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Comprehensive Modified Latarjet Technique: What the Masters Taught Us.

Eddie Y Lo1,2, Paolo Montemaggi3, Temilola Majekodunmi1,2

  • 1The Shoulder Center, Baylor Scott & White Research Institute, Dallas, Texas.

JBJS Essential Surgical Techniques
|October 15, 2021
PubMed
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The Latarjet procedure effectively treats anterior shoulder instability by reconstructing bone and soft tissues. This surgical technique offers reliable success in reducing recurrence and minimizing complications, even in high-risk athletes.

Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Shoulder Instability

Background:

  • Anterior shoulder instability, especially with bone loss, leads to significant recurrence rates, with nonoperative treatments failing in up to 87% of young patients.
  • Arthroscopic repairs show high failure rates (up to 75%) in cases with bone loss.
  • The Latarjet procedure addresses glenoid and/or humeral bone loss, restoring stability by reconstructing osseous anatomy and capsular laxity.

Purpose of the Study:

  • To describe the modified Latarjet technique for treating recurrent anterior shoulder instability with bone loss.
  • To evaluate the efficacy and outcomes of the Latarjet procedure in a cohort of patients.

Main Methods:

  • The Latarjet technique involves an axillary-based approach with horizontal subscapularis splitting and a medially based T-plasty capsular release.

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  • Coracoid osteotomy and preparation for en-face implantation, followed by fixation with two cortical screws.
  • Soft-tissue reconstruction includes selective tensioning and capsular shift augmented with a pants-over-vest repair.
  • Main Results:

    • In a series of 34 patients, the mean Single Assessment Numeric Evaluation score was 90.7.
    • Recurrent instability with graft issues occurred in 11.8% of cases.
    • Meta-analysis of long-term studies shows an 8.5% recurrence rate and 86% success in returning to sports.

    Conclusions:

    • The Latarjet procedure is a reliable and effective treatment for anterior shoulder instability with bone loss.
    • It offers superior outcomes compared to arthroscopic labral repair, with low recurrence rates, even in high-risk athletes.
    • A subscapularis-sparing approach and meticulous technique are crucial for optimal results and minimizing complications.