Latarjet procedure

The mechanism of action has been described as a triple blocking effect:

1. conjoint tendon of shoulder i.e short head of the biceps and coracobrachialis, acting as a sling on the subscapularis and capsule with the arm abducted and externally rotated;
2. increasing or restoring the glenoid bone; and
3. repair of the capsule to the stump of coracoacromial ligament.{{cite journal|last=Young|first=AA|author2=Maia R |author3=Berhout J |author4=Walch G |title=Open Latarjet procedure for management of bone loss in anterior instability of the glenohumeral joint.|journal=Journal of Shoulder and Elbow Surgery|date=March 2011|volume=20|issue=2 Suppl|pages=S61-9|doi=10.1016/j.jse.2010.07.022|pmid=21145262}}

The Latarjet procedure involves the removal and transfer of a section of the coracoid process and its attached muscles to the front of the glenoid. This placement of the coracoid acts as a bone block which, combined with the transferred muscles acting as a strut, prevents further dislocation of the joint.{{Cite web|url=http://www.shoulderdoc.co.uk/article.asp?section=914|title = Latarjet-Bristow Procedures | ShoulderDoc}} In layman's terms, this procedure involves removing a piece of bone from another part of the shoulder, and attaching it to the front of your shoulder socket. The bone will then act as a barrier which will physically block the shoulder from slipping out of the socket, while the muscles which are transferred with the bone will give additional stability to the joint.

While the Latarjet procedure can be used for surgical treatment of most cases of shoulder dislocations or subluxation, it is particularly indicated in cases with bone defects.{{cite journal|last=Edwards|first=TB|author2=Boulahia A |author3=Walch G |title=Radiographic analysis of bone defects in chronic anterior shoulder instability|journal=Arthroscopy|date=2003|volume=19|pages=732–9|doi=10.1016/S0749-8063(03)00684-4|pmid=12966381|issue=7}} The failure rate following arthroscopic Bankart repair has been shown to dramatically increase from 4% to 67% in patients with significant bone loss.{{cite journal|last=Burkhart|first=SS|author2=De Beer JF |title=Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion|journal=Arthroscopy|date=2000|volume=16|pages=677–94|pmid=11027751|issue=7|doi=10.1053/jars.2000.17715}} The same authors subsequently reported much improved results when the Latarjet operation was used in patients with bone loss.{{cite journal|last=Burkhart|first=SS|author2=De Beer JF |author3=Barth JR |author4=Cresswell T |author5=Roberts C |author6=Richards DP |title=Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss|journal=Arthroscopy|date=2007|volume=23|pages=1033–41|doi=10.1016/j.arthro.2007.08.009|pmid=17916467 |issue=10}} A number of technical variations have been proposed including both open and arthroscopic variations.{{cite journal|last=Lafosse|first=L|author2=Boyle S |title=Arthroscopic Latarjet procedure|journal=J Shoulder Elbow Surg|date=2010|volume=19|issue=2 suppl|pages=2–12|doi=10.1016/j.jse.2009.12.010|pmid=20188263}} Complication rates are between 15–30%, with long-term issues such as graft osteolysis continuing to be an issue with the procedure.{{cite journal |last1=Gupta |first1=A |last2=Delaney |first2=R |last3=Petkin |first3=K |last4=Lafosse |first4=L |title=Complications of the Latarjet procedure. |journal=Current Reviews in Musculoskeletal Medicine |date=March 2015 |volume=8 |issue=1 |pages=59–66 |doi=10.1007/s12178-015-9258-y |pmid=25644052|pmc=4596182 }}

With appropriate patient selection, the Latarjet procedure can be expected to prevent recurrent anterior instability in approximately 94–99% of cases.{{cite journal|last=Allain|first=J|author2=Goutallier D |author3=Glorion C |title=Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder|journal=J Bone Joint Surg Am|date=1998|volume=80|issue=6|pages=841–52|doi=10.2106/00004623-199806000-00008|pmid=9655102|s2cid=11735619}}{{cite journal|last=Hovelius|first=LB|author2=Akermark C |author3=Albrektsson B |author4=Berg E |author5=Körner L |author6=Lundberg B |author7=Wredmark T |title=Bristow-Latarjet procedure for recurrent anterior dislocation of the shoulder. A 2–5 year follow-up study on the results of 112 cases|journal=Acta Orthop Scand|date=1983|volume=54|issue=2|pages=284–90|pmid=6846008 |doi=10.3109/17453678308996571|doi-access=free}}{{cite journal|last=Hovelius|first=L|author2=Sandström B |author3=Sundgren K |author4=Saebö M |title=One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: study I—clinical results|journal=J Shoulder Elbow Surg|date=2004|volume=13|issue=5|pages=509–16|pmid=15383806 |doi=10.1016/j.jse.2004.02.013}}{{cite journal|last=Walch|first=G|author2=Boileau P |title=Latarjet-Bristow procedure for recurrent anterior instability|journal=Tech Shoulder Elbow Surg|date=2000|volume=1|issue=4|pages=256–61|doi=10.1097/00132589-200001040-00008}} Full recovery can take six months; however, the majority of activities can be resumed after three. The main long-term side effect is reduced external rotation range in the shoulder.

The Latarjet operation has also been demonstrated to be successful in contact athletes and rugby players.{{cite journal|last=Joshi|first=M |author2=Young AA |author3=Balestro J-C |author4=Walch G|title=The Latarjet-Patte Procedure for Recurrent Anterior Shoulder Instability in Contact Athletes|journal=Clinics in Sports Medicine|date=2013|volume=32|issue=4|pages=731–9|pmid=24079431|doi=10.1016/j.csm.2013.07.009}}{{cite journal|last=Neyton|first=L|author2=Young A |author3=Dawidziak B |author4=Visona E |author5=Hager JP |author6=Fournier Y |author7=Walch G. |title=Surgical treatment of anterior instability in rugby union players: clinical and radiographic results of the Latarjet-Patte procedure with minimum 5-year follow-up.|journal=J Shoulder Elbow Surg|date=2012|volume=21|issue=12|pages=1721–7|doi=10.1016/j.jse.2012.01.023|pmid=22565042}}

In summary, the Latarjet operation may ideally be suited as the shoulder reconstruction procedure of choice for contact athletes, patients with increased shoulder laxity, failed previous shoulder reconstructions or if there is significant bone damage.

{{reflist}}

• [http://www.sydneyshoulder.com.au/allan-young/latarjet-operation-for-shoulder-reconstruction.html Latarjet Operation for Shoulder Reconstruction – Diagram & Image Gallery]
• [http://www.shoulderdoc.co.uk/article.asp?section=914 Explanation of Latarjet-Bristow Procedures]

{{Bone, cartilage, and joint procedures}}

Category:Shoulder surgery