Recurrent Shoulder Dislocation and the Latarjet Procedure: Indications, Outcomes, and Risks (1)

After one shoulder dislocation, some people regain stability with reduction and rehabilitation, while others dislocate repeatedly during sport, overhead arm positions, or even daily activity.

As dislocations recur, the anterior labrum, capsule, and bony structures can be damaged further. When anterior glenoid bone loss becomes more obvious, soft-tissue repair alone may no longer restore stability.

The Latarjet procedure transfers a small coracoid bone block to the anterior glenoid and uses the conjoint tendon for dynamic protection. It is mainly used for recurrent anterior shoulder dislocation with high recurrence risk or significant bone loss.

The shoulder has the greatest range of motion in the body. The humeral head is like a relatively large ball, while the glenoid is shallow and small. Stability therefore depends on the labrum, capsule, ligaments, rotator cuff muscles, and bony anatomy working together.

Anterior dislocation is the most common pattern. During the first dislocation, the humeral head moves anteroinferiorly out of the glenoid and may tear the anteroinferior labrum and capsule, known as a Bankart lesion. Some patients also develop anterior glenoid bone loss or a posterolateral humeral head impaction injury called a Hill-Sachs lesion.

If the stabilizing structures do not recover adequately, the shoulder may dislocate again when the arm moves into abduction and external rotation. Each episode can further erode the anterior glenoid rim, turning a small bone defect into a larger one and making the shoulder progressively less stable.

This is especially important in young patients, competitive or contact athletes, and anyone who has already had multiple dislocations.

The basic technique removes part of the coracoid process with the attached conjoint tendon, transfers the bone block to the anteroinferior glenoid, and fixes it in place.

It improves stability in three main ways. First, it increases the anterior glenoid bony surface. Recurrent dislocation can wear away part of the glenoid rim; transferring the coracoid bone block restores anterior bony support.

Second, the conjoint tendon forms a dynamic sling. After transfer, the tendon lies in the anteroinferior shoulder. When the arm enters the vulnerable abduction and external rotation position, this structure provides dynamic restraint to the humeral head.

Third, the anterior capsule and labral structures may be reinforced. Some procedures also address the Bankart lesion and anterior capsule so that bony and soft-tissue stability are restored together.

For this reason, Latarjet has particular value when significant glenoid bone loss is already present.

The decision should be based on CT measurement of glenoid bone loss, the Hill-Sachs lesion, age, sport demand, and previous surgery.

Common indications include recurrent anterior shoulder dislocation with obvious glenoid bone loss, recurrent instability or redislocation after Bankart repair, a substantial Hill-Sachs lesion with high recurrence risk, young patients who play competitive or contact sports, and cases where isolated soft-tissue repair is unlikely to restore stability.

A traditional threshold for considering bony reconstruction has been glenoid bone loss greater than 20%. More recent clinical research suggests that once bone loss exceeds about 15%, isolated Bankart repair may no longer fully restore normal shoulder mechanics.

Some data also suggest that bone loss around 13.5% can still carry a high postoperative instability risk in certain patients. For high-level athletes, thresholds may be stricter.

Therefore, 20% is a reference point rather than an absolute dividing line. A young collision-sport athlete with 16% bone loss may need a different plan from a low-demand patient with the same number.

Bankart repair mainly treats the detached labrum and lax anterior capsule. If the bony anatomy is largely intact and the main problem is soft tissue, it can work well and has less impact on normal anatomy.

When the glenoid has clear bone loss, the situation is more complex. Even if the labrum and capsule are repaired, the missing anterior bony support remains. The risk of recurrent instability after isolated Bankart repair may therefore rise in patients with larger bone defects.

In a retrospective comparison of 58 patients with recurrent shoulder dislocation, 29 underwent minimally invasive modified Bristow-Latarjet surgery and 29 underwent Bankart repair. The postoperative Rowe score was 82.52 in the Latarjet group and 66.78 in the Bankart group; ASES-related scores, UCLA shoulder scores, and activities of daily living were also better in the Latarjet group. Complication rates were recorded as 6.90% in the Latarjet group and 31.03% in the Bankart group.

This evidence comes from a small single-center retrospective study, and differences in bone loss and procedure selection may affect results, so it should not be used to conclude that all recurrent shoulder dislocations are better treated with Latarjet.

In appropriately selected patients, current evidence generally shows that Latarjet can improve shoulder stability and function, especially in recurrent anterior dislocation with meaningful glenoid bone loss.

In 42 patients with recurrent anterior shoulder dislocation and glenoid bone loss greater than 20%, modified elastic fixation Latarjet was followed for 20 to 34 months. No patient had redislocation or subluxation. ASES scores improved from 72.26 to 90.36, Rowe scores improved from 36.32 to 92.72, and pain scores decreased significantly.

Another series included 15 patients with severe bone loss treated with all-arthroscopic elastic fixation Latarjet. They had an average of 4.2 dislocations and mean glenoid bone loss of 24.4%. After a mean 18.7 months, Rowe scores improved from 42.8 to 93.3 and ASES scores from 72.5 to 90.2. Active forward elevation, external rotation, and internal rotation did not significantly decline, and no recurrent shoulder dislocation occurred during follow-up.

These results suggest that Latarjet can provide good stability for some patients with anterior instability caused by significant bone loss. Many available domestic reports remain small and short- or mid-term, so long-term interpretation still requires more follow-up data.