Open (Laterjet) Shoulder Stabilisation
What is Open (Latarjet) Shoulder Stabilisation?
The Latarjet procedure is performed to treat shoulder instability. It involves reinforcing the joint with a piece of bone and a tendon. The procedure is performed through a 5 cm open incision.
What gives the Shoulder Joint its Stability?
The shoulder joint is a ball-and-socket joint with the head of the humerus (long arm bone) forming the ball, and a cup-shaped depression on the shoulder blade (glenoid cavity) forming the socket. The joint is stabilised by the labrum, a cartilaginous rim of the glenoid cavity, and the capsule, a series of ligaments that enclose the joint.
How does Shoulder Instability occur?
Injury and trauma can tear or stretch the labrum and/or ligaments, causing instability. Tearing of the labrum due to trauma is called a Bankart tear, which sometimes also involves the breaking of bone, which is referred to as a bony Bankart tear.
Shoulder instability may be associated with pain, a feeling of giving way and can lead to dislocation. The shoulder can dislocate in front (anterior), down (inferior) or behind (posterior), but anterior dislocation is the most common.
When is Open (Latarjet) Shoulder Stabilisation Recommended?
The Latarjet procedure is indicated for anterior shoulder instability that is recurrent and caused by a bony Bankart lesion. The surgery is considered when a surgical repair of the labrum alone does not significantly improve shoulder stability.
What are the Benefits of Open (Latarjet) Shoulder Stabilisation?
The Latarjet procedure has been shown to successfully treat shoulder instability due to bone loss or laxity with minimal recurrence.
What are the Alternatives to Open (Latarjet) Shoulder Stabilisation?
Shoulder instability may also be treated by arthroscopic Bankart repair.
What is the Procedure for Open (Latarjet) Shoulder Stabilisation?
The Latarjet procedure is performed under general anaesthesia. You are made to lie in a semi-reclined or beach-chair position.
- An incision of 5 cm is made from your shoulder blade towards the armpit.
- Retractors are used to separate the muscles of the shoulder and chest, and expose the coracoid process (a small hook-like process of the shoulder bone) and its attached tendons.
- The coracoid process is freed of its attachments except the conjoined tendon and is cut across from its base.
- Holes are drilled into the cut coracoid process.
- The subscapularis muscle, which passes in front of the shoulder joint, is split in line with its fibres.
- The capsule of the shoulder joint is entered and the glenoid is exposed and prepared to receive the coracoid.
- The cut coracoid with the conjoined tendon is passed through the separated subscapularis muscle and fixed to the glenoid rim with screws through the previously drilled holes. This increases the glenoid surface and stabilises the joint. The conjoined tendon and subscapularis muscle provide additional stability by acting as a sling.
- Upon completion, the instruments are withdrawn, the incision is closed and covered with a sterile bandage.
What Happens After Open (Latarjet) Shoulder Stabilisation?
Following the procedure, your arm is placed in a sling to rest the shoulder and promote healing. You may remain in the hospital the night of the surgery before being discharged home. Pain is controlled with medication and ice packs. You will be instructed to keep the surgical wound dry and wear your sling while sleeping for a few weeks after the procedure. The sling may be removed in 3 to 6 weeks.
What is the Rehabilitation Process after Open (Latarjet) Shoulder Stabilisation?
Rehabilitation usually begins early on the first postoperative day with finger movements and passive assisted range of motion exercises. A physical therapy program is recommended for 3 months, after which you can return to your regular activities. Adequate physical rehabilitation is necessary for you to return to your regular activities early, without complications.
What are the Risks Associated with Open Shoulder Stabilisation?
The Latarjet procedure usually provides good results, but as with all surgical procedures, complications may occur and include:
- Hematoma (bleeding)
- Fracture or failure of union of the coracoid
- Stiffness due to inadequate rehabilitation
- Recurrence of instability and infection (rare)