Arthroscopic Latarjet Procedure

The arthroscopic Latarjet procedure is a minimally invasive surgical technique employed for the treatment of shoulder instability and recurrent shoulder dislocations in the presence of bone loss from the front of the glenoid (the socket portion of the shoulder joint).

The procedure involves transfer of the coracoid process (a small structure on the shoulder blade), with its attached muscles to the area of bone loss over the front of the glenoid. This replaces the missing bone, and the transferred muscle also functions as a dynamic muscular restraint, preventing further dislocations.

Anatomy of the Shoulder

The shoulder joint (glenohumeral joint) is a ball-and-socket joint with the head of the humerus (the arm bone) forming the ball, and a cup-shaped depression on the shoulder blade (called the glenoid) forming the socket. The joint is stabilized by the labrum, a cartilaginous rim of the glenoid cavity, and the capsule, a series of ligaments that enclose the joint. Injury and trauma can tear or stretch the labrum and/or ligaments, causing instability and dislocation of the joint.

Indications

Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint. A dislocation occurs when the end of the humerus (the ball portion) comes out of the socket.  Recurrent or multiple dislocations can damage the socket, resulting in bone loss.

The arthroscopic Latarjet procedure is indicated for shoulder instability and dislocation associated with:

• Significant glenoid bone loss or fractures
• An engaging Hill Sach’s lesion
• or a failed previous stabilization surgery

Preparation for Surgery

In preparation for surgery, your doctor will evaluate your medical history to make sure you are healthy enough to undergo the surgery.  Imaging studies such as MRIs and CT scans will be reviewed for planning purposes. You will receive specific instructions regarding how to care for your shoulder after surgery.

Surgical procedure

In general, the arthroscopic Latarjet surgery involves the following steps:

• The procedure is performed under general anaesthesia with you lying in a semi-reclined position.
• Your surgeon makes a few small incisions (arthroscopic portals), about a half-inch in length, over your shoulder joint.
• An arthroscope, a slender tubular device attached with a light and a small video camera at the end is inserted through the incisions into the shoulder joint.  This allows your surgeon to see the inside of your shoulder and assess the damage on a high-definition monitor. 
• Your surgeon then uses small surgical instruments inserted through the other tiny incisions to expose the coracoid process and its attached tendons.
• The coracoid process is freed of its attachments and, along with the conjoined tendon, is transected from its base.
• Holes are drilled into the transected coracoid process.
• The subscapularis muscle, which passes in front of the shoulder joint is split in line with its fibers.
• The capsule of the shoulder joint is entered and the glenoid is exposed and prepared to receive the coracoid.
• The transected coracoid with the conjoined tendon is passed through the separated subscapularis muscle and fixed to the glenoid rim with screws or a suture button through the previously drilled holes. This increases the glenoid surface area and stabilizes the joint. The conjoined tendon and subscapularis muscle provide additional stability by acting as a sling.
• Upon completion, the scope and the instruments are withdrawn, and the incisions are closed and covered with sterile bandages.

Postoperative care

In general, postoperative care and recovery after an arthroscopic Latarjet procedure will involve the following steps:

• Following the surgery, your arm will be placed in a shoulder sling for 2 to 4 weeks to rest the shoulder and protect the repaired joint.
• You may experience pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications are provided as needed to address these.
• You may also apply ice packs on the shoulder area to help reduce swelling and pain.
• Instructions on incision site care and bathing will be provided to keep the wound clean and dry.
• Elbow, wrist, and hand motion is encouraged right away. 
• Physical therapy should start about 1 week after surgery.  The physical therapist will instruct you on how to stretch the shoulder in a safe manner.
• Once the coracoid bone has healed to its new location, most of the restrictions can be removed and strengthening exercises can begin.  Generally, athletes can return to sports within 3 and 4 months after this type of surgery.

Benefits

Benefits of the arthroscopic Latarjet procedure over traditional open Latarjet surgery include:

• Smaller incisions
• Minimal muscle trauma
• Minimal blood loss
• Less post-operative pain
• Quicker recovery
• Improved ability to see and repair other damaged structures in the shoulder.

Risks and Complications

The arthroscopic Latarjet procedure is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

• Infection
• Bleeding
• Injury to surrounding nerves or blood vessels.
• Stiffness or restricted motion
• Recurrence of instability
• Failure of union of the coracoid process
• Hardware irritation

Summary

The shoulder joint provides a wide range of movement to the upper extremity but it is prone to instability. Dislocations can damage the bone structures which can increase the chance of future dislocations. The arthroscopic Latarjet procedure is a minimally invasive surgical procedure performed to treat shoulder instability. This procedure increases the surface area of the damaged socket and adds a dynamic muscular restraint which resists dislocations. In cases where there is significant bone damage or when previous surgeries have failed, the arthroscopic Latarjet procedure can restore the stability and function of the shoulder.