Management of Failed Latarjet Procedure Using a Distal Clavicular Autograft.

Area of Science:

• Orthopedic surgery
• Shoulder instability management
• Bone grafting techniques

Background:

• The Latarjet procedure is a standard surgical treatment for shoulder instability with significant bone loss.
• Recurrent instability after Latarjet procedures presents management challenges.
• Revision techniques often involve soft tissue repairs or grafts, each with drawbacks like donor-site morbidity or increased costs.

Purpose of the Study:

• To present a novel surgical technique for failed Latarjet procedures.
• To describe the use of an ipsilateral distal clavicular osteochondral autograft for revision shoulder instability surgery.
• To evaluate the feasibility and initial outcomes of this revision strategy.

Main Methods:

• The technique involves a delto-pectoral approach, accessing the distal clavicle and glenohumeral joint.
• An osteochondral autograft is harvested from the distal clavicle, preserving acromioclavicular and coracoclavicular ligaments.
• The graft is then fixed to the scapula to address bone loss, similar to the Latarjet procedure.

Main Results:

• Patients experienced reduced shoulder pain and returned to daily activities within 3 weeks.
• No clavicle instability or donor-site complications were reported at 6 weeks.
• CT scans confirmed adequate graft positioning and fusion at 3 months postoperatively.

Conclusions:

• Distal clavicular osteochondral autograft is a viable option for revision of failed Latarjet procedures.
• This technique effectively minimizes donor-site morbidity and avoids additional costs associated with allografts.
• Further prospective studies are warranted to assess long-term efficacy.