1. Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss 
Kevin J. McHale, M.D., George Sanchez, B.S., Kyle P. Lavery, M.D., William H. Rossy, M.D., Anthony Sanchez, B.S., Marcio B. Ferrari, M.D., Matthew T. Provencher, M.D. 
Arthroscopy Techniques 
Volume 6, Issue 3, Pages e791-e799 (June 2017)
DOI: /j.eats
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2. Fig 1
Arthroscopic view of glenoid bone loss. After the induction of general anesthesia, the patient is placed in the beach-chair position with all bony prominences appropriately well padded. A routine diagnostic arthroscopy is performed in a right shoulder, showing the anterior glenoid defect and its relation to the humeral head (HH). (G, glenoid.)
Arthroscopy Techniques 2017 6, e791-e799DOI: ( /j.eats )
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3. Fig 2
Surgical approach. The open approach begins after the diagnostic arthroscopy. The coracoid process is palpated under the clavicle in this right shoulder. The coracoid is then marked with a surgical pen (arrow), and a line over the axillary fold is drawn. A 5- to 7-cm incision is marked from the tip of the coracoid process extending distally along the deltopectoral interval.
Arthroscopy Techniques 2017 6, e791-e799DOI: ( /j.eats )
Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

4. Fig 3
Coracoid osteotomy. Once the coracoid process of the right shoulder is identified and the soft tissue is appropriately released, a 90° oscillating saw (arrow) is used to harvest the coracoid bone graft by performing an osteotomy at a position just anterior to the insertion of the coracoclavicular ligaments at the coracoid base.
Arthroscopy Techniques 2017 6, e791-e799DOI: ( /j.eats )
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5. Fig 4
Subscapularis split. To access the anterior glenoid defect in a right shoulder, the subscapularis is sharply, longitudinally split along the junction of the superior two-thirds and inferior one-third of the muscle (arrow). We suggest an L-shaped capsulotomy. However, if significant scarring is encountered from prior surgical procedures, a T-shaped capsulotomy may also be used to optimize exposure.
Arthroscopy Techniques 2017 6, e791-e799DOI: ( /j.eats )
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6. Fig 5
Positioning coracoid graft. Once the coracoid process of the right shoulder has been sufficiently cut and any remaining soft tissue is debrided from the medial surface of the coracoid to improve conformity between this surface and the glenoid margin, 2 Kirschner wires (white arrows) are placed into the coracoid graft (yellow arrow) to assist with positioning and are later advanced into the glenoid neck for provisional fixation.
Arthroscopy Techniques 2017 6, e791-e799DOI: ( /j.eats )
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7. Fig 6
Coracoid graft fixation. The 2 Kirschner wires previously introduced into the graft are used to transport and provisionally fixate the graft to the anterior aspect of the glenoid, which has been previously prepared. Once optimal leveling between the graft and native bone is verified, definitive fixation is performed with 2 anteroposterior 4.0-mm malleolar screws and suture washers (arrow), approximately 1 cm apart.
Arthroscopy Techniques 2017 6, e791-e799DOI: ( /j.eats )
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8. 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.
Arthroscopy Techniques 2017 6, e791-e799DOI: ( /j.eats )
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9. Fig 8
Completion of Latarjet procedure. The right arm is adducted to the side and placed in approximately 45° of external rotation to perform the capsular repair, utilizing the No. 2 FiberWires preloaded in the suture washers (Arthrex), as well as additional free high-strength No. 2 sutures and the coracoacromial ligament. At the completion of the repair of the capsule and subscapularis, the conjoint tendon will exit anteriorly through the previously divided segments of the subscapularis.
Arthroscopy Techniques 2017 6, e791-e799DOI: ( /j.eats )
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10. Fig 9
Postoperative radiograph. A radiographic study in the axillary view of the right shoulder at 3 months after the Latarjet procedure shows coracoid graft fixation with 2 screws (arrow) inserted in an anteroposterior direction. One should note the restoration of the anterior defect, preventing recurrent anterior instability.
Arthroscopy Techniques 2017 6, e791-e799DOI: ( /j.eats )
Copyright © 2017 Arthroscopy Association of North America Terms and Conditions