The Latarjet procedure is ideal for those with complex shoulder dislocations with bone loss, failed shoulder stabilisations, and/or high level athletes (particularly collision or overhead contact). The surgery is more involved than a keyhole labral repair; however, post-operative pain and rehabilitation is much the same. Strengthening and training for your sport commences at 3 months and full, unrestricted contact is possible at 6 months after surgery.
A Latarjet procedure involves transferring a piece of bone (coracoid) to the front of your glenoid (socket) to address shoulder instability (dislocations out the front). There are three reasons why this operation works so well:
This operation works well in the following conditions:
Watch a surgical animation demonstrating how Dr Pant performs a Latarjet Procedure to address recurrent anterior instability in high-level athletes and overhead contact sportspersons.
Dr Pant utilises the JPL pathway for most patients and this will form the basis of your rehabilitation after surgery; it will be modified to suit your individual circumstance.
The JPL pathway allows for self-directed, early passive shoulder range of movement:
After the surgery you will be in a sling and protect your shoulder to allow the Latarjet procedure (coracoid bone graft) to heal. At two weeks after the surgery Dr Pant will see you at your review appointment and discuss the JPL rehabilitation protocol with you. This JPL physiotherapy protocol will commence two weeks after your surgery.
The therapy program will focus on flexibility and range of motion exercises initially. These gentle stretches will improve your range of motion and prevent shoulder stiffness. As the bone graft begins to heal you will be able to progress to exercises that strengthen your shoulder muscles. Shoulder strengthening is commenced at 12 weeks post Latarjet surgery.
The type of sling is selected specific to you and your shoulder surgery
When can I drive?
Showering and getting dressed
Sleeping after Shoulder Surgery
Elbow and hand movement
Surgery is a carefully choreographed process and you are being treated by a sub-specialist shoulder surgeon and a highly experienced team; however, all surgeries inherently carry some risk of complications.
The risk of complications after Latarjet surgery are less than 1% in the Sydney Shoulder Unit experience. General risks include:
Neurovascular injury during surgery
Reoperation and failure of surgery
Bone healing – Latarjet Procedure (coracoid to glenoid graft)
Dr Pant is a Sports Orthopaedic Shoulder Surgeon and with his involvement at Sydney Sports Medicine Centre at Olympic Park he treats both elite and amateur sports persons with shoulder instability. When done well, the Latarjet procedure provides patients with the lowest risk of recurrent instability.
Return to sport
Patients commence a strengthening program at 3 months and generally return to full unrestricted overhead contact and collision sport at 6 months post-operatively (after bone healing has been confirmed).
The gentleman is a keen surfer and dislocated his shoulder. He presented with instability symptoms and an X-ray that showed a bony bankart (fractured glenoid). He was unstable on examination and wished to return to his previous level of function overhead.
The MRI scan confirmed an anterior labral tear with a bony bankart; in addition he had a posterior (back of the shoulder) labral tear and a SLAP tear. He had a corresponding Hill-Sachs lesion (fracture at the back of the Humeral head).
He underwent an Arthroscopic bony bankart and labral repair as pictured below. We were able to repair the tissues back to their anatomical (original) position using suture anchors and achieved a nice “bumper” at the front of the shoulder. We also repaired the posterior labrum and the unstable SLAP lesion – all keyhole – a total of 3 small 1cm incisions around the shoulder.
He commenced JPL therapy at two weeks and went on to strengthen his shoulder at 3 months. He is back surfing at six months post-surgery and happy with his outcome.
After a shoulder dislocation some patients may be a candidate for a “bone transfer” procedure: a Latarjet. This is a good procedure for high level athletes, those who participate in overhead contact type sport, those with significant bone loss, and revision cases of failed previous “key-hole” stabilisation surgery.
This 16 year old high level wakeboarder dislocated his shoulder and sustained both a rotator cuff tear and an anterior labral tear. This is an uncommon injury pattern and presents unique decision making and surgical challenges.
Given his high level sporting ambitions and demands we repaired the Rotator Cuff and did a Latarjet procedure to treat his instability. He was in a sling for six weeks and commenced JPL rehabilitation at two weeks post surgery. He commenced formal Physiotherapy at 3 months, eventually regaining full ROM and function with his shoulder. He is back to his active lifestyle and riding waves around the waterways of Australia.
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