BLOG

Anterior shoulder instability, particularly when accompanied by bone loss, is a common challenge in orthopaedic practice. The Latarjet procedure has become a reliable surgical solution for patients with recurrent dislocations or failed previous repairs. Both open and arthroscopic approaches are available, each offering specific advantages depending on the patient’s condition and the surgeon’s expertise.

Understanding the Latarjet Procedure

 The Latarjet procedure involves repositioning a section of the coracoid bone, along with its attached tendons, to the front of the shoulder socket (glenoid). This enhances joint stability by enlarging the socket’s bony surface, strengthening the surrounding soft tissues, and forming a supportive sling that helps prevent future dislocations, particularly in cases with significant bone loss or recurrent instability.

The Open Latarjet Technique

The open Latarjet procedure uses a traditional incision over the shoulder to directly expose the joint structures. This allows the surgeon to visualise the coracoid bone and glenoid rim clearly, ensuring precise placement of the bone graft. The graft is typically fixed in place with screws.

Open surgery has been used for decades and is associated with strong long-term outcomes. Studies report high success rates with low recurrence of instability. Bone graft healing rates with open surgery are also favourable. However, open surgery involves a larger incision, more soft tissue disruption, and may lead to slightly longer early recovery. The risk of nerve injury exists but remains low with experienced surgical techniques.

The Arthroscopic Latarjet Technique

The arthroscopic Latarjet procedure uses small incisions and a camera system to perform the surgery inside the joint. This minimally invasive approach reduces soft tissue damage and may result in less postoperative pain and faster initial recovery.

Arthroscopy offers excellent visualisation of the joint, allowing precise graft positioning. Additional intra-articular problems can also be addressed during the same procedure if necessary. However, the arthroscopic technique is technically more demanding, with a steeper learning curve. In centres with experienced surgeons, the arthroscopic Latarjet technique has shown highly accurate graft positioning and stable fixation. Although earlier reports during the learning phase indicated slightly lower bone graft healing rates compared to open surgery, current data suggest that with growing surgical expertise, healing, and functional outcomes are now largely comparable between both approaches.

Comparing Clinical Outcomes

Both techniques have demonstrated excellent outcomes in improving shoulder stability and function. Recurrence rates, long-term function, and complication rates are largely comparable between the two methods. Early recovery may be slightly quicker with arthroscopic surgery, but this difference tends to level out after the initial weeks of rehabilitation.

Cost remains a consideration, as arthroscopic Latarjet procedures are generally more expensive due to longer surgical times and the use of specialised equipment and implants. Despite these additional costs, long-term clinical outcomes remain similar between the two approaches.

Conclusion

Both open and arthroscopic Latarjet procedures offer reliable solutions for patients with anterior shoulder instability. While the arthroscopic technique provides the benefits of less invasive surgery and quicker early recovery, it demands greater surgical expertise and comes with higher costs. The open approach remains a dependable option with a long-standing record of success. The choice between these techniques should be guided by surgeon experience, patient-specific factors, and available resources, ensuring the best possible outcome for each individual.

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