20Shoulder Care
AC Joint Injuries
Arthritis
Biceps Tendon Injuries
Calcific Tendinitis
Clavicle Fractures
Frozen Shoulder
Labral and SLAP Tears
Rotator Cuff Injuries
Shoulder Dislocation/Instability
Subacromial Impingement/Busitis
A-C Joint Stabilization
Biceps Tenodesis
Clavicle Fracture Fixation
Pectoralis Major Repair
Rotator Cuff Repair
Shoulder Instability Surgery – Bankart Repair
Shoulder Instability Surgery – Latarjet Procedure
Subacromial Decompression and Acromioplasty
Superior Capsular Reconstruction
Total Shoulder Replacement
28Knee Care
ACL Tear
Cartilage Injury
Lateral Meniscus Tear
LCL Injury
MCL Injury
Medial Meniscus Tear
Osteoarthritis
Patellar Instability
Patellofemoral Chondromalacia
Posterolateral Corner Injury
Trochlear Dysplasia
Anterior Cruciate Ligament (ACL) Reconstruction
Cartilage Restoration Surgery – Autologous Chondrocyte Implantation (ACI-Carticel)
Cartilage Restoration Surgery – Donor Graft
Collagen Meniscal Implant (CMI)
Lateral Collateral Ligament (LCL) Reconstruction
Medial Collateral Ligament (MCL) Reconstruction
Meniscus Repair
Meniscus Root Repair
Meniscal Transplant
Nanofracture
Osteochondral Allograft Transfer
Osteochondral Autograft Transfer (OATS)
Partial Meniscectomy
Posterior Cruciate Ligament (PCL) Reconstruction
Posterolateral Corner (PLC) Surgery
Tibial Tubercle Osteotomy
Trochleoplasty
17Hip Care
Cartilage Injury
Femoroacetabular Impingement (FAI)
Gluteal Tears
Hamstring Tears
Hip Instability
Labral Tears
Psoas Impingement (Internal Snapping Hip)
Trochanteric Bursitis
Acetabuloplasty
Chondroplasty
Femoroplasty
Gluteal Repair
Labral Debridement
Labral Repair
Labral Reconstruction
Nanofracture
Trochanteric Bursa Debridement
2Biologics
Bone Marrow Aspirate Stem Cell Concentrate (BMC)
Platelet-Rich Plasma “PRP”

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.

Post-Operative Rehabilitation

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.