The Stabilizing Mechanism of the Latarjet Procedure

Yamamoto, Nobuyuki; Muraki, Takayuki; An, Kai Nan; Sperling, John W.; Cofield, Robert H.; Itoi, Eiji; Walch, Gilles; Steinmann, Scott P.

doi:10.2106/jbjs.l.00777

Cited by 257 publications

(229 citation statements)

References 2 publications

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“…33 The final stabilizing mechanism of the Latarjet procedure is provided by the reconstruction of the glenoid concavity by the coracoid transfer, which contributes a significant portion of glenohumeral stability in the midranges of motion. 32,34 Multiple clinical outcome studies have further confirmed the efficacy of the Latarjet procedure's ability to restore glenohumeral stability. Hovelius et al 35 reported a 3.4% recurrence rate after the Bristow-Latarjet procedure performed in 118 patients at 15-year followup, with a 98% satisfaction rate in their cohort.…”

Section: Discussionmentioning

confidence: 94%

“…Three distinct mechanisms have been described that contribute to the stability of the Latarjet procedure. 32 The primary stabilizing mechanism, known as the "sling effect," is provided by the conjoint tendon's reinforcement of the dynamic Fig 7. Fastening of preloaded suture washers. After placement of two 3.5-mm cortical or 4.0-mm malleolar screws and washers, preloaded suture washers (Arthrex) (Fig 6) are fastened for coracoid graft fixation in the right shoulder.…”

Section: Discussionmentioning

confidence: 99%

“…This sling effect has been reported to provide greater than 75% of the resistance to glenohumeral dislocation at the extremes of the apprehension position. 32 The capsular repair with augmentation from the CAL, the second stabilizing mechanism of the Latarjet procedure, accounts for the additional stability at the end range of abduction and external rotation. 32 However, the significance of the stabilizing mechanism has been questioned, given that capsular repair has been associated with decreased glenohumeral external rotation without providing additional stability compared with the Latarjet procedure performed without capsular repair in one cadaveric biomechanical study.…”

Section: Discussionmentioning

confidence: 99%

“…32 The capsular repair with augmentation from the CAL, the second stabilizing mechanism of the Latarjet procedure, accounts for the additional stability at the end range of abduction and external rotation. 32 However, the significance of the stabilizing mechanism has been questioned, given that capsular repair has been associated with decreased glenohumeral external rotation without providing additional stability compared with the Latarjet procedure performed without capsular repair in one cadaveric biomechanical study. 33 The final stabilizing mechanism of the Latarjet procedure is provided by the reconstruction of the glenoid concavity by the coracoid transfer, which contributes a significant portion of glenohumeral stability in the midranges of motion.…”

Section: Discussionmentioning

confidence: 99%

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Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss

McHale

Sánchez

Lavery³

et al. 2017

Arthroscopy Techniques

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Anterior glenohumeral instability is a common clinical entity, particularly among young athletic patient populations. Nonoperative management and arthroscopic treatment of glenohumeral instability have been associated with high rates of recurrence, particularly in the setting of glenohumeral osseous defects. Coracoid transfer, particularly the Latarjet procedure, has become the treatment of choice for recurrent anterior glenohumeral instability in the setting of osseous deficiencies greater than 20% to 30% of the glenoid surface area and may also be considered for the primary treatment of recurrent instability in the high-risk contact athlete, even in the setting of limited osseous deficiency. The following Technical Note provides a diagnostic approach for suspected glenohumeral instability, as well as a detailed description of the congruent-arc Latarjet procedure, performed with a deltoid split, with its postoperative management.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss

McHale

Sánchez

Lavery³

et al. 2017

Arthroscopy Techniques

View full text Add to dashboard Cite

show abstract

“…[12][13][14][15][16] The Bristow-Latarjet procedure has been reported to have three stabilizing mechanisms: (i) buttress effect of the coracoid bone; (ii) sling effect of the conjoint tendon and subscabularis; and (iii) reinforcement through an anterior capsular duplication with the released coracoacromial ligament. [17][18][19] However, there are several reported complications, such as bony non-union, progressive impingement and loosening or migration of hardware. 8,9 We consider, particularly in young patients with anterior instability and glenoid bone loss, that the use of screws and permanent alteration of the anatomy should be avoided.…”

