Systematic Review
The Outcomes and Surgical Techniques of the Latarjet Procedure

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Purpose

To determine the optimal position and orientation of the coracoid bone graft for the Latarjet procedure for recurrent instability in patients with recurrent anterior instability and high degrees of glenoid bone loss.

Methods

A systematic review of the literature including the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2012), and Medline (1980-2012) was conducted. The following search teams were used: glenoid bone graft, coracoid transfer, glenoid rim fracture, osseous glenoid defect, and Latarjet. Studies deemed appropriate for inclusion were then analyzed. Study data collected included level of evidence, patient demographic characteristics, preoperative variables, intraoperative findings, technique details, and postoperative recovery and complications where available.

Results

The original search provided a total of 344 studies. A total of 334 studies were subsequently excluded because they were on an irrelevant topic, used an arthroscopic technique, or were not published in English or because they were review articles, leaving 10 studies eligible for inclusion. Given the different methods used in each of the studies included in the review, descriptive analysis was performed. The duration of follow-up ranged from 6 months to 14.3 years postoperatively. With the exception of 2 studies, all authors reported on recurrent shoulder instability after Latarjet reconstruction; the rate of recurrent anterior shoulder instability ranged from 0% to 8%. Overall patient satisfaction was listed in 4 studies, each of which reported good to excellent satisfaction rates of more than 90% at final follow-up.

Conclusions

As noted in this review, the current literature on Latarjet outcomes consists mostly of retrospective Level IV case series. Although promising outcomes with regard to a low rate of recurrent instability have been seen with these reports, it should be noted that subtle variations in surgical technique, among other factors, may drastically impact the likelihood of glenohumeral degenerative changes arising in these patients.

Level of Evidence

Level IV, systematic review of Level IV studies.

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.

References (26)

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    Treatment of recurrent dislocation of the shoulder

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    (1954)
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    Coracoid transplantation for recurring dislocation of the shoulder

    J Bone Joint Surg Br

    (1958)
  • S.J. Lombardo et al.

    The modified Bristow procedure for recurrent dislocation of the shoulder

    J Bone Joint Surg Am

    (1976)
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    The authors report that they have no conflicts of interest in the authorship and publication of this article.

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