Latarjet Procedure
What Is the Latarjet Procedure?
The shoulder is the most mobile joint in the body; the humeral head (the ball) and the glenoid of the shoulder blade (the socket) provide a wide range of movement. This mobility also makes the shoulder prone to dislocating to the front. Repeated anterior dislocations can, over time, cause bone loss at the front rim of the socket.
The Latarjet procedure is an open shoulder stabilization operation that restores stability by transferring part of the coracoid process at the front of the shoulder, together with its attached muscles, to the front rim of the glenoid. It is used particularly in cases with significant anterior glenoid bone loss. For general information about shoulder dislocation and instability you can review the shoulder dislocation page.
How Does It Provide Stability?
The effect of Latarjet rests not on a single mechanism but on a combination of several. This is why it can be a strong option for shoulders with significant bone loss and a high risk of recurrence.
- Bony support: the transferred coracoid fragment fills the bone loss at the front rim of the glenoid and widens the socket.
- Sling effect: the muscles attached to the coracoid prevent the humeral head from slipping forwards when the arm is raised at certain angles.
- Capsular support: the tension of the joint capsule is reorganised to contribute to front stability.
Who Is a Candidate, and Who Is Not?
Latarjet is considered for selected patients in whom bone loss is the decisive factor. The decision is made according to the bone loss established by examination and imaging, the frequency of dislocations, age and sporting demands.
- Patients with recurrent anterior shoulder dislocation and significant anterior glenoid bone loss.
- Patients whose instability persists despite a previous soft-tissue stabilization and in whom bone loss is found; those at high risk of recurrence, such as contact athletes.
- In patients with limited bone loss a Bankart repair is often enough; the place of Latarjet is significant bone loss.
Preoperative Assessment
The direction, frequency and mechanism of the dislocation are clarified from the history; examination assesses the direction and degree of instability. The most critical step is measuring the bone loss.
An X-ray gives basic information; a three-dimensional CT shows the bone loss at the glenoid and the humeral head (including a Hill-Sachs lesion) in detail. MRI assesses the labrum and soft tissue. This imaging clarifies the choice between Latarjet and a Bankart repair. For bone loss and alternative methods you can review the bone graft surgery page.
How Is the Surgery Performed?
The operation is performed through an incision at the front of the shoulder. Part of the coracoid process is freed together with its attached muscles and transferred to the front rim of the glenoid, to the area of bone loss.
The transferred bone fragment is fixed flush with the glenoid surface with one or two screws, and the joint capsule is repaired at an appropriate tension. Correct placement of the bone fragment and the direction of the screws are technical details that affect the outcome and are carried out carefully.
Because Latarjet is an open operation, protecting the nerves and vessels near the coracoid is important. In experienced hands this risk is kept low; but it should be remembered that the operation is a technical procedure requiring detailed planning.
Anaesthesia and Duration
The operation is performed under general anaesthesia, usually with a regional nerve block; the block helps with pain control afterwards. The duration varies with the degree of bone loss and any accompanying repairs. Most patients are discharged after a short hospital stay.
The First Period After Surgery
In the early period the arm is supported in a sling to protect the repair. The duration of the sling and the movements allowed are set according to the surgeon's plan; forceful movements that rotate the shoulder outwards are avoided early on.
Cold application and the pain medication advised by the doctor are used for pain and swelling. Movement of the elbow, hand and neck is preserved in this period, and excessive loading is avoided early on so that the bone fragment can unite.
Rehabilitation and Return to Sport
Physiotherapy progresses in stages: first passive and protected range of motion, then active movement, then progressive strengthening, and finally sport-specific work. The programme is planned for each patient.
Return to sport is guided by criteria rather than a fixed date: union of the bone fragment, pain-free movement, muscle strength close to the other shoulder and good joint control. Return to contact and overhead sports takes longer; no fixed timeframe is promised.
Risks and When Should You See a Doctor?
The procedure is generally safe; nevertheless, as with any surgery, certain risks are kept in mind: infection, nerve injury (particularly because of the proximity to nerves in the area), failure of the bone fragment to unite, screw-related problems, joint stiffness and recurrence of the instability.
- Your shoulder dislocates repeatedly or a sense of apprehension persists; for assessment of bone loss and the appropriate method.
- Dislocations continue despite a previous shoulder stabilization.
- After surgery there is increasing pain, fever, wound drainage or numbness or weakness in the arm; do not delay.
For the assessment of shoulder instability and bone loss you can contact Assoc. Prof. Serkan Sürücü, and you can also review the other conditions covered within shoulder surgery.