Latarjet Surgery for the Shoulder

Surgery to prevent recurrent shoulder dislocation

Woman suffering from shoulder pain, France
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Shoulder dislocations are common injuries, especially in young, active people. Latarjet surgery can be done to prevent repeated dislocations. Once someone has dislocated their shoulder once, recurrent (or repeat) dislocations can become more and more common. Some people develop such severe instability of the ball-and-socket shoulder joint that dislocations can occur with simple activities or while sleeping.

Each time the shoulder dislocates, further damage can occur to the joint. For this reason, people who have recurrent shoulder dislocations will usually have surgery in an effort to stabilize the joint and prevent future dislocations.

Damage in the Shoulder from Dislocations

Typical damage to the shoulder joint starts as a torn ligament the first time the shoulder comes out of the socket. This injury is called a Bankart tear and is seen very commonly, especially in young patients (under the age of 35) who sustain an initial shoulder dislocation. During that initial dislocation, or with subsequent dislocations, additional damage to other structures can occur. Often cartilage or bone about the socket is damaged, and these injuries may be more difficult to repair.

Glenoid Bone Loss

When bone damage occurs, the damage can either occur to the ball or the socket of the shoulder. Damage to the ball is called a Hill-Sachs lesion.

Damage to the socket causes fractures and bone loss to the glenoid (the socket of the shoulder).

When the shoulder socket is damaged, the socket may progressively get worn away. As this occurs, the chance of recurrent dislocation goes up. In fact, glenoid bone loss can get to the point where patients have a hard time keeping the shoulder in the socket at all.

One treatment for glenoid bone loss is called Latarjet surgery.

Latarjet Surgery

The Latarjet procedure was designed to augment the glenoid with additional bone. The bone comes from the scapula (shoulder blade) and is a hook of bone called the coracoid. The coracoid is a hook of bone in the front of the shoulder blade and is the attachment for several muscles. During Latarjet surgery, the surgeon removes the coracoid from its attachment to the scapula and moves the coracoid, and the muscle attachments, a few centimeters to the front of the shoulder socket. Once in position, the coracoid is screwed to the shoulder socket.

The Latarjet procedure accomplishes two important tasks: First, it increases the amount of bone of the shoulder socket to restore bone that had been lost. Second, the muscles attached to the coracoid create a sling, to help support the shoulder in the front of the joint.

The Latarjet is a very successful procedure at restoring stability to the shoulder joint. In fact, historically, this surgery was used as a standard treatment for people with shoulder dislocations.

As newer surgical techniques have improved, the Latarjet is now seldom used for a standard dislocation repair. Rather, the Latarjet procedure is preferred for those patients who have worn away at least 25% of the shoulder socket.

Rehabilitation following Latarjet surgery lasts for at least 4-6 months. The initial phases of rehabilitation is needed to protect the shoulder sufficiently to allow for full bone healing. Therefore, the mobility is restricted for the first few months while bone healing occurs. At that point, gradually the shoulder motion can be increased, followed by progressive strengthening.

Complications

Complications are unusual after Laterjet surgery, but there are some significant concerns. This is not a minor surgical procedure, and rehab after surgery can be lengthy. Some of the unique concerns include a nonunion of the bone that is transferred to the shoulder socket. In order for the surgery to fully heal, the bone must fuse to the front of the socket; in about 3% of patients, a nonunion of this bone can occur. Many major nerves surround the coracoid in the front of the shoulder. Damage to these nerves is possible during the surgical procedure. Lastly, patients having this surgery should understand that most people who have Laterjet surgery do not have normal range of motion of the joint after surgery. This is usually acceptable given the improvement in the stability of the joint.

Sources:

Sahajpal DT and Zuckerman JD "Chronic Glenohumeral Dislocation" J Am Acad Orthop Surg July 2008 ; 16:385-398.

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