Latarjet procedure

FAQs on Latarjet Procedure

 

The Latarjet procedure is one of the most used surgical methods to treat recurrent anterior instability in the shoulder. First invented in 1954 by French surgeon Dr Michel Latarjet, the advanced versions help achieve above 98% success rate. With low risk of complications and ability to make up for bone loss, the procedure continues to be one of the foremost shoulder reconstruction methods.

What is Latarjet procedure?

Latarjet procedure is a reconstruction method to treat shoulder anterior instability. The surgery involves taking a bone section from the coracoid process in the shoulder assembly with its muscles and grafting it to the glenoid, the front part of the shoulder joint socket, using two screws. This leads to reconstruction of a deeper socket within which a protective sling is formed to prevent arm dislocation. The procedure also adds tendons as replacements to make up for the bone loss and create a muscular strut for sling effect in the glenoid cavity.

The process acts through “triple effect” mechanism.

  • It enhances the glenoid bone surface.
  • Grafted tendon acts as a sling and keeps the joint stabilized during abductions and rotation of arm.
  • It repairs the capsule.

What are conditions treated with Latarjet procedure?

The Latarjet procedure reconstruction is used to treat shoulder dislocations traced to

  • Increased shoulder laxity
  • Bankart tear or significant ligament damage
  • Failure of previous shoulder stability procedures
  • Glenoid bone fracture
  • Labral damage
  • Hill Sach’s fracture
  • Significant bone damage in the glenoid cavity

Who is a candidate for Latarjet procedure?

A patient is considered for Latarjet procedure shoulder reconstruction when

  • He experiences chronic and recurrent shoulder destabilization
  • No significant relief despite using non-surgical methods over a period of time
  • Previous shoulder stabilization surgery failed
  • Athletes injured in a contact sports
  • Patient has too much glenoid bone damage

How is Latarjet procedure performed?

Latarjet procedure involves a two-stage surgery. First, a bone is taken from the coracoid process and secondly, it is attached to the front of the shoulder socket to become a barrier and stop the slipping of the humeral head from the socket. It also enhances the distance your shoulder joint requires to move past and dislocate. Graft tendons act as an internal sling to push the shoulder back to the socket.

The surgery is performed using both arthroscopic and the open methods. Open methods requires hospitalization for a few days while arthroscopic process needs overnight hospitalization and even done in outpatient setting.

The patient is sedated with a general anesthetic. A nerve block is also done on the affected shoulder side. The patient is placed in a “beach chair” position and incisions are made on the front of the shoulder where the collarbone ends. A section of the coracoid bone along with tendons is cut and prepared as a graft.

The shoulder capsule is opened or accessed using an arthroscope and the graft is implanted. It was tightened using two screws and the incision is closed.

How long does Latarjet procedure take?

It takes about 90 minutes to 2 hours.

Do I need to stay at the hospital after Latarjet procedure?

If the arthroscopic Latarjet procedure is performed, you may be discharged after 2 to 3 hour of observation. In case of open surgeries, it may need hospitalization for one to two days.

Do I need rest after Latarjet procedure?

Take rest for 2 to 3 days after you are discharged. Use a sling for 2 to 3 weeks to avoid discomfort.

What are the restrictions following Latarjet procedure?

  • Keep your arm immobile for two to three days
  • Use a sling for 2-3 weeks
  • Keep the wound dry for a week
  • No shower for 48 hours
  • Use sling while sleeping to avoid stress on the shoulder and keep it stabilized
  • Take pain and anti-inflammatory medication, as prescribed
  • Apply ice pads and avoid removing sutures
  • No heavy machinery operating for 8 weeks
  • No driving for 4 weeks
  • No overhead sports for 3 to 6 months

What kind of rehabilitation is needed following Latarjet procedure?      

Start with pendulum and passive exercises on the next day of surgery. Start light activities after 3-4 days and continue them for 2 to 3 weeks. Proper and active physical therapy should begin after 4 weeks. Add gradual strength training workouts and start resistance training after six weeks. The standard protocol prescribes a 3-month rehabilitation program.

How long is the recovery period following Latarjet procedure?

The bone graft heals completely after six weeks. You can start intense activities after six weeks. However, it takes 3 to 6 months to return to sports and regain full strength. You have to confirm complete recovery prior to returning to contact sports.

What are the potential complications of Latarjet procedure?

Surgery related complications may occur if the standard procedure is not followed. This may lead to avoidable complications, such as infection, blood clots, bleeding, nerve injury, tear of the graft, hamstring-related problems, knee stiffness, and implant irritability. Rare side effects, including knee weakness, knee cap pain, graft failure, continued knee instability, may also occur.

References

Young AA, et al. Open Latarjet procedure for management of bone loss in anterior instability of the glenohumeral joint. J Shoulder Elbow Surg, 2011 Mar;20(2 Suppl):S61-9

Edwards TB, Walch G. The Latarjet procedure for recurrent anterior shoulder instability: rationale and technique. Operative Techniques in Sports Medicine 2002; 10:25-32.

Walch G, Boileau P. Latarjet-Bristow procedure for recurrent anterior instability. Techniques in shoulder and elbow surgery 2000; 1:256-261

Burkhart SS, et al. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy 2007; 23:1033-1041.

Bessiere C, et al.The open latarjet procedure is more reliable in terms of shoulder stability than arthroscopic bankart repair. Clin Orthop Relat Res. 2014 Aug;472(8):2345-51. doi: 10.1007/s11999-014-3550-9.

Sahajpal DT and Zuckerman JD “Chronic Glenohumeral Dislocation” J Am Acad Orthop Surg July 2008 ; 16:385-398.

Lafosse L, Boyle S. Arthroscopic Latarjet procedure. J Shoulder Elbow Surg. 2010;19 (2 Suppl): 2-12

Shah AA, Butler RB, Romanowski J et-al. Short-term complications of the Latarjet procedure. J Bone Joint Surg Am. 2012;94 (6): 495-501.

Neyton L, et al (2012). “Surgical treatment of anterior instability in rugby union players: clinical and radiographic results of the Latarjet-Patte procedure with minimum 5-year follow-up.”. J Shoulder Elbow Surg. 21 (12): 1721–7

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