Latarjet Procedure: Difference between revisions


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[edit | edit source]

[1]

  1. The conjoint tendon acts as a sling to the inferior subscapularis and anteroinferior capsule when the arm is abducted and externally rotate. [2]
  2. The addition of bone to the glenoid rim increases the anteroposterior (AP) osseous diameter.
  3. The inferior capsule is reinforced with a portion of the coracoacromial ligament.

A study by Yamamoto et al . 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.[3] 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 Glenohumeral Joint .[4]

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, we can also use latarjet procedure in Superior Labral Anterior Posterior SLAP Lesion[5]

  • 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 .[6]

Computed Tomography scan ( CT ): This will be conducted to see weither the Glenoid cavity intact or not

Magnetic resonance imaging (MRI): MRI can be used to see the soft tissue lesion and in Latarjet procedure commonly will be a lesion of SLAP or the suerface of joint will not be curved.

Pre-operative physiotherapy could strengthen the weak muscles through Isometric strengthening exercises and treat any inflammatory process in the shoulder joint as well as Electrophysical modilities .

Shoulders should immobilized with a sling for at least for 2 weeks to prevent pain and all patients started self-rehabilitation exercises 1 day after surgery then a standard protocol , followed by a rehabilitation program supervised by a physiotherapist. Patients are allowed to return to daily activities after 1 month if there are no complications, but allowed to resume sports after 3 months only if they had recovered mobility and followed physical therapy protocols . Patients are allowed to Real-time Transport Protocol (RTP), if they were pain-free, with full ROM, regardless of time since index surgery.[7]

  1. (2) Whart is an Open Latarjet Stabilisation? – YouTube
  2. 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.
  3. 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.
  4. Bigliani LU, Kelkar R, Flatow EL, Pollock RG, Mow VC. Glenohumeral Stability: Biomechanical Properties of Passive and Active Stabilizers. Clinical Orthopaedics and Related Research (1976-2007). 1996 Sep 1;330:13-30.
  5. 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.
  6. Gupta A, Delaney R, Petkin K, Lafosse L. Complications of the Latarjet procedure. Current reviews in musculoskeletal medicine. 2015 Mar;8(1):59-66.
  7. Fedorka CJ, Mulcahey MK. Recurrent anterior shoulder instability: a review of the Latarjet procedure and its postoperative rehabilitation. The Physician and sportsmedicine. 2015 Jan 2;43(1):73-9.

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