SHOULDER INSTABILITY SURGERY – LATARJET PROCEDURE
In those patients who sustain a shoulder dislocation or multiple shoulder dislocations, the labrum (bumper) on the front of the shoulder joint tears. This type of labral tear is called a “Bankart” tear. In addition, the ligaments that surround the shoulder joint – the capsule – stretches and loosens. In addition, on occasion, part of the bone on the front of the socket (glenoid) may fracture or break down. If there is significant bone loss on the front of the socket, an arthroscopic procedure (Bankart repair) could fail and Dr. Keller may recommend a Latarjet procedure.
The Latarjet procedure has been popular in Europe for many years and has become much more popular in the United States in the past decade. There is now clear evidence that the Latarjet stabilizes the shoulder better than the arthroscopic Bankart repair in those patients with significant bone loss in the front of the shoulder socket. During surgery, Dr. Keller makes an incision along the front of the shoulder. He then removes a bony prominence (the coracoid) from the scapular bone. Next, Dr. Keller opens the capsule in front of the shoulder and places the coracoid bone block on the front of the shoulder socket. Dr. Keller then fixes the bone block to the shoulder with two screws. He then tensions the shoulder capsule over the front of the shoulder. The added bone increases the stability of the shoulder joint. Further, the tendons attached to the coracoid bone block provide a stabilizing “sling” to the front of the shoulder. This “sling effect” provides added stability to the shoulder joint when the shoulder is placed in certain positions.
Following surgery, patients are given a sling for comfort. Dr. Keller recommends intermittent icing and gentle range of motion following surgery. Dr. Keller also recommends starting physical therapy approximately 2-4 weeks after surgery. Physical therapy focuses on reducing swelling in the shoulder, restoring full range of motion, and maintaining strength in the shoulder. It is also important to avoid certain shoulder positions for 8-12 weeks after surgery.