Latarjet Procedure - Shoulder

Diagnosis

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Shoulder instability. Repeated movement of the shoulder bone out of the socket (recurrent dislocations) is the cause of concern in patients usually belonging to the age group of 18 to 40. Apprehension sign where the patient experiences the scare of joint dislocation in certain angles of shoulder movement is noted.

X-ray. Xray may reveal if there is a bony Bankarts, where a fragment of bone is lifted up from the front edge of the socket (Glenoid bone). Xray may also reveal a large dent in the back part of the upper portion of the shoulder bone (head of the humerus). However, in majority of patients with this problem, X-ray may not reveal any abnormalities.

MRI Scan. With contrast is the gold standard investigation for identifying the extent of the tear of the lip (labrum), the dent (Hill Sach’s lesion) on the back side of the shoulder bone due to rubbing against the front of the socket.

 

Treatment

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Acute dislocation of the shoulder joint needs immediate medical attention to reduce the shoulder joint back into place. Once the pain and inflammation reduces, it needs a prompt assessment regarding the risk of further dislocation.

 

Latarjet Procedure

 

In patients with risk of repeated dislocations with ligament laxity or in patients with previous Bankarts repair (Labral repair) which has failed, the Latarjet procedure is undertaken. If a significant amount of glenoid (socket) bone loss is observed, then Latarjet procedure is indicated. Latarjet procedure entails detaching a part of the coracoid bone (a part of shoulder wing bone) and fashioning it to sit and fuse with the front portion of the glenoid (socket) bone. This will provide a mechanical block for the humerus head to jump  out from its position. In addition, the muscles attached to coracoid bone work like a dynamic sling preventing dislocation. This is done either as a mini-open fracture or as an arthroscopic procedure. The Coracoid bone gets fixed to the glenoid bone by using titanium screws. 

 

Rehabilitation

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Post-surgery, for the first 6 weeks using a broad arm sling is recommended. Gentle passive stretches are started early. Upto 6 weeks external rotation and abduction movements need to be avoided. Return to non-contact sports by around 4 months and for contact sports by 6 months.

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