Traumatic Failure of Primary Latarjet Revised With Distal Tibial Allograft Reconstruction: A Case Report

Recurrent anterior shoulder instability in young, high-demand patients is frequently compounded by significant glenoid bone loss, a known risk factor for failure of isolated soft-tissue stabilization. The Latarjet procedure has demonstrated reliable outcomes in restoring stability in this population; however, traumatic postoperative complications such as coracoid graft fracture and hardware failure are rare and pose substantial challenges in revision management. Optimal strategies for addressing failed coracoid transfer remain incompletely defined. In this case report, a case of traumatic failure of a primary Latarjet procedure is reported and distal tibial allograft (DTA) reconstruction as a biologically and anatomically favorable revision technique is evaluated. An adolescent male patient with recurrent anterior shoulder instability and critical anterior glenoid bone loss underwent primary Latarjet stabilization for a chronic bony Bankart lesion. At three months postoperatively, the patient sustained a high-energy traumatic reinjury. Advanced imaging demonstrated coracoid graft fracture with associated hardware failure. Revision surgery was performed with the removal of failed hardware and reconstruction of the anterior glenoid using a distal tibial allograft, selected for its congruent articular surface and structural compatibility with native glenoid anatomy. A standardized postoperative rehabilitation protocol was implemented. Clinical and radiographic outcomes were assessed longitudinally. The patient experienced an uncomplicated postoperative course with progressive functional recovery. Serial imaging confirmed appropriate graft positioning, stability, and osseous incorporation without evidence of resorption or complication. At final follow-up, the patient demonstrated near-complete restoration of range of motion and strength, with no recurrent instability and successful return to unrestricted activity. Distal tibial allograft reconstruction represents a robust and anatomically restorative option for the revision of failed Latarjet procedures following traumatic graft compromise. This technique offers several advantages, including preservation of native glenoid contour, restoration of the articular surface, and avoidance of donor-site morbidity associated with autograft harvest. In young, high-demand patients, DTA reconstruction may provide reliable stability and favorable functional outcomes in complex revision settings. Further investigation is warranted to establish long-term outcomes and comparative efficacy relative to alternative revision strategies.