Latarjet Technique For Shoulder Dislocation

For all traumatic or chronic diseases of the musculoskeletal system, the Centrokinetic private clinic in Bucharest is prepared with an integrated Orthopedic Department, which offers all the necessary services to the patient, from diagnosis to complete recovery.

The Department of Orthopedic Surgery of Centrokinetic is dedicated to providing excellent patient care and exceptional education for young physicians in the fields of orthopedic surgery and musculoskeletal medicine.

Centrokinetic attaches great importance to the entire medical act: investigations necessary for correct diagnosis (ultrasound, MRI), surgery, and postoperative recovery.

Discover the open MRI imaging center in our clinic. Centrokinetic has a state-of-the-art MRI machine, dedicated to musculoskeletal conditions, in the upper and lower limbs. The MRI machine is open so that people suffering from claustrophobia can do this investigation. The examination duration is, on average, 20 minutes.

The shoulder joint offers such a large area of movement and much greater flexibility than other joints in the body, being consequently the joint most prone to dislocations and subluxations. Recurrent trauma, scapulohumeral dislocations, or congenital laxity of the soft parts can lead to a chronic condition called joint instability.

The Latarjet procedure is a surgical technique that tries to regain the stability of the shoulder. It is indicated in recurrent shoulder dislocations, but sometimes this technique is used as the first intention after an acute scapulohumeral dislocation.

Surgical indications in previous instability include inefficiency of orthopedic (non-surgical) treatment, recurrent dislocations, irreducible dislocations, unstable reductions. Surgical treatment can be divided into 2 groups: soft tissue procedures and bone tissue procedures.

If preclinical investigations reveal bone damage to the anterior glenoid, surgical techniques that directly address the bone deficit are of choice. Bone lesions can occur as a result of trauma, recurrent scapulohumeral dislocations, congenital deformities. The most used surgical technique is the one described by Bristow (later modified by Latarjet et al.).

Pre-surgery preparation

The patient is placed in a supine position on the surgical table, with a roll under the medial edge of the scapula. Alternatively, the patient can be positioned on the surgical table in a "beach chair position". Options for anesthesia include general anesthesia and mildly sedated interscalenic block. The interscalenic block is preferable in this intervention, being less invasive, significantly reducing bleeding, and bringing postoperative analgesia.

The surgical technique consists in sectioning the coracoid process and fixing it in the anteroinferior part of the glenoid. Thus, the short head of the biceps and the coracobrachialis act as support in the anteroinferior area of the joint when the shoulder is in the vulnerable position of abduction and external rotation. Also, the transfer of the coracoid process through a breach in the subscapularis muscle, causes the muscular insertions of the 2 muscles to prevent the lower part of the subscapularis to move superior to the humeral head when the shoulder is in abduction.

An incision is made starting from the coracoid process and continuing inferiorly along the deltopectoral groove of about 4-7 cm. The cephalic vein is identified and retracts laterally. Place the arm in abduction and external rotation. The deltopectoral groove opens, mobilizing ms. lateral deltoid if ms. large medial pectoral. The coracoid process with muscle insertions is exposed. The coracoacromial ligament is highlighted and is sectioned 1 cm from the coracoid process. Place the arm in adduction and internal rotation, section the large pectoral ms insert on the medial surface of the coracoid process, leaving the ms inserts intact. biceps (short head) and coracobrachialis. Osteotomy of the coracoid process is performed with an osteotomy curved at 90 degrees, so that a 1-3cm bone graft results with the muscle inserts attached, at the base of the insertion of the coracoclavicular ligaments. Care must be taken to mobilize the coracoid process so that it is not damaged n. Musculocutaneous penetrating ms. coracobrachialis a few inches from the coracoid process. The arm is placed in the abduction and external rotation and the coracoid process is completely released.

Place the arm in adduction and external rotation. Subsequently, the upper and lower edges of ms. subscapularis is identified, which is incised along the fibers in the middle 1/3 with the lower. This allows exposure of the anterior capsule of the scapulohumeral joint. The capsule is incised and the joint is opened. A spacer for the humeral head is inserted, and the arm is placed in internal rotation. Inspect the joint cavity and extract any loose bone fragments.

Exposure of the scapular neck is necessary for proper fixation of the bone graft. A subperiosteal dissection reveals the neck of the scapula. The coracoid fragment must be fixed in the lower half of the glenoid, at a maximum of 5 mm from the joint edge.

Drill a hole in the anteroinferior part of the neck of the scapula with a 3.2mm drill that must perforate the posterior cortex and not interfere with the articular surface. A similar hole is drilled in the coracoid fragment. It is very important that the positioning of the fragment is done on a healthy bone surface, without the interposition of soft parts. The edges of the anterior capsule are approached with separate sutures, before the definitive fixation of the bone fragment. Fix the coracoid process on the neck of the scapula with a previously measured ankle screw. A washer can be used to prevent the bone from breaking. After the final fixation, we make sure that there is no tension.

Finally, the breach is sutured in the subscapular muscle. The deltopectoral fascia closes and the wound is sutured.

After the intervention, the patient remains hospitalized for 1-2 days. He will receive pain medication and antibiotics during his hospitalization. The operated limb is partially immobilized in a Dessault bandage for a few days.

After the surgery, you will be discharged, with the related indications to the recovery and the subsequent controls. Passive early mobilization of the shoulder joint is necessary for the patient to regain normal mobility. Our medical team guides the patient to physical therapy and physiotherapy under the guidance of one of our doctors.

The patient must understand that following surgery he has certain limitations in mobility, ie he is forbidden to make certain movements.

At home

Although recovery from arthroscopy is much faster than a classic operation, it will still take a few weeks for you to fully recover your shoulder joint. You should expect pain and discomfort for at least a week postoperatively. Ice will reduce pain and inflammation.

You must be careful not to sleep on the operated shoulder in the first weeks because the pain and discomfort can worsen. You can take a bath, but without wetting the bandage and incisions. The threads are suppressed at 14 days postoperatively. Physical therapy plays a very important role in the rehabilitation program, and the exercises must be supervized by a physical therapist until the end of the recovery period.

It is very important to follow the recovery program strictly and seriously for the surgery to be a success. Our medical team works on average with the patient after this intervention, 12-18 weeks until the complete recovery of the shoulder.