1. LATARJET PROCEDURE
Dr.T.K.Byakika

2. PICS

3. 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

4. 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): Pascal Boileau et al

5. 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)

6. 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

7. Beach chair

9. 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

10. 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

11. 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

13. 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.

15. Arthrex system

16. 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

18. Conjoined tendon

19. 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

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

21. ASANTE SANA