Latarjet Procedure for Recurrent Shoulder Dislocation: A Comprehensive Guide by Dr. Ajinkya Achalare
Recurrent shoulder dislocation is a common problem among athletes, young adults and individuals who have experienced a significant shoulder injury like a road traffic accident. Repeated episodes of dislocation can cause pain, apprehension, reduced confidence during physical activities and damage to the bones and soft tissues of the shoulder joint.
When the shoulder continues to dislocate repeatedly, surgical stabilisation is necessary. Surgical treatment of shoulder instability can be broadly divided into Open Vs Arthroscopic procedures and also Soft Tissue Vs Bony procedure. Multiple factors need to be considered before a deciding a perfect option for the patient.
Latarjet procedure is one of the commonest bony procedure performed for anterior shoulder instability, named after a French surgeon Dr. Michel Latarjet.
Understanding the Latarjet procedure, its indications, benefits and recovery can help patients make informed decisions about their shoulder health.
What exactly is the Latarjet Procedure?
Shoulder is a ball-and-socket joint in which the rounded head of the upper arm bone (humerus) fits into a relatively shallow socket (glenoid).
After the first episode of dislocation, the soft tissue stabiliser (labrum) of the joint gets torn and damaged. But following repeated episodes of dislocation, the front portion of the socket (glenoid) starts losing bone. These bony changes can make the shoulder more and more unstable.
During the Latarjet procedure, a small piece of bone called the coracoid process of shoulder, along with its attached conjoint tendon, is fixed to the front of the shoulder socket.
The procedure provides stability through a TRIPLE MECHANISM:
Increasing the bony support at the front of the socket,
Creating a dynamic sling effect through the attached conjoined tendons
Reinforcing the anterior soft tissues (capsule)
This combination makes the Latarjet procedure useful for selected patients with recurrent shoulder instability and associated bone loss of the socket.
When is the Latarjet Procedure recommended?
Not every patient with a shoulder dislocation requires surgery, and not every patient who needs surgery requires a Latarjet procedure.
The treatment depends on age of the patient, occupation, involvement in sporting activities, duration and severity of symptoms, amount of bone loss and previous treatment.
Possible indications for a Latarjet procedure are as follows:
Recurrent anterior shoulder dislocation: Patients who experience multiple repeated episodes of the shoulder ball slipping out of its socket even during routine activities or during sleep
Glenoid bone loss: Patients having bone loss of more than 20-25% of the socket (glenoid) width
Failure of previous shoulder stabilisation surgery: Patients who experience recurrent instability after a previous soft tissue repair
High-risk contact and collision athletes: Rugby players, wrestlers, boxers and other athletes exposed to repeated shoulder trauma benefit from a more robust bony stabilisation procedure when their anatomy and risk profile support this approach.
Combined bone defects: Patients having bone loss over both socket and the ball (Hill-Sachs lesion)
Latarjet procedure is not the best option for every patient with shoulder instability. Alternatives may be more suitable when bone loss is lesser or when the patient is not involved in heavy activities or contact sports.
How is the Latarjet Procedure performed?
The Latarjet procedure is performed under general anaesthesia (GA). It can be performed through an open or arthroscopic approach.
The key steps include:
Step 1: Surgical exposure: The surgeon accesses the front of the shoulder and identifies the coracoid process and its attached tendons.
Step 2: Coracoid osteotomy & graft preparation: A carefully measured portion of the coracoid process is detached while preserving its attached tendons and preparation is done for better healing.
Step 3: Preparation of the shoulder socket: The front of the glenoid is prepared to provide an appropriate surface for bone graft healing.
Step 4: Bone graft transfer: The coracoid bone block is transferred to the front of the glenoid through a split in the subscapularis muscle.
Step 5: Fixation: The bone graft is secured to the glenoid with screws or buttons, in a position that restores the bony contour without excessively projecting into the joint.
Step 6: Soft-tissue repair and closure: The surgeon completes the required soft-tissue repair and closes the surgical incision.
Precise graft positioning and secure fixation are essential for successful healing and long-term shoulder stability.
What are the advantages of Latarjet Procedure?
The primary goal of Latarjet surgery is to prevent further shoulder dislocations and improve functional stability.
