Abstract
Surgical treatment of anterior glenohumeral joint instability can be challenging and carries the inherent risk of recurrent instability, dislocation arthropathy, and postoperative loss of external rotation. In the current manuscript, a technique for combined reconstruction of anterior labrum and capsule, with concomitant reduction of the humeral head during anterior capsule reconstruction in open Latarjet procedure, is presented. Analogous to other techniques, the coracoid graft is fixed on the anteroinferior part of the glenoid between 3 and 5 o'clock. However, for this technique, reattachment of the labrum is performed between the native glenoid and the bone graft. Additionally, during the reconstruction of the anterior capsule on the coracoacromial ligament, while the operated arm is held in external rotation to avoid the postoperative rotational deficit, the humeral head is reduced posteriorly in the center of the glenoid during adduction, slight anterior forward flexion, and a posterior lever push. By doing so, the inherent theoretical risks of persistent instability and dislocation arthropathy are believed to be decreased. Further studies are needed to clarify the long-term consequences of this surgical technique in the clinical setting.
Highlights
Surgical treatment of anterior glenohumeral joint instability can be challenging and carries the inherent risk of recurrent instability, dislocation arthropathy, and postoperative loss of external rotation
The Latarjet procedure has a “triple-blocking effect” composed of 3 mechanisms that improve the anterior shoulder stability: first, the bony effect by bony coracoid block, which restores the glenoid bone loss and acts as a static restraint; second, the hammock and sling effects by conjoined tendon, which limits the anterior translation of the humeral head in a position of abduction and external rotation; and third, the bumper effect by reattachment of the anterior labrum and the capsule to the glenoid rim or coracoid process and reinforcement with coracoacromial ligament.[23]
It is unclear whether the labrum and the capsule should be reconstructed during the Latarjet procedure.[15,24]
Summary
The Latarjet procedure has a “triple-blocking effect” composed of 3 mechanisms that improve the anterior shoulder stability: first, the bony effect by bony coracoid. Block, which restores the glenoid bone loss and acts as a static restraint; second, the hammock and sling effects by conjoined tendon, which limits the anterior translation of the humeral head in a position of abduction and external rotation; and third, the bumper effect by reattachment of the anterior labrum and the capsule to the glenoid rim or coracoid process and reinforcement with coracoacromial ligament.[23] It is unclear whether the labrum and the capsule should be reconstructed during the Latarjet procedure.[15,24] it might have an important role. Repairing the capsule to the anterior glenoid rim makes the coracoid block extra-articular, lowering the rate of dislocation arthropathy.[22] Second, as shown in the cadaveric biomechanical study by Yamamoto et al.,[25] the suturing of the capsular flap to the coracoacromial ligament contributed to 23% to 24% of shoulder stability at end-range arm position In another biomechanical study, Kleiner et al.[26] compared the effect of the Latarjet procedure with and without capsular-coracoacromial ligament repair. Redislocation, persistent apprehension, postoperative limitation of external rotation, and development of glenohumeral osteoarthritis have long been described as one of the possible complications of the Latarjet procedure.[3,28,29,30,31,32,33] placing the arm in adduction, e8
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