Latarjet procedure

The Latarjet operation, also known as the Latarjet-Bristow procedure, is a surgical procedure used to treat recurrent shoulder dislocations, typically caused by bone loss or a fracture of the glenoid. The procedure was first described by French surgeon Dr. Michel Latarjet in 1954.[1]

Mechanism

The mechanism of action has been described as a triple blocking effect:

  1. conjoint tendon acting as a sling on the subscapularis and capsule with the arm abducted and externally rotated;
  2. increasing or restoring the glenoid bone; and
  3. repair of the capsule to the stump of coracoacromial ligament.[2]

Procedure

The Latarjet procedure involves the removal and transfer of a section of the coracoid process and its attached muscles to the front of the glenoid. This placement of the coracoid acts as a bone block which, combined with the transferred muscles acting as a strut, prevents further dislocation of the joint.[3] In layman's terms, this procedure involves removing a piece of bone from another part of the shoulder, and attaching it to the front of your shoulder socket. The bone will then act as a barrier which will physically block the shoulder from slipping out of the socket, while the muscles which are transferred with the bone will give additional stability to the joint.

Effectiveness

While the Latarjet procedure can be used for surgical treatment of most cases of shoulder dislocations or subluxation, it is particularly indicated in cases with bone defects.[4] The failure rate following arthroscopic Bankart repair has been shown to dramatically increase from 4% to 67% in patients with significant bone loss.[5] The same authors subsequently reported much improved results when the Latarjet operation was used in patients with bone loss.[6] A number of technical variations have been proposed including both open and arthroscopic variations.[7][2][6] Complication rates are between 15 - 30%, with long term issues such as graft osteolysis continuing to be an issue with the procedure.[8]

With appropriate patient selection, the Latarjet procedure can be expected to prevent recurrent anterior instability in approximately 94-99% of cases.[9][6][10][11][12] Full recovery can take 6 months, however the majority of activities can be resumed after 3.[1] The main long term side effect is reduced external rotation range in the shoulder.

The Latarjet operation has also been demonstrated to be successful in contact athletes and rugby players.[13][14]

In summary, the Latarjet operation may ideally be suited as the shoulder reconstruction procedure of choice for contact athletes, patients with increased shoulder laxity, failed previous shoulder reconstructions or if there is significant bone damage.

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References
  1. Latarjet, M (1954). "A propos du traitement des luxations re´cidivante de l'e´paule". Lyon Chir. 49: 994–1003.
  2. Young, AA; Maia R; Berhout J; Walch G (March 2011). "Open Latarjet procedure for management of bone loss in anterior instability of the glenohumeral joint". Journal of Shoulder and Elbow Surgery. 20 (2 Suppl): S61-9. doi:10.1016/j.jse.2010.07.022. PMID 21145262.
  3. http://www.shoulderdoc.co.uk/article.asp?section=914
  4. Edwards, TB; Boulahia A; Walch G (2003). "Radiographic analysis of bone defects in chronic anterior shoulder instability". Arthroscopy. 19 (7): 732–9. doi:10.1016/S0749-8063(03)00684-4. PMID 12966381.
  5. Burkhart, SS; De Beer JF (2000). "Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion". Arthroscopy. 16 (7): 677–94. doi:10.1053/jars.2000.17715. PMID 11027751.
  6. Burkhart, SS; De Beer JF; Barth JR; Cresswell T; Roberts C; Richards DP (2007). "Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss". Arthroscopy. 23 (10): 1033–41. doi:10.1016/j.arthro.2007.08.009. PMID 17916467.
  7. Lafosse, L; Boyle S (2010). "Arthroscopic Latarjet procedure". J Shoulder Elbow Surg. 19 (2 suppl): 2–12. doi:10.1016/j.jse.2009.12.010. PMID 20188263.
  8. Gupta, A; Delaney, R; Petkin, K; Lafosse, L (March 2015). "Complications of the Latarjet procedure". Current reviews in musculoskeletal medicine. 8 (1): 59–66. doi:10.1007/s12178-015-9258-y. PMC 4596182. PMID 25644052.
  9. Allain, J; Goutallier D; Glorion C (1998). "Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder". J Bone Joint Surg Am. 80 (6): 841–52. PMID 9655102.
  10. Hovelius, LB; Akermark C; Albrektsson B; Berg E; Körner L; Lundberg B; Wredmark T (1983). "Bristow-Latarjet procedure for recurrent anterior dislocation of the shoulder. A 2–5 year follow-up study on the results of 112 cases". Acta Orthop Scand. 54 (2): 284–90. doi:10.3109/17453678308996571. PMID 6846008.
  11. Hovelius, L; Sandström B; Sundgren K; Saebö M (2004). "One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: study I—clinical results". J Shoulder Elbow Surg. 13 (5): 509–16. doi:10.1016/j.jse.2004.02.013. PMID 15383806.
  12. Walch, G; Boileau P (2000). "Latarjet-Bristow procedure for recurrent anterior instability". Tech Shoulder Elbow Surg. 1: 256–61. doi:10.1097/00132589-200001040-00008.
  13. Joshi, M; Young AA; Balestro J-C; Walch G (2013). "The Latarjet-Patte Procedure for Recurrent Anterior Shoulder Instability in Contact Athletes". Clinics in Sports Medicine. 32 (4): 731–9. doi:10.1016/j.csm.2013.07.009. PMID 24079431.
  14. Neyton, L; Young A; Dawidziak B; Visona E; Hager JP; Fournier Y; Walch G. (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. doi:10.1016/j.jse.2012.01.023. PMID 22565042.
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