Latarjet Procedure

Why this approach — at MOS

The Latarjet procedure requires anatomic precision and surgeon familiarity with the approach. We perform a careful pre-operative analysis of bone loss for every instability patient using CT with three-dimensional glenoid reconstruction. Glenoid bone loss is measured as a percentage of the inferior glenoid circle diameter — the threshold of 20–25% is where the literature consistently shows soft-tissue repair is insufficient.

We use a standard deltopectoral approach with a horizontal subscapularis split rather than tenotomy, which preserves subscapularis integrity and reduces the risk of post-operative internal rotation weakness. Coracoid fixation is achieved with two bicortical screws, and we confirm screw position fluoroscopically before closure. The coracoid should be flush with — never proud of — the glenoid articular surface to avoid iatrogenic arthritis.

Patients from the Germantown area should understand that this procedure, while more involved than an arthroscopic Bankart repair, is still performed outpatient in the ambulatory surgery center setting and does not require a hospital stay for most patients.

We have a detailed post-operative protocol that respects the biology of bone-to-bone healing. The coracoid bone block typically incorporates into the glenoid within 6–8 weeks, confirmed by CT if needed. Return to full contact sport is at 5–6 months when strength and stability testing confirm readiness.

The Latarjet carries a small but real risk of hardware complications. We follow every patient with post-operative imaging to confirm screw position and bone block incorporation, and we are transparent with patients about the possibility — in a small percentage of cases — of needing hardware removal if a screw causes discomfort after healing is complete.

Who is a candidate?

Indications

• Glenoid bone loss exceeding approximately 20–25% of the glenoid width on CT scan
• Engaging Hill-Sachs lesion with an "off-track" position relative to the glenoid
• High-demand contact or collision athletes (football, rugby, wrestling, martial arts) at high risk of recurrence
• Failed prior Bankart repair with recurrent instability
• First-time dislocation with large bone loss in young athletes who require return to high-risk sport
• Patients with hyperlaxity in whom soft-tissue repair alone is likely to be insufficient

Contraindications

• Minimal or absent glenoid bone loss where Bankart repair will suffice
• Severe glenohumeral arthritis
• Active shoulder infection
• Coracoid anatomy not suitable for transfer (very rare)
• Patients unable to comply with post-operative protocol
• Large posterior bone loss (posterior instability requires different approaches)

Conservative Treatment First

Recurrent shoulder instability with documented glenoid bone loss rarely resolves with physical therapy alone. Dynamic muscular stabilization through rotator cuff and periscapular strengthening can reduce subluxation episodes in patients with minimal bone loss, but once bone loss exceeds 20%, the structural deficit is beyond what muscle strengthening can compensate. In patients presenting after a first dislocation with large bone loss confirmed on CT, the natural history with non-operative care is very poor, and the conversation should shift toward surgical planning early. In patients with borderline bone loss (15–20%), a careful shared decision-making process weighs activity level, sport demands, and tolerance of recurrence risk.

Physical therapy may still play a role in optimizing strength before surgery in patients who are deconditioned or who have significant muscle inhibition from pain. Strengthening the subscapularis and posterior rotator cuff before the Latarjet procedure facilitates post-operative rehabilitation.

The procedure

What Is the Latarjet Procedure?

The Latarjet procedure transfers the coracoid bone and attached tendons from the top of the shoulder to the front of the glenoid socket. It restores lost bone, deepens the socket, and adds a dynamic stabilizing sling. It is preferred when bone loss is too great for soft-tissue Bankart repair alone.

The coracoid process is a beak-shaped bone projection on the front of the shoulder blade. Two muscles — the short head of the biceps and the coracobrachialis, collectively called the conjoint tendon — attach to it. In the Latarjet procedure, the coracoid tip (roughly 2.5 cm) along with the conjoint tendon is detached from its native position and transferred to the front of the glenoid, where it is fixed with two small screws. This accomplishes three separate goals simultaneously.

First, the coracoid bone block extends the articular width of the glenoid, directly replacing the bone that has been lost through repeated dislocations. Second, the transferred bone block acts as a bony bumper — even if the repair fails, the bone prevents the humeral head from subluxing anteriorly. Third — and this is the most elegant aspect of the procedure — the conjoint tendon passes beneath the subscapularis and acts as a dynamic sling. When the arm is in the position most likely to dislocate (abduction and external rotation), the subscapularis and conjoint tendon tighten, actively resisting anterior translation of the humeral head.

This triple mechanism explains why the Latarjet procedure achieves recurrence rates of under 5% even in high-risk patients — contact athletes, patients with significant bone loss, and those who have failed prior Bankart repair — where soft-tissue repair alone would have unacceptably high failure rates.

The procedure is technically demanding. The proximity of the brachial plexus, axillary nerve, and musculocutaneous nerve requires precise anatomic knowledge. Surgeons should have specific training in the Latarjet technique, as complication rates correlate strongly with experience.

What Happens During the Latarjet Procedure?

Before Surgery

You arrive at the ambulatory surgery center 90 minutes before the procedure. An interscalene nerve block is placed by the anesthesiologist while you are sedated. This provides 12–18 hours of post-operative analgesia and reduces intraoperative anesthetic requirements.

Positioning

You are positioned in the beach chair position with the shoulder and upper arm freely accessible. General anesthesia is administered. The shoulder, neck, and upper chest are cleaned and draped.

Diagnostic Arthroscopy (Optional)

Many surgeons perform a brief arthroscopic inspection of the joint to assess the labrum, cartilage, biceps, and rotator cuff before proceeding with the open Latarjet. This allows any additional intra-articular pathology to be addressed. The arthroscope is then removed and the open approach is performed.

Deltopectoral Approach

A 4–6 cm incision is made along the deltopectoral groove at the front of the shoulder. The cephalic vein is preserved and retracted. The deltoid and pectoralis muscles are separated (not cut), and the coracoacromial ligament and pectoralis minor are divided from the coracoid.

Coracoid Osteotomy

The coracoid tip (approximately 2–2.5 cm) is cut with an osteotome or saw. The conjoint tendon remains attached to the transferred fragment. The undersurface of the coracoid fragment is decorticated with a burr to create a flat surface that will contact the glenoid.

Subscapularis Split

The subscapularis tendon is split horizontally (rather than detached) to create a passage for the coracoid transfer. This preserves subscapularis function, which is critical for shoulder strength and stability.

Coracoid Fixation to Glenoid

Two cannulated screws (typically 3.5–4.5 mm) are placed through pre-drilled holes in the coracoid and into the anterior glenoid. The bone block is positioned flush with the glenoid articular surface — slightly below the equator of the glenoid. Screw position and bone block alignment are confirmed fluoroscopically. The conjoint tendon now runs beneath the subscapularis, completing the sling effect.

Closure

The subscapularis interval is re-approximated with sutures. The deltopectoral interval is loosely closed. Subcutaneous tissue and skin are closed in layers. The arm is placed in a sling.

Recovery Room

Most patients spend 45–90 minutes in the recovery room before discharge. Given the slightly longer and more involved nature of this procedure, some patients experience more initial discomfort than after an arthroscopic repair — though the nerve block reliably provides comfort for the first 12–18 hours.

Recovery timeline

Frequently Asked Questions