The latarjet procedure is used for patients with significant glenoid (socket) and/or humeral head bone loss, which often occur in cases of recurrent shoulder instability. To make up for the bone loss on the glenoid side, most of the coracoid (a bony extension of the scapula) is cut and secured to the front of the socket. This increases the diameter of the socket and the distance the humeral head would have to travel before it could dislocate. Also, the tendon attached to the tip of the coracoid (called the conjoined tendon) tensions a muscle in the front of the shoulder called the subscapularis and creates a sling effect by limiting the movement of the humeral head when the arm is in the throwing position, which is the position that puts the shoulder at most risk to dislocate.
The patient is positioned in a sitting position on the operating room table and the arm is placed in an arm holder. A 4-5 inch vertical incision is made over the front of the shoulder. The coracoid is exposed and a guide is placed to measure the length of the coracoid. Retractors are placed to protect underlying nerve structures and 2 holes are drilled through the coracoid. The coracoid is cut at the base. The front rotator cuff muscle, called the subscapularis, is usually split in line with the muscle fibers, but occasionally part of the tendon is peeled off the bone in addition to improve visualization. The capsule is identified and cut in line with the subscap split. The front of the glenoid is prepared by roughening up the bone and the coracoid is passed through the split in the subscap and capsule. The coracoid is fixed to the glenoid with 2 screws. The capsule and subscapularis are closed with absorbable sutures and/or suture anchors. The wound is closed in multiple layers with absorbable sutures and sterile dressings are applied. The arm is placed into a sling. The surgery is performed under general anesthesia with a nerve block.
- This surgery is usually outpatient, which means the patient will be able to go home the same day.
- Surgery typically lasts 2-2.5 hours
- Patients will be fit for a sling at a preoperative appointment and this sling will be placed on the patient prior to waking up from anesthesia
- The sling is to be worn at all times until the nerve block has worn off. At that point, the arm should be removed from the sling at least three times a day for elbow, wrist, and finger motion.
- Eliminate shoulder instability
- Restore shoulder range of motion and function
- Decrease/eliminate catching or popping in the shoulder
- Return to work, sport, and activities with confidence
- Recurrent symptomatic shoulder instability
- Significant glenoid and/or humeral head bone loss
- Contact athlete
- Failed previous arthroscopic stabilization procedure
Most frequently, patients will be placed in a sling for 4 weeks postop. The sling may be removed for elbow, wrist, and finger movement by the first day after surgery. Physical therapy (PT) will start 2 weeks after surgery. Physical therapists follow a prescribed protocol outlined by Dr. Faulkner to regain range of motion and strength. Physical therapy and home exercises are a critical part of a patient’s outcomes and quality of life after surgery. Patients should expect to continue to improve with range of motion and strength up to 6 months after surgery, with most of the gains occurring within the first few months. Patients should plan on being seen in clinic about every 6 weeks until 5-6 months after surgery for close monitoring and to ensure any questions are answered. Radiographs will be taken at 2 weeks, 6 weeks, and 3 months from surgery to ensure that the bone transfer is healing appropriately. Most patients are cleared for full activity 6 months after surgery.
4 weeks. The sling should be removed at least 3x/day for elbow, wrist, and finger range of motion exercises as will be instructed. You should do pendulum exercises 3x/day as well.
No. Driving with a sling is considered driving impaired and could be subject to a citation.
Yes. You are also usually unaware of their arm movements at night. The sling helps to ensure that the arm stays in a good position for healing.
Physical therapy typically starts 2 weeks after surgery.
2 days after surgery. Once you remove the bandages, you will see 3 sticky white strips covering the wounds. These are called steri-strips and should be left in place until your first postoperative appointment.
The ice machine should be used for about 30 minutes at least 3 times a day until your first postop. You may ice more frequently if desired.
An anesthetic injection performed by the anesthesiologist to turn off pain signals that go to a targeted region.
This will be discussed at your preop appointment. If a narcotic is prescribed, the risks and side effects will be reviewed with you. We encourage you to try and discontinue these by your first postop appointment. Depending on your health history, it is encouraged to take anti-inflammatories and Tylenol instead of the narcotics.
The most common risk after this surgery is stiffness, especially with abducted external rotation (throwing position); however, most patients are able to recover functional range of motion that does not limit them. Other less common risks include infection, bleeding, arthritis, fracture, hardware loosening, nerve injury, and bone resorption.