Arthroscopy: The Journal of Arthroscopic & Related Surgery
Systematic ReviewThe Outcomes and Surgical Techniques of the Latarjet Procedure
Section snippets
Evolution of Latarjet Technique
Although Latarjet,1 a French surgeon, was the first to describe the coracoid process transfer technique for recurrent anterior shoulder instability in 1954, in 1958 Helfet2 published his results using a similar procedure that he attributed to his mentor, Rowley Bristow; this technique became known as the Bristow operation in the English language. The original Bristow procedure is unique in that the coracoid process is sutured to the anterior part of the scapular neck through a transversely
Methods
A systematic review of outcomes after the Latarjet reconstruction was performed to help summarize patient prognosis. To identify studies, a literature search including the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2012), and Medline (1980-2012) was conducted. Inclusion criteria for the search included a minimum of 6 months' follow-up, open procedure (not arthroscopic), English language, publication in 1980 or later, and isolated
Results
A total of 10 studies10, 11, 12, 13, 14, 15, 16, 17, 18, 19 met the inclusion criteria and were included in the final analysis. A summary of the results is presented in Table 1. Given the different methods used in each of the studies included in the review, quantitative statistical analysis of the studies as a whole was not possible. Therefore descriptive analysis was performed. Overall, most studies were Level IV and retrospective in design. The duration of follow-up, as noted in Table 1,
Patient Positioning and Surgical-Site Preparation
Immediately after an interscalene block is placed and general anesthesia is induced, the patient is placed in a modified beach-chair position with the head of the bed elevated 40° (Fig 1).20 Two folded towels are placed under the medial border of the ipsilateral scapula. The shoulder is shaved, prepared, and draped in the usual fashion. The arm should be draped free to allow for intraoperative manipulation of the upper extremity, particularly abduction and external rotation. A specialized arm
Discussion
Large glenoid bone defects in patients with recurrent anterior shoulder instability often present as extremely challenging problems for even the most experienced shoulder surgeon. Patients frequently present with a history involving at least 1 failed arthroscopic shoulder stabilization procedure in addition to other comorbidities and high functional expectations. It is imperative that proper clinical decision making and lengthy preoperative counseling, as well as realistic patient expectations,
Conclusions
Low recurrent instability rates are reported after stabilization surgery with the Latarjet procedure; however, subtle variations in surgical technique, among other factors, may impact the development of glenohumeral degenerative changes and morbidity to the subscapularis.
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The authors report that they have no conflicts of interest in the authorship and publication of this article.