Latarjet Procedure: Difference between revisions
== Surgical techniques ==
== Surgical techniques ==
Depending on surgeon experience, the two techniques were used to perform the Latarjet procedure: a mini-open technique with a commercially available drill guide (Arthrex GmbH, Munich, Germany) and two 4 mm cannulated cancellous screws as based on the modified Latarjet procedure described by Walch and Boileau , or an arthroscopic technique with a specific guide (DePuy, Indiana, United States) and two 3.5-mm cannulated cancellous screws as described by Lafosse et al.<ref>Bohu Y, Abadie P, van Rooij F, Nover L, Société Française de Traumatologie du Sport Jean Kany Philippe Colotte François Kelberine Didier Fontes Charles Edouard Thelu Matthieu Sanchez, Berhouet J, Hardy A. Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores. Knee Surgery, Sports Traumatology, Arthroscopy. 2021 Aug;29:2606–15.
Depending on surgeon experience, the two techniques were used to perform the Latarjet procedure: a mini-open technique with a commercially available drill guide (Arthrex GmbH, Munich, Germany) and two 4 mm cannulated cancellous screws as based on the modified Latarjet procedure described by Walch and Boileau , or an arthroscopic technique with a specific guide (DePuy, Indiana, United States) and two 3.5-mm cannulated cancellous screws as described by Lafosse et al .<ref>, , , L. Latarjet procedure. . ;:-.
==Diagnostic Tests==
==Diagnostic Tests==
CT scan
CT scan
MRI
MRI
==Pre-Op Physiotherapy==
==Pre-Op Physiotherapy==
Pre-operative physiotherapy could strengthen the weak muscles through [[strengthening exercises]] and treat any inflammatory process in the shoulder joint <ref>Lokapavani Y, Madhavi K. INFLUENCE OF PRE OPERATIVE PHYSICAL THERAPY EDUCATION AND EXERCISE ON POST OPERATIVE SHOULDER RANGE OF MOTION AND FUNCTIONAL ACTIVITES IN SUBJECTS WITH MODIFIED RADICAL MASTECTOMY. International Journal of Physiotherapy. 2014 Oct 7:170-7.</ref>
Pre-operative physiotherapy could strengthen the weak muscles through [[Iscometric strengthening exercises]] and treat any inflammatory process in the shoulder joint <ref>Lokapavani Y, Madhavi K. INFLUENCE OF PRE OPERATIVE PHYSICAL THERAPY EDUCATION AND EXERCISE ON POST OPERATIVE SHOULDER RANGE OF MOTION AND FUNCTIONAL ACTIVITES IN SUBJECTS WITH MODIFIED RADICAL MASTECTOMY. International Journal of Physiotherapy. 2014 Oct 7:170-7.</ref>
==Post-Op Physiotherapy==
==Post-Op Physiotherapy==
Original Editor – Shreya Pavaskar
Top Contributors – Yahya Al-Razi and Shreya Pavaskar
The Latarjet procedure is a possible surgical procedure to treat patients with anterior shoulder instability and accompanied bone loss. It involves transferring the coracoid process and its attached conjoint tendon to the anterior glenoid rim. In 1954, Latarjet first proposed the transfer of the coracoid tip by suggesting that the horizontal limb of the coracoid process be fixed to the anteroinferior margin of the glenoid with a screw
Biomechanics of Latarjet[1][edit | edit source]
- The conjoint tendon acts as a sling to the inferior subscapularis and anteroinferior capsule when the arm is abducted and externally rotate.
- The addition of bone to the glenoid rim increases the anteroposterior (AP) osseous diameter.
- The inferior capsule is reinforced with a portion of the coracoacromial ligament.
A study evaluated the contribution to stability of the bone block, sling, and capsule repair and concluded that the sling effect provided 76-77% and capsule 23-24% of the stability at the end-range arm position and the sling contributed 51-62% and the bone block 38-49% at the mid-range position.[2] This is known as the triple blocking effect of the Latarjet procedure, and it should be noted that each portion of the procedure contributes to the overall stability of the GHJ.
The Latarjet operation employs a triple blocking mechanism, including lengthening the glenoid arc by adding a coracoid graft to the anterior glenoid rim. In the presence of significant glenoid bone loss, various bone-block methods have been used, most commonly the open Latarjet procedure[3]
- Instability with glenoid bone loss
- Combinations of glenoid and humeral bone loss
- Complex soft-tissue injury
- Revision of a Bankart repair
- Patients engaged in high-risk sports (climbing, rugby) or occupations (carpentry), or who have a high risk of recurrence due to the intensity and action of their activity (throwers), are ideal candidates for the Latarjet procedure
Depending on surgeon experience, the two techniques were used to perform the Latarjet procedure: a mini-open technique with a commercially available drill guide (Arthrex GmbH, Munich, Germany) and two 4 mm cannulated cancellous screws as based on the modified Latarjet procedure described by Walch and Boileau , or an arthroscopic technique with a specific guide (DePuy, Indiana, United States) and two 3.5-mm cannulated cancellous screws as described by Lafosse et al .[4]
CT scan
MRI
Pre-operative physiotherapy could strengthen the weak muscles through Isometric strengthening exercises and treat any inflammatory process in the shoulder joint [5]
Shoulders were immobilized with a sling for a minimum of 2 weeks to prevent pain, and all patients started self-rehabilitation exercises 1 day after surgery following a standard protocol , followed by a rehabilitation program supervised by a physiotherapist. Patients were allowed to return to daily activities after 1 month, but allowed to resume sports after 3 months only if they had recovered mobility. Patients were allowed to RTP if they were pain-free, with full ROM, regardless of time since index surgery.
here is an article publish in the Massachusetts General Brigham Sports Medicine hospital. Rehabilitation-protocol-for-latarjet.pdf
Resources[edit | edit source]
- ↑ Bradley H, Lacheta L, Goldenberg BT, Rosenberg SI, Provencher MT, Millett PJ. Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability in the Athlete–Key Considerations for Rehabilitation. International Journal of Sports Physical Therapy. 2021;16(1):259.
- ↑ Yamamoto N, Muraki T, An KN, Sperling JW, Cofield RH, Itoi E, Walch G, Steinmann SP. The stabilizing mechanism of the Latarjet procedure: a cadaveric study. JBJS. 2013 Aug 7;95(15):1390-7.
- ↑ Degen RM, Camp CL, Werner BC, Dines DM, Dines JS. Trends in bone-block augmentation among recently trained orthopaedic surgeons treating anterior shoulder instability. JBJS. 2016 Jul 6;98(13):e56.
- ↑ Gupta A, Delaney R, Petkin K, Lafosse L. Complications of the Latarjet procedure. Current reviews in musculoskeletal medicine. 2015 Mar;8(1):59-66.
- ↑ Lokapavani Y, Madhavi K. INFLUENCE OF PRE OPERATIVE PHYSICAL THERAPY EDUCATION AND EXERCISE ON POST OPERATIVE SHOULDER RANGE OF MOTION AND FUNCTIONAL ACTIVITES IN SUBJECTS WITH MODIFIED RADICAL MASTECTOMY. International Journal of Physiotherapy. 2014 Oct 7:170-7.