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Modified Boneless Latarjet Procedure for Recurrent Anterior Shoulder Dislocation

February 19, 2016

Contributors: Pierlui Serlorenzi, MD; Daniele Mazza, MD; Cosma Calderaro, MD; Lorenzo Proietti, MD; Domenico Lupariello; Andrea Redler, MD; Andrea Ferretti, MD; Antonio Vadala, MD; Antonio Vadala, MD

Currently, the Latarjet procedure is the most widely performed open procedure to manage recurrent anterior shoulder dislocation. However it is a nonanatomic procedure associated with a high risk for intraoperative complications. This video demonstrates a modification of the Latarjet procedure in which Bankart repair of the damaged anterior capsule is perofrmed in combination with transposition of the conjoined tendon alone. Dissimilar to the classic Latarjet procedure, this technique is based on reconstruction of the anterior glenohumeral capsule via harvest of the conjoined tendon without the tip of the coracoid. After closing the Bankart lesion, as performed in classic capsulorrhaphy techniques, we focus on the conjoined tendon to improve the anterior wall of the joint and create a stronger soft-tissue construct. Essentially, the Latarjet procedure is performed without the osteotomy of the tip of the coracoid, which avoid all the complications related to this surgical step, such as fracture or the risks associated with harvest of a small amount of bone block. With this modification, we aim to benefit from the tendon sling effect, which is provided by transposition of the conjoined tendon, and Bankart repair. In addition, this modification of the Latarjet procedure may be classified as an anatomic technique because it works with soft tissue alone and its main benefits result from repair of the Bankart lesion and transposition of the conjoined tendon, which reinforces the medial and inferior glenohumeral ligaments. We have surgically treated eight patients. All the patients were involved in sports activities; however, none of them was a professional athlete. The mean clinical follow-up was 9 months. The mean Western Ontario Shoulder Instability Index score was 92, and the mean Rowe score was excellent in six patients and good in two patients. Complete range of motion was achieved in seven patients. None of the patients reported intraoperative or postoperative complications. The patients resumed physical activities 5 months postoperatively. Despite the short follow-up, this modification of the Latarjet procedure appears to afford satisfactory shoulder stability. The modification benefits from the sling effect afforded by the transposed conjoined tendon.