Arthroscopic Latarjet and Capsular Shift (ALCS) Procedure

Abstract

Anterior shoulder instability associated with significant bone loss has been described as "bony-instability," and this condition is usually treated with an anterior glenoid bone grafting procedure (Latarjet procedure). The Latarjet procedure involves transfer of the horizontal limb of the coracoid process along with the conjoint tendon to the anterior glenoid rim, and is traditionally performed as an open surgical procedure. Recently, an arthroscopic technique for the Latarjet procedure has been described; the technique necessitates the use of specialized instrumentation and involves excision of the entire anterior capsule to facilitate coracoid fixation. We describe a new "freehand" arthroscopic technique for the Latarjet procedure, and, in addition, a simultaneous capsular shift to further optimize mid and end range stability. This technique eliminates the use of additional instrumentation and can be done using routine arthroscopic instruments. Preliminary experience with this technique suggests that the arthroscopic Latarjet and capsular shift is a technically demanding procedure. Glenohumeral capsule can be preserved, and this should be attempted wherever possible to optimize stability. Additional specialized instrumentation would probably reduce surgical time; however, the procedure can be performed with routine instruments.

Classifications in Brief: The Instability Severity Index Score for Predicting Recurrent Shoulder Instability After Arthroscopic Bankart Repair

“…Another limitation of the ISI scoring system pertains to the treatment of those with an intermediate risk of recurrent instability; that is, a score between 4 and 6. Currently, there is no widely accepted treatment standard for this group, which might include arthroscopic Bankart repair with or without capsular plication or remplissage, open Bankart repair with or without capsular shift, the Latarjet procedure, or free bone block reconstruction procedures with the use of autograft or allograft [4,34,36,39,41,49]. In fact, several recent studies have shown that the addition of the remplissage procedure to an arthroscopic Bankart repair results in equivalent functional outcomes and a similar risk of revision surgery compared with the Latarjet procedure in patients with off-track Hill-Sachs lesions [24,38,50].…”