At Physio Tullamore we see athletes and patients that sustained a shoulder dislocation. If continued dislocation occurs following
conservative management and rehabilitation surgical treatments such as the Latarjet procedure can be used.
The Latarjet procedure, named after the French surgeon Michel Latarjet who first described it in the 1950s, is a surgical technique used to treat shoulder instability, particularly recurrent anterior shoulder instability. This procedure has gained prominence in recent years due to its high success rates and effectiveness in restoring stability to the shoulder joint. This essay delves into the details of the Latarjet procedure, its indications, surgical technique, postoperative rehabilitation, and outcomes.
Recurrent Anterior Shoulder Instability
The primary indication for the Latarjet procedure is recurrent anterior shoulder instability, often associated with repetitive dislocations or subluxations of the glenohumeral joint. This condition frequently occurs in athletes and individuals with high physical demands on their shoulders.
Failed Conservative Management
Patients who have failed conservative treatments, such as physical therapy and rehabilitation, and continue to experience shoulder instability, are often candidates for the Latarjet procedure. This surgery is considered when non-operative measures do not provide sufficient relief or stability.
Anatomy and Pathophysiology
Before discussing the surgical technique, it is essential to understand the underlying anatomy and pathophysiology of anterior shoulder instability. In this condition, the labrum and the glenoid socket's capsule are often damaged, contributing to instability. The Latarjet procedure aims to address these issues by creating stability through the transfer of a piece of the coracoid process.
The Latarjet procedure involves several key steps:
2.2.1. Exposure: A standard deltopectoral approach is used to access the shoulder joint. This approach provides the surgeon with excellent visualization of the glenoid and the coracoid process.
2.2.2. Coracoid Transfer: A portion of the coracoid process, along with the attached conjoined tendon, is carefully dissected and mobilized. The surgeon then transfers this bony segment to the anterior glenoid rim, where it is fixated using screws. This transferred bone acts as a barrier, preventing the humeral head from dislocating anteriorly.
2.2.3. Capsular Shift: The capsule of the shoulder joint may be tightened or shifted as necessary to enhance stability.
2.2.4. Repair of Labral Tears: Any labral tears or damage to the glenoid labrum are repaired or reconstructed during the procedure to optimize joint integrity.
2.2.5. Closure: The incisions are closed, and the surgical site is carefully dressed and protected.
Rehabilitation following the Latarjet procedure is a critical component of the patient's recovery and the long-term success of the surgery. The postoperative rehabilitation process typically includes:
Immobilization: Patients are often placed in a shoulder sling for a period of time to protect the surgical site and allow for initial healing.
Range of Motion Exercises: Controlled range of motion exercises is initiated gradually to prevent stiffness while avoiding excessive stress on the surgical repair.
Strengthening Exercises: As the shoulder heals, progressive strengthening exercises are introduced to restore muscle function and stability.
Functional Training: Patients undergo a tailored rehabilitation program to regain functional use of the shoulder, with an emphasis on sports-specific or occupational demands.
Return to Activity: The timing for returning to sports or physical activities varies depending on the individual's progress and the surgeon's recommendations. Full return to high-impact activities often takes several months.
Outcomes and Complications
Excellent Stability
The Latarjet procedure has demonstrated excellent stability and a low recurrence rate in patients with recurrent anterior shoulder instability. This stability is attributed to the anatomic reconstruction of the glenoid rim and the added barrier effect provided by the transferred coracoid bone.
Pain Relief
Patients often experience pain relief following the procedure, as the shoulder joint becomes more stable, reducing the risk of impingement and abnormal movement.
Improved Function
Many patients report improved shoulder function and enhanced quality of life after the Latarjet procedure, enabling them to return to their desired activities with reduced apprehension.
Complications
While the Latarjet procedure has a high success rate, it is not without potential complications, including infection, nerve injury, graft non-union, and hardware-related issues. However, these complications are relatively rare and can be managed with appropriate medical attention.
Recurrence
In some cases, recurrent instability or subluxation may still occur despite the Latarjet procedure. This is more likely to happen in patients with certain risk factors, such as hyperlaxity or significant bone loss.
Conclusion
The Latarjet procedure has emerged as a highly effective surgical solution for recurrent anterior shoulder instability, providing patients with improved stability, pain relief, and restored function. Its success lies in the anatomic reconstruction of the glenoid rim using the transferred coracoid bone, which acts as a protective barrier against anterior dislocation. When performed by skilled orthopedic surgeons and followed by appropriate postoperative rehabilitation, the Latarjet procedure offers a reliable means of addressing the challenges of shoulder instability and allowing individuals to return to their active lifestyles with confidence. While complications may occur, they are generally rare, and the benefits of the procedure often outweigh the risks for eligible patients. As medical advancements continue, the Latarjet procedure is likely to remain a valuable tool in the management of anterior shoulder instability.
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