Latarjet Procedure for Recurrent Anterior Shoulder Instability

The Latarjet procedure is widely used to treat recurrent anterior shoulder instability, especially in cases with significant glenoid bone loss. The procedure involves transferring the coracoid process to the anterior inferior glenoid. Typically performed as an open surgery, arthroscopic Laterjet techniques have evolved, each offering unique benefits and challenges.

The Latarjet procedure is indicated for patients with recurrent anterior shoulder instability, particularly those with substantial glenoid bone loss (typically >20%), or failed soft tissue (Bankart) repairs. It is also recommended for patients with engaging Hill-Sachs lesions (off-track), and high-risk individuals following their first dislocation. The glenoid track concept assists in evaluating bone loss and deciding when the Latarjet is warranted.

The patient is positioned in a beach-chair setup with anesthesia administered. An anterior incision is made using a deltopectoral approach. The coracoid is mobilized and prepared for the congruent arc technique, then affixed to the anterior glenoid using screws. The joint is irrigated, and the capsule and subscapularis are repaired to ensure stability and preserved mobility.

The congruent arc modification has shown favorable outcomes, particularly in patients with significant glenoid bone loss. Meta-analyses reveal a low redislocation rate (1.1%) and high return-to-sport rate (94.3%). Graft integration rates are approximately 92.1%, and patients report improved shoulder function, with notable gains in Rowe and American Shoulder and Elbow Surgeons scores.

While the Latarjet procedure provides excellent stability and functionality for shoulder instability, risks such as graft fragmentation and screw malposition require careful planning and execution. The procedure's high success rate and favorable functional outcomes solidify its role in managing complex shoulder instability, ensuring its continued relevance in orthopaedic practice.

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