Arthroscopic Latarjet procedure

Abstract

Hypothesis: Arthroscopy reveals many previously unrecognized soft tissue and bony lesions underlying recurrent anterior shoulder instability. Certain stabilising procedures however fail to adequately address the underlying pathology. The open Latarjet procedure has shown to have excellent and reproducible results in recurrent instability. We believe that this success can be transferred using an all arthroscopic technique and gain the advantages of minimally invasive surgery.

Materials and methods: Since December 2003, we performed over 180 arthroscopic Latarjet procedures. The technique and instruments have been refined and modified during this time. We prospectively collected the results for the first 100 shoulders.

Results: The average patient age was 27.5 with 88% actively involved in sports. Mean return to work was 2 months (7 days-4 months) and return to sport at 10 weeks (21 days-6 months). At 26 months, patient-reported outcomes revealed 91% excellent scores and 9% good. Range of motion showed an average loss of external rotation of 18 degrees . Perioperative complications included 2 hematomas, 1 graft fracture, and 1 transient musculocutaneous nerve palsy. Late complications included 4 cases of graft non-union and 3 of graft lysis. Graft position was flush with the glenoid in 80%, vertical positioning was excellent in 78% (3-5 o'clock).

Discussion: The all-arthroscopic Latarjet is a reliable but difficult technique, with a steep learning curve. Our technique has shown excellent results through midterm follow-up, with minimal complications and good graft positioning.

Conclusions: We recommend this procedure to those surgeons with good anatomic knowledge, advanced arthroscopic skills, and familiarity with the instrumentation.