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Open Latarjet with Modified Bankart Repair in Collision Athletes

February 01, 2014

Contributors: Augustus D Mazzocca, MD, MS; Robert A Arciero, MD; Robert A Arciero, MD

Keywords: Bony Procedure

Although arthroscopic Bankart repair is the most popular technique to treat recurrent anterior shoulder instability more recent long term follow-up has shown recurrence rates as high as 35% . Male patients 20 years or younger and those involved in collision sports are at high risk for recurrence after arthroscopic Bankart repair. This is magnified in those who also have bone loss. The Latarjet procedure or coracoid transfer has gained recent popularity because it addresses the condition of bone loss on either the glenoid or humeral head and with the sling effect of the transferred conjoint tendons has demonstrated effectiveness in stabilizing shoulders in the most demanding patient groups. This open procedure is fraught with complexities and can be intimidating in an era when most instability surgery is performed arthroscopically. In this video, a technique for the open Latarjet coracoid transfer procedure will be highlighted. Tips for improving the initial exposure, coracoid isolation, osteotomy, splitting the subscapualris, deep exposure of the scapular neck, drilling and fixation of the coracoid will be detailed. In addition, a modification of the open Bankart repair will be added to the reconstruction. This provides the addition of a more anatomic capsular repair and places the coracoid transfer in an extraarticular location. We have found this procedure to be highly effective in the most high demand youngcollision athletes.