Latarjet surgery to treat shoulder instability

What is the Latarjet procedure?

Shoulder instability and dislocation

Shoulder instability is defined after 2 to 3 episodes of shoulder dislocation. A subluxation refers to a partial dislocation in which the joint spontaneously relocates.

In addition to being very painful, shoulder instability causes functional limitation of the shoulder. Patients often experience significant apprehension during overhead or throwing movements (for example, serving in tennis or spiking in volleyball). As a result, they often limit their own movements, both in daily life and during sports activities.

Principle of the Latarjet surgery

In cases of recurrent shoulder dislocation, the Latarjet procedure involves placing a bone block at the front of the glenoid (shoulder socket). First, this creates a physical barrier that prevents the humeral head from dislocating again. Second, the procedure repositions nearby tendons and muscles so that they act as an additional stabilizing sling, helping keep the humeral head in place during arm movements.

The bone graft is taken through the same incision from the coracoid process, a small bony projection of the shoulder blade. It is therefore simply transferred a few centimeters to its new position.

Latarjet or Bankart procedure?

The Latarjet procedure is one of the two main surgical techniques, along with the Bankart procedure, used to treat shoulder instability.

The risk of recurrence is generally lower after a Latarjet procedure. However, the Bankart procedure can often be performed arthroscopically, resulting in simpler recovery, faster functional improvement, and smaller, more cosmetic scars.

The choice of surgical technique depends on your individual condition and will be discussed during your consultation with Dr. Roure. He will explain the advantages and disadvantages of each approach based on your specific situation.

How is the procedure performed?

Summary

• Anesthesia: General anesthesia
• Hospital stay: Usually 1 night
• Immobilization: Approximately 4 weeks in a sling; sling wear is not permanent, and the hand and elbow may be used immediately
• Rehabilitation: Immediate self-directed passive exercises; formal physiotherapy begins after 4 to 6 weeks

Surgical procedure

The Latarjet procedure is performed under general anesthesia. A one-night hospital stay is usually required.

The operation begins with a vertical incision measuring approximately 5 to 8 cm at the front of the shoulder. The surgeon examines the shoulder joint and removes any damaged cartilage or injured labral tissue. Once the coracoid process has been harvested, it is secured with screws just in front of the joint surface. The joint capsule is then tightened to improve stability.

The skin closure is performed using absorbable sutures placed beneath the skin (an intradermal running stitch), providing the best possible cosmetic result.

After the procedure

A Redon suction drain is usually placed and removed before discharge from the clinic.

For the first two weeks after surgery, dressings should be changed every two days by a home nurse. Swimming and bathing are generally allowed afterward.

Postoperative recovery after a Latarjet procedure

Pain and occasional clicking sensations may persist for several months after surgery but usually improve progressively.

External rotation is generally the most difficult movement to regain. A small loss of motion compared to the opposite shoulder may remain.

Immobilization and rehabilitation

After surgery, the arm is placed in a sling for approximately 4 weeks.

However, the arm remains free during the day, and the hand and elbow may be used immediately. Patients are simply asked not to lift the arm out to the side or perform rotational movements. In practice, the sling should be worn outdoors and at night to prevent accidental movements.

Patients must perform daily self-rehabilitation exercises, which will be taught by a physiotherapist before discharge from the clinic.

At the end of the immobilization period, a structured physical therapy program begins. Rehabilitation typically lasts 1 to 3 months to optimize shoulder mobility and function.

When can sports be resumed?

Jogging can generally be resumed after 6 to 8 weeks, as well as swimming (starting with breaststroke), followed by golf after approximately 2 months (putting initially).

Return to gym training, tennis, and upper-body strengthening usually begins progressively after about 3 months. Contact sports can typically be resumed after 5 months, once shoulder strength and conditioning have been adequately restored.

Possible complications

The risk of complications after Latarjet surgery is low, but they should nevertheless be considered before the procedure.

• Recurrence remains possible, although the Latarjet procedure is considered one of the most reliable techniques for preventing recurrent instability.
• Infections and subcutaneous hematomas are rare and unpredictable. Additional surgery may occasionally be required.
• Pain and clicking sensations may persist, although they generally improve over time.
• Shoulder stiffness, particularly affecting external rotation, may remain, especially in cases complicated by complex regional pain syndrome.
• In the event of significant trauma, the bone graft or fixation screw may fracture. Over time, partial bone graft resorption may be observed on follow-up X-rays. This is usually not problematic, as stability is also maintained by the transferred tendons.
• If the fixation screw causes discomfort, the hardware may need to be removed.
• Complex regional pain syndrome (CRPS) is unpredictable and can cause pain and stiffness affecting the shoulder and sometimes the entire arm. Recovery may be prolonged and difficult, occasionally lasting several years and leaving some permanent limitation of shoulder mobility.
• The scar may widen because of the specific characteristics of the skin in this area. In some patients, the scar may become hypertrophic or keloid (raised and inflamed), which cannot be reliably predicted or prevented.