Recurrent Shoulder Dislocation and the Latarjet Procedure: Indications, Outcomes, and Risks (2)

Traditional Latarjet usually uses two screws to fix the coracoid bone block to the anterior glenoid. Screws provide relatively firm rigid fixation and have a long history of use.

Screw fixation can cause screw-related issues, including loosening, breakage, prominence, graft fracture, bone resorption, nonunion, and malposition. In high-intensity athletes, repeated long-term stress may further increase hardware-related problems.

Modified elastic fixation methods using Endobutton or other looped plates have emerged in recent years. They use smaller bone tunnels and high-strength sutures to fix the bone block, reducing the bone area occupied by screws. Biomechanical studies suggest looped plates and traditional screws can achieve similar fixation strength while potentially reducing some screw-related complications.

In 42 patients treated with modified elastic fixation Latarjet, no nonunion of the transferred coracoid block and no redislocation or subluxation were observed during follow-up. In another 15 all-arthroscopic elastic fixation cases, one patient had partial bone resorption and nonunion, but no redislocation was present at final follow-up.

Elastic fixation has not fully replaced screws. It places high demands on arthroscopic technique, bone block positioning, tunnel creation, and suture tension control, and most available clinical results come from small samples with limited follow-up.

Open Latarjet, arthroscopically assisted Latarjet, and all-arthroscopic Latarjet are all used.

Arthroscopy allows direct visualization of the inside of the shoulder and can address Bankart lesions, Hill-Sachs lesions, and other intra-articular problems. The arthroscopic view may also help judge bone block position more accurately and reduce some soft-tissue trauma.

However, arthroscopic Latarjet is technically demanding. Coracoid osteotomy, subscapularis passage creation, tunnel positioning, and bone block transfer require substantial experience, and the learning curve is long.

The choice between open and arthroscopic surgery should therefore depend on the patient and on the medical team’s familiarity with the specific technique.

Long-term success after Latarjet is closely related to the position of the coracoid bone block.

The graft should reconstruct the missing anteroinferior glenoid contour. If it is too medial, it may not provide enough bony support and instability can persist. If it protrudes beyond the joint surface, the humeral head may repeatedly contact the graft during motion, increasing long-term cartilage wear and arthritis risk.

Preoperative CT or three-dimensional CT is usually used to measure glenoid bone loss, and intraoperative tunnel direction and graft height must be controlled.

Some arthroscopic techniques use dedicated guides or navigation to improve graft placement accuracy. In patients with severe bone loss, this may influence long-term outcome more directly than the choice between screws and button fixation.

Latarjet can provide strong stability, but it is a bony reconstruction procedure and usually involves more anatomic work than isolated Bankart repair.

Reported risks include poor graft position, graft fracture, bone resorption or nonunion, screw loosening, screw breakage or prominence, recurrent dislocation or persistent instability, stiffness especially loss of external rotation, axillary or musculocutaneous nerve injury, vascular injury, infection, and long-term cartilage degeneration or osteoarthritis.

Some reports place the overall complication rate of traditional Latarjet around 15%, including redislocation, subluxation, nerve injury, and osteoarthritis.

Modified elastic fixation aims to reduce screw-related problems, but suture laxity, graft micromotion, resorption, and nonunion can still occur, so long-term follow-up remains necessary.

During anterior shoulder dislocation, the posterolateral humeral head may impact the anterior glenoid rim, creating a depressed Hill-Sachs lesion. If this defect is large and engages the glenoid during abduction and external rotation, the risk of redislocation increases.

Doctors therefore assess glenoid bone loss and the Hill-Sachs lesion together, often using concepts such as the glenoid track to understand the relationship between the two bony defects.

In some severe cases, Latarjet may be combined with Remplissage or another procedure to address the Hill-Sachs lesion. The glenoid bone loss percentage on CT is only one parameter in surgical decision-making.

Both procedures can treat severe bone loss by increasing glenoid bone stock, but the graft source and stabilizing mechanism differ.

Latarjet uses the patient’s own coracoid process and preserves the attached conjoint tendon, so it provides both a bony block and dynamic sling effect.

Eden-Hybbinette usually uses a free bone graft, such as iliac crest bone, to reconstruct the glenoid and does not include the conjoint tendon sling. It allows the graft to be shaped more freely to the defect and may be useful in very large glenoid defects, unsuitable coracoid anatomy, or revision after failed Latarjet.

In a 10-patient series with severe glenoid bone loss treated arthroscopically with Eden-Hybbinette, ASES scores improved from 60.6 to 90.8 at 18 months, Rowe scores improved from 35.5 to 90, and the graft healed. This is early evidence from a very small cohort and cannot be used to prove superiority over Latarjet.

The early postoperative goal is to protect the bone graft and repaired tissues while the graft gradually heals to the glenoid.

Rehabilitation varies by surgical method. Some arthroscopic Latarjet protocols use a brace for about 6 weeks. Early wrist and elbow motion may be allowed, with gradual small-range passive shoulder forward elevation.

After about 6 weeks, active shoulder motion is increased according to graft stability. Around 3 months, movement in all directions may progress further and resistance training may be added. Some protocols allow gradual return to sport only after imaging and functional assessment at about 6 months.

Recovery should not be judged by pain alone. For basketball, rugby, combat sports, weightlifting, and similar activities, graft healing, strength, range of motion, stability, and sport-specific movement control must be assessed.

After two or more shoulder dislocations, especially in young or high-demand patients, the bony injury pattern should be evaluated carefully.

MRI is mainly used for the labrum, capsule, rotator cuff, and other soft tissues. CT, especially three-dimensional CT, is more important for measuring glenoid bone loss and evaluating Hill-Sachs lesions.

Doctors also ask about age at first dislocation, number of dislocations, whether the patient can self-reduce, sport participation, previous Bankart repair, and fear of redislocation when the arm enters abduction and external rotation.

For recurrent anterior shoulder dislocation with significant bone loss, Latarjet is an important stabilizing procedure. It restores glenoid bone stock and adds dynamic stability, especially in young high-demand patients and after failed Bankart repair.

It also changes part of the anterior shoulder anatomy. Graft position, fixation method, and surgical technique all affect outcome. Before surgery, patients should discuss their glenoid bone loss percentage, Hill-Sachs pattern, recurrence risk, recommended fixation method, and expected timeline for work and sport.