Overview
When the shoulder dislocates, the ball (humeral head) slips forward and strikes the front rim of the socket (glenoid). Each dislocation can chip off a sliver of bone. After enough of them, the front of the socket is too worn down for a soft-tissue repair alone to hold. The arc of the socket is simply too shallow to keep the ball from sliding forward again. That is the problem the Latarjet procedure is designed to solve.
A standard repair stitches the torn ligaments back to the worn rim. The Latarjet does more: it moves a piece of bone to the rim instead. That piece is the coracoid, a bony hook at the front of the shoulder blade. The transferred bone rebuilds the missing arc of the socket with real bone. The tendon attached to the coracoid (the conjoint tendon) comes along with it and acts as a living sling. It tightens across the front of the joint just as the arm reaches the old danger position. The result is both a structural fix and a working one. That is why patients with significant bone loss re-dislocate less often after a Latarjet than after a soft-tissue Bankart repair.
How the Procedure Works
We work through the subscapularis, the rotator-cuff muscle that crosses the front of the shoulder. We split it sideways rather than detach it, so the muscle keeps working. Through that split, we pass the coracoid to the front of the socket and fix it with two screws. The bone block must sit flush with the joint surface. A block that stands too high rubs on the ball; one that sits too low fails to extend the arc. The conjoint tendon, now crossing the split muscle, adds a second layer of protection. It tightens just as the arm reaches the overhead, rotated-out position that used to dislocate the shoulder. Two nerves run close to this exposure. Both are identified and protected throughout the operation.
When to Consider Latarjet Procedure
We generally offer the Latarjet when your symptoms, your imaging, and a full course of non-surgical care all point the same way. The typical picture includes:
Recurrent dislocation after Bankart repair
A shoulder that keeps dislocating despite a prior soft-tissue repair.
Significant anterior glenoid bone loss
Bone loss beyond the point where a Bankart repair alone holds up reliably.
High re-dislocation risk
Contact athletes whose sport makes even a small risk of another dislocation unacceptable.
Conditions This Treats
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause a shoulder that stays unstable, where a soft-tissue repair alone is unlikely to hold and each new dislocation wears away more of the socket. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
The risks we discuss with you before the Latarjet procedure include:
- bleeding and infection (the infection rate is slightly higher than for arthroscopic repairs)
- anesthesia risk
- graft non-union or resorption of the transferred coracoid
- hardware irritation that occasionally requires screw removal
- recurrent instability
- stiffness (typically loss of external rotation)
- injury to the musculocutaneous or axillary nerve (rare but specific to this exposure)
The reason to proceed is repeated forward dislocation with significant bone loss at the socket, or a failed prior soft-tissue repair. If the operation is not right for you, we will say so.
Frequently Asked
questions we hear in clinicWhy isn't a standard repair enough for my shoulder?
Each dislocation can chip off a sliver of bone from the front rim of the socket. After enough of them, the rim is too worn down for a soft-tissue repair alone to hold; the arc of the socket is simply too shallow to keep the ball from sliding forward again. That is the problem the Latarjet is designed to solve.
Where does the bone block come from?
From you. The coracoid, a bony hook at the front of your own shoulder blade, is moved to the front of the socket and fixed with two screws. The tendon attached to it comes along and acts as a living sling across the front of the joint.
Why does this hold better than a Bankart repair?
The transferred bone rebuilds the missing arc of the socket with real bone, and the conjoint tendon tightens across the front of the joint just as the arm reaches the old danger position. The result is both a structural fix and a working one, which is why patients with significant bone loss re-dislocate less often after a Latarjet than after a soft-tissue Bankart repair.
Is the muscle at the front of the shoulder cut?
We work through the subscapularis, but we split it sideways rather than detach it, so the muscle keeps working.
What about the nerves near the shoulder?
Two nerves run close to this exposure, and both are identified and protected throughout the operation. Injury to the musculocutaneous or axillary nerve is rare but specific to this approach, and it is one of the risks we discuss beforehand.
Do the screws ever come out?
The bone block is fixed with two screws, and hardware irritation occasionally requires screw removal later.
Further Reading
Outside reading we trust, plus related OSI pages:
