Latarjet shoulder stabilisation surgery

Shoulder dislocations can be painful and disruptive, especially when they happen repeatedly. For some individuals, particularly those who have experienced significant bone loss in the shoulder socket (glenoid) due to multiple dislocations, standard repair procedures might not be enough to restore stability. This is where the Latarjet shoulder stabilisation surgery, often simply called the Latarjet procedure, comes into play.

If you’re experiencing recurrent shoulder instability and have been told you have glenoid bone loss, the Latarjet procedure might be a recommended treatment option. This surgical technique is designed specifically to address instability in the presence of bone damage, offering a robust solution to help prevent future dislocations and restore function to your shoulder joint.

This article will delve into the Latarjet procedure, explaining what it involves, why it’s performed, what to expect during recovery, and the potential outcomes.

Understanding Shoulder Instability and Why Latarjet is Needed

The shoulder is the body’s most mobile joint, resembling a golf ball (the humeral head, or top of the arm bone) sitting on a small tee (the glenoid, or shoulder socket). While this design allows for incredible range of motion, it also makes the shoulder prone to instability and dislocation.

Ligaments, tendons (like the rotator cuff), and cartilage (including the labrum) work together to keep the ball centred on the tee. An injury, often a traumatic shoulder dislocation, can tear these soft tissues, particularly the labrum at the front of the socket (a Bankart lesion).

In many cases, an arthroscopic Bankart repair (reattaching the torn labrum) is sufficient to restore stability. However, with repeated dislocations or a particularly forceful initial injury, a piece of the glenoid bone can break off or wear away. This glenoid bone loss effectively makes the “tee” smaller, making it much harder for the “ball” to stay in place, even if the soft tissues are repaired.

When significant bone loss (typically more than 20-25% of the glenoid surface) is present, a standard Bankart repair has a higher chance of failure. The Latarjet procedure is specifically designed to address this bone loss and provide a more durable stabilisation. It’s often considered for:

  • Patients with significant glenoid bone loss.
  • Individuals involved in high-risk or contact sports.
  • Patients who have had a previous stabilisation surgery fail.
  • Cases of chronic shoulder instability.

What is the Latarjet Procedure? A Closer Look

The Latarjet procedure is a type of shoulder stabilisation surgery that involves transferring a piece of bone along with attached tendons from one part of the shoulder blade (the coracoid process) to the front edge of the shoulder socket (glenoid).

Here’s a breakdown of the surgical technique:

  1. Access: The surgeon makes an incision at the front of the shoulder. While traditionally an open surgery, arthroscopic Latarjet techniques (keyhole surgery) are also increasingly used, potentially offering smaller incisions and quicker initial recovery, though the underlying procedure remains the same.
  2. Coracoid Transfer: A small piece of bone called the coracoid process (part of the shoulder blade) is carefully detached along with the tendons that attach to it (short head of biceps and coracobrachialis).
  3. Glenoid Preparation: The surgeon prepares the front edge of the damaged glenoid socket.
  4. Bone Graft Fixation: The detached coracoid bone graft is then transferred and securely fixed onto the front of the glenoid, usually with two screws.
  5. Sling Effect: This transferred bone block effectively widens the glenoid socket, making it harder for the humeral head to slip out. Additionally, the attached tendons act as a ‘sling’ at the front of the joint, providing extra dynamic stability when the arm is raised.
  6. Capsule Repair: The joint capsule is often repaired alongside the bone transfer.

By adding bone to the socket and creating a muscle sling effect, the Latarjet procedure provides a powerful, dual stabilisation mechanism, making it highly effective for complex shoulder instability cases involving bone loss.

Preparing for Latarjet Shoulder Stabilisation Surgery

If the Latarjet procedure is deemed appropriate for you, several steps will occur before surgery:

  • Consultation: You will have a detailed discussion with your orthopaedic surgeon. They will review your history, symptoms, perform a physical examination, and discuss the risks and benefits of the procedure.
  • Imaging: X-rays are standard. A CT scan is often crucial to precisely measure the amount of glenoid bone loss and plan the surgery. An MRI scan may also be used to assess the condition of the labrum, rotator cuff, and other soft tissues.
  • Pre-operative Assessment: You may need a pre-operative check-up to ensure you are fit for general anaesthetic and surgery. This might involve blood tests or other investigations depending on your age and general health.
  • Instructions: You will receive specific instructions regarding fasting before surgery, medications to stop (like blood thinners), and what to bring to the hospital.

