The Open Capsular Shift-Latarjet Procedure for Recurrent Anterior Shoulder Instability

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Shoulder Reconstruction

Background:

• Anterior shoulder instability poses a significant risk for developing glenohumeral arthritis.
• Capsular management is crucial in open Latarjet procedures to prevent postoperative arthritis.
• The open capsular shift-Latarjet procedure integrates the Latarjet technique with glenoid T-based capsular shifting.

Purpose of the Study:

• To describe the technique and evaluate the outcomes of the open capsular shift-Latarjet procedure.
• To assess the efficacy in treating recurrent anterior shoulder instability, especially in high-risk patients.
• To investigate the procedure's impact on preventing glenohumeral arthritis.

Main Methods:

• The procedure involves a deltopectoral approach, coracoid osteotomy, and subscapularis split.
• A glenoid T-based capsulotomy is performed, followed by capsular shifting using suture anchors and passing wire.
• The coracoid graft is secured to the glenoid, and the capsule is repaired to the anchors and glenoid.

Main Results:

• A low recurrence rate and no revision surgeries were reported in one study.
• A significantly lower incidence of osteoarthritis (8.6%) at 10-year follow-up was observed compared to literature.
• Concerns exist regarding osteoarthritis risk if the capsule is sutured directly to the coracoid.

Conclusions:

• The open capsular shift-Latarjet procedure is safe and reliable for managing anterior shoulder instability.
• Combining capsular repair with the Latarjet procedure helps restore anatomy and prevent long-term glenohumeral arthritis.
• Careful patient selection is essential for optimal outcomes and minimizing surgical risks.