Section: Introductionmentioning

confidence: 99%

Outcomes for intra-substance free coracoid graft in patients with antero-inferior instability and glenoid bone loss in a population of high-risk athletes at a minimum follow-up of 2 years

et al. 2014

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Background: The aim of this retrospective case series study was to assess the outcomes of patients with recurrent anterior shoulder instability with antero-inferior glenoid bone loss treated with a specific open stabilization technique using intra-substance coracoid bone-grafting and Bankart repair. Methods: Over a 4-year period, 34 shoulders in all male patients of mean age 21 years were stabilized with this technique. Pre-and postoperative function, motion and stability were assessed as part of Rowe stability scoring, and American Shoulder and Elbow Surgeons (ASES) and Oxford Instability were recorded, with at least 2 years of follow-up in all patients. Union of the graft was determined by post-operative computed tomography (CT) of the affected shoulder. Results: For all cases, two redislocations (5.9%) and two subluxations occurred when continuing high-risk sport after 2 years. Post-operative scores [median, mean (SD): Rowe 77.5, 77.2 (19.5); ASES 94.2, 92 (7.7); Oxford 43, 41.2 (6)]. CT scans on 28 shoulders at a mean of 4.5 months after surgery showed non-union in three cases (10%).Conclusions: These results demonstrate a high rate of success in cases of glenoid bone loss in the young contact athlete with recurrent instability treated with open stabilization and bone grafting.

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The moment arms and lines of action of subscapularis after the Latarjet procedure

Fox,

Ernstbrunner,

Henze

et al. 2024

Journal Orthopaedic Research

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The Latarjet procedure is an established surgical treatment for recurrent glenohumeral joint instability with glenoid bone loss. Intraoperatively, the conjoint tendon is routed through a split in subscapularis to the coracoid bone graft, which is fixed to and augments the anteroinferior glenoid. The objective of this in vitro study was to quantify the influence of glenohumeral joint position and conjoint tendon force on the lines of action and moment arms of subscapularis muscle sub‐regions after Latarjet surgery. Eight fresh‐frozen, entire upper extremities were mounted onto a testing apparatus, and a cable system used to apply physiological muscle loading to the major shoulder muscles. The lines of action and moment arms of four sub‐regions of subscapularis (superior, mid‐superior, mid‐inferior, and inferior) were quantified radiographically with the conjoint tendon unloaded and loaded while the shoulder was in (i) 0° abduction (ii) 90° abduction (iii) 90° abduction and full external rotation (ABER), and (iv) the apprehension position, defined as ABER with 30° horizontal extension. Conjoint tendon loading after Latarjet surgery significantly increased the inferior inclination of the lines of action of the mid‐inferior and inferior sub‐regions of subscapularis in the scapular plane in ABER and apprehension positions (p<0.001), as well as decreased the horizontal flexion moment arm of the inferior subscapularis (p=0.040). Increased subscapularis inferior inclination may ultimately increase inferior joint shear potential, while smaller horizontal flexion leverage may reduce joint flexion capacity. The findings have implications for Latarjet surgical planning and post‐operative rehabilitation prescription.This article is protected by copyright. All rights reserved.

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The Stabilizing Mechanism of the Latarjet Procedure

Abstract: The Latarjet procedure remains an effective procedure for restoring stability to an unstable glenohumeral joint, particularly when there is glenoid bone deficiency.

Cited by 257 publications

References 2 publications

Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss

Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss

Outcomes for intra-substance free coracoid graft in patients with antero-inferior instability and glenoid bone loss in a population of high-risk athletes at a minimum follow-up of 2 years

The moment arms and lines of action of subscapularis after the Latarjet procedure

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