The shoulder joint is stabilized by the labrum, a cartilaginous rim of the glenoid cavity, and the capsule, a series of ligaments that enclose the joint. Injury and trauma can tear or stretch the labrum and/or ligaments, causing instability and dislocation of the joint. The shoulder can dislocate in front (anterior)) or behind (posterior), but anterior dislocation is the most common. It is particularly common in those that participate in contact or collision sports.
Tearing of the labrum due to trauma is called a Bankart tear, which sometimes involves the breaking of bone along with the labrum. This is referred to as a bony Bankart tear. Shoulder instability can lead to pain and a feeling of giving way and recurrent instability of the shoulder. With multiple recurrences the bone of the socket can be gradually worn away, and there is usually a corresponding area of bone loss on the back of the ball (humeral head). This is called a Hill-Sachs lesion. When bone loss is present and contributing to shoulder instability a soft tissue procedure has an increased risk of failure. In this situation the bone damage also needs to be addressed.
What is the Latarjet Procedure?
The Latarjet procedure is a surgical procedure performed to treat shoulder instability when bone loss is present. It is done by relocating a piece of bone called the coracoid process with an attached tendon to the front of the shoulder joint.
Indications for the Latarjet Procedure
The Latarjet procedure is indicated for recurrent anterior shoulder instability that is caused by a bony Bankart lesion or when progressive bone loss has occurred due to multiple dislocations. The surgery is considered when a surgical repair of the labrum only will not correct the damage to the shoulder joint. It is also increasingly used as a primary procedure in athletes who participate in a high level of contact or collision sport, due to it being more robust than a soft tissue repair alone.
- The Latarjet procedure is performed under general anaesthesia with you in a semi-reclined or beach-chair position.
- An initial arthroscopy is performed to assess the joint and deal with any associated damage.
- An incision of 5 cm is made from your armpit extending up towards the collarbone at the front of the shoulder.
- Retractors are used to separate the muscles of the shoulder and chest and expose the coracoid process (a small hook-like process of the shoulder bone) and its attached tendons.
- The coracoid process is freed of its attachments, and along with the conjoined tendon, is transected from its base.
- Holes are drilled into the transected coracoid process.
- The subscapularis muscle, which passes in front of the shoulder joint, is split in line with its fibres.
- The capsule of the shoulder joint is entered and the glenoid (socket) is exposed and prepared to receive the coracoid.
- The transected coracoid with the conjoined tendon is passed through the separated subscapularis muscle and fixed to the glenoid rim with screws through the previously drilled holes. This increases the glenoid surface and stabilizes the joint. The conjoined tendon and subscapularis muscle provide additional stability by acting as a sling.
- The labrum and ligaments are then repaired back to the native glenoid for additional stability.
- Upon completion, the instruments are withdrawn, the incision is closed and covered with a sterile bandage.
Post-procedure Care for Latarjet Procedure
- Following the procedure, your arm is placed in a sling to rest the shoulder and promote healing.
- You will remain in hospital the night of surgery and be discharged the next day.
- Pain is controlled with medication and ice packs. You will be instructed to keep the surgical wound dry and wear your sling while sleeping.
- The sling may be removed in 4 to 6 weeks.
- Rehabilitation usually begins early on the first postoperative day with finger movements and passive range of motion exercises.
- A physical therapy program is recommended beginning at 3 months after which you can return to your regular activities.
- Sport and other more physical activities are usually not permitted for 4 to 6 months after the procedure.