Key benefits include:
Improved shoulder stability: The procedure addresses both bony deficiency and dynamic instability, removing the apprehension of a dislocation
Reduced risk of recurrent dislocations: It provides a robust stabilisation in appropriately selected patients
Return to sports and physical activity: Successful rehabilitation can help patients gradually return to athletic activities or heavy work occupation
Treatment for failed primary surgery: It provides an option for patients whose shoulder remains unstable after failed soft-tissue stabilisation procedures.
Restoration of confidence: Improved stability may reduce apprehension during movements that previously triggered fear of dislocation.
Outcomes are largely positive depending on the extent of the original injury, surgical technique, compliance to rehabilitation and individual patient factors.
What are the risks involved in the surgery?
Although Latarjet procedure is well established, it is a technically demanding operation and carries potential risks. Patients should discuss these with their treating orthopaedic surgeon before surgery.
Possible risk or complications include
Infection
Excessive bleeding
Joint stiffness,
Nearby nerve or blood vessel injury,
Fracture of the transferred bone,
Delayed or no healing despite good technique
Graft misplacement and joint arthritis recurrent instability
Careful patient selection, appropriate surgical planning, precise graft placement and supervised rehabilitation help reduce avoidable risks. Regular postoperative follow-up is important to assess recovery and bone healing.
How is the recovery after surgery?
Recovery after the Latarjet procedure takes a few months and requires patience and supervised rehabilitation.
A) Initial rest: A sling support is used for 4 weeks to protect the repair. Pain management, wound care and gentle movements permitted by the surgeon are important during this period.
B) Early rehabilitation: Physiotherapy begins 4 weeks onwards. The initial focus is on protecting the transferred bone, controlling pain and gradually restoring complete shoulder movements (range of motion).
C) Strengthening phase: As healing progresses, advanced exercises are introduced at around 6-8 weeks to improve shoulder strength, movement control and muscular coordination.
D) Return to sports: Contact sports, heavy lifting and overhead athletic activities are resumed only after adequate healing, recovery of strength and movement, and clearance from the treating surgeon. Return to competitive sports often takes approximately 9 months to 1 year, depending on the patient profile and recovery.
Latarjet Procedure vs Bankart Repair
Both of them are used to treat anterior shoulder instability, but they are two ends of the surgical spectrum and address different problems.
Bankart repair restores the detached labrum (boundary of the socket) and associated soft tissues to the glenoid. It is preferred when the bony structure is relatively preserved (< 15% bone loss) and the soft-tissue injury is the principal cause of instability. It is essentially performed arthroscopically.
Latarjet procedure adds bone stock to the front of the socket and adds a dynamic sling of the tednon. It is often preferred when significant socket (glenoid) bone loss is present, when the risk of recurrence is high, or when a previous soft-tissue repair has failed. It can be performed by open or arthroscopic means, open being more common.
The choice between these procedures depends on amount of glenoid bone loss, clinical examination, imaging findings, sporting demands and previous surgery. A personalised assessment by the surgeon is essential to select the most appropriate treatment.
Latarjet Procedure & Shoulder Instability Treatment at Dadar, Mumbai
Dr. Ajinkya Achalare at ArthroSports Speciality Orthopaedic Clinic provides thorough assessment and treatment plan for shoulder instability and sports-related orthopaedic problems.
Patients experiencing recurrent shoulder dislocations can seek an evaluation to understand which exact treatment is appropriate for their condition.
The aim of treatment is to restore stability, improve shoulder function and support a safe return to an active lifestyle.
If you are looking for a shoulder instability specialist or information about the Latarjet procedure in Mumbai, consult an expert orthopaedic shoulder and sports surgeon in the form of Dr.Ajinkya Achalare to discuss your diagnosis and treatment options.
ArthroSports Speciality Orthopaedic Clinic
201, Sanskruti by Sugee, above Hotel Aaswad, app Shivsena bhavan, LJ road, Shivaji Park, Dadar West, Mumbai - 400028
Contact: 8928196661
Disclaimer: This article is intended for educational purposes and does not replace an individual medical consultation. The appropriate treatment and expected recovery depend on each patient's clinical findings.
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