Being well-informed and prepared can help ensure a smoother surgical experience. Don’t hesitate to ask your surgeon any questions you may have.

Recovery and Rehabilitation After Latarjet Surgery

Recovery from Latarjet shoulder stabilisation surgery is a gradual process requiring commitment to rehabilitation.

  • Hospital Stay: Most patients stay in the hospital for one night, primarily for pain management and initial monitoring.
  • Pain Relief: You will likely experience pain after the surgery. A nerve block performed during surgery often provides numbness for the first 12-24 hours. Oral pain medication will be prescribed to manage discomfort as the block wears off. Ice packs can also help reduce pain and swelling.
  • Sling: Your arm will be placed in a sling immediately after shoulder surgery. This protects the repair and allows healing. You will typically need to wear the sling for around 4 to 6 weeks, even while sleeping, only removing it for showering (as advised) and specific exercises.
  • Physiotherapy: Rehabilitation is critical for a successful outcome. You will start gentle exercises soon after surgery, often guided by a physiotherapist before you leave the hospital. This usually begins with hand, wrist, and elbow exercises to prevent stiffness. Gentle shoulder range of motion exercises will be introduced gradually, respecting healing timelines.
  • Recovery Timeline:
    • Weeks 0-6: Focus on protecting the repair (sling use), managing pain, and gentle passive/active-assisted range of motion exercises as guided by your physiotherapist.
    • Weeks 6-12: Weaning off the sling, progressing range of movement, and starting gentle strengthening exercises.
    • Months 3-6: Gradual increase in strengthening, focusing on restoring full function and endurance.
    • Return to Activities: Driving is usually possible around 6-8 weeks (once out of the sling and safe to control a vehicle). Return to desk work might be possible within a few weeks, but manual labour will take longer (3-4 months). Return to sport, especially contact or overhead sports, is typically delayed until at least 6 months post-surgery, once sufficient strength, motion, and stability are regained, and requires clearance from your surgeon and physiotherapist.

Full Latarjet recovery time can take 6 months or longer. Adhering strictly to the physiotherapy protocol is essential for regaining strength, motion, and stability.

Potential Risks and Outcomes of the Latarjet Procedure

Like any surgery, the Latarjet procedure carries potential risks and complications, although they are relatively uncommon. These include:

  • Infection: Requiring antibiotics or further surgery.
  • Stiffness (Frozen Shoulder): Usually managed with intensive physiotherapy, occasionally requiring further intervention.
  • Nerve Damage: Temporary or, rarely, permanent numbness or weakness around the shoulder or arm. Care is taken during surgery to protect nearby nerves.
  • Bleeding: Excessive bleeding during or after surgery.
  • Blood Clots (DVT/PE): Rare but serious.
  • Hardware Issues: Problems with the screws (loosening, breakage, irritation).
  • Non-union/Graft Issues: The bone graft may not heal properly to the glenoid.
  • Recurrent Instability: While the Latarjet has high success rates, there is still a small risk the shoulder could dislocate again.
  • Ongoing Pain: Some patients may experience persistent pain.

Despite these potential risks, the Latarjet procedure has a very high success rate (often reported above 90%) in preventing further dislocations and improving function for patients with significant glenoid bone loss. Most patients experience significant pain relief and restoration of shoulder stability, allowing them to return to most activities, including sports.

Key Takeaways and Next Steps

The Latarjet shoulder stabilisation surgery is a reliable and effective procedure for treating recurrent shoulder instability, especially when associated with significant glenoid bone loss. By transferring bone and tendons (coracoid process transfer), it provides robust stability to the shoulder joint.

Key points to remember:

  • It’s primarily indicated for instability with bone loss where standard repairs may fail.
  • It involves transferring the coracoid process to the front of the glenoid socket.
  • It can be performed via open surgery or sometimes arthroscopic Latarjet techniques.
  • Recovery involves sling use for several weeks and extensive physiotherapy over several months.
  • It has a high success rate but carries standard surgical risks.

If you are struggling with recurrent shoulder dislocations and instability, discussing your specific situation with an orthopaedic shoulder specialist is crucial. They can assess your shoulder, determine if bone loss is present, and advise if the Latarjet procedure is the right option for you.

Ready to discuss your shoulder instability?