end-range external rotation is common after Latarjet and usually does not affect function. Most patients regain full overhead movement and return to their previous level of activity. Stiffness in the early post-operative period is normal and resolves with physiotherapy.

References

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