LATARJET PROCEDURE Dr.T.K.Byakika

PICS

Indications& Contraindications INDICATIONS (Some controversies) Chronic recurrent anterior instability, with or without multidirectional instability with or without glenoid rim fracture CONTRAINDICATIONS Voluntary or reproducible subluxation or dislocation Painful chronic shoulder in the throwing athlete without a clear bankart or hill-sach lesion There has been a greater shift to latarjet procedure in the young athlete

The ideal patient Young < 20yrs In active sports With or without bone loss Hyperlaxity Above factors in the instability severity index score The open latarjet procedure is more reliable in terms of shoulder stability than arthroscopic bankart repair clincal orthop related Res 2014ug:472(8):2345-2351 Pascal Boileau et al

Diagnosis History Good shoulder examination, exclude multi directional laxity, relocation sign, apprehension sign Plain xrays, internal and external rotation, may detect Hill- sachs and glenoid defect MRI= bankart lesion CT scan for delineating bone loss( don’t do it routinely)

Procedure Beach chair position Coracoid bone is landmark make a 7cm incision below it Identify the cephalic vein and the deltopectoral groove is separated with the cephalic vein retracted laterally The coracoid process is identified and the CA ligament divided about 1cm from it, the coracohumeral ligaments and the pectoralis minor are also divided

Beach chair

Procedure The coracoid is osteotomised and then prepared making 2 holes ensure CA ligamnet intact The subscapularis is split along its fibres between upper and middle third. Capsule opened and the humeral head retracted with a fukuda retractor Glenoid is prepared and the coracoid fixed to the glenoid with 2 screws

Post-operative care Arm sling for 2 weeks Start ROM exercise and ADL almost imediatley Muscle strengthening at 2weeks onward May return to sports in 3/12

Results 2015-2017 14 patients Male=13, female=1 Age range 17-49 10 pts 18 to 30 year, 4 > 30 FU, preliminary results are encouraging 2 cases coracoid slightly lateralised

Challenges Generally demanding surgery, requires training Instrumentation was lacking especially handling of the coracoid bone block and drilling of the glenoid It is very crucial in this surgery that the coracoid bone block doesn’t overlap the glenoid rim (lateralisation) as this may lead to glenohumeral osteoarthritis.

Arthrex system

Caveat The new arthrex systems solve the challenges of coracoid placement and maintenance of a parallel alignment of the screws Good but means added costs which need to be addressed so that the overall benefits ar not outweighed by the costs Think though of improving skills Also costs of GH osteoarthritis in a relatively young patient

Conjoined tendon

Conclusions Latarjet procedure is recommended for young pts, who are involved in active sports and may have hyperlaxity It’s a relatively difficult procedure to perfom but is doable Ensure don’t lateralise the coracoid Be ready to deal with the complications

Future Arthroscopic LATARJET Pioneered by Laurent Laffose Many centres taking this up but STEEP LEARNING CURVE Shall we get there? Is it cost effective?

ASANTE SANA