Latarjet Shoulder Reconstruction
The Latarjet shoulder reconstruction is a specialized shoulder procedure for people who have shoulder instability. It is usually not the first procedure that is done, but in France, many surgeons are using this procedure for first time shoulder dislocations. Usually if you dislocate your shoulder we treat it conservatively with a sling and physical therapy. If this does not work, we can try and stabilize your shoulder arthroscopically (i.e. with a small camera and tiny incisions). Finally in some cases when that does not work, we use the Latarjet shoulder reconstruction. Occasionally we use the Latarjet as a first-line procedure if the shoulder is very unstable and there is bone loss of the ball or socket of the shouder.
The Latarjet procedure uses a bone from the front of your shoulder called the coracoid to provide stability. We take the coracoid and fix it to the front of your socket (called the glenoid) with two screws. This essentially makes your socket wider and gives you back any bone you lost from the recurrent dislocations. There is a similar version of the same procedure, where we can also use donated bone (i.e. an allograft) to do the same thing. Your surgeon will talk to you about the benefits of each of those options.
The surgery typically is an overnight hospitalization procedure. Sometimes if we are doing things through a very small incision, the surgery will be done as an outpatient.
You will receive a general anesthetic, in addition to a nerve block to your operative side. The nerve block is placed by the anesthesia service and allows you to wake up relatively pain-free. The block lasts for approximately 12-18 hours, after which you can start easing into your pain medication.
You are positioned into a “beach chair” position, with all of your extremities carefully padded. Your head is also supported in a padded head holder. After performing a “time out”, where we verify the operative site, your arm is cleaned and sterilely draped. Typically we make an incision in the front of the shoulder from the end of the clavicle bone down to the bottom of your pectoralis tendon (basically just above the arm pit area).
We can spread most of the tissues and tendons so that we are looking directly at the muscles (subscapularis) at the front of the shoulder. With a small saw, we make a cut in your coracoid bone and carefully prepare the bone to match the contour of your socket.
Then we spread your subscapuarlis muscle to get down to the capsule of your shoulder. The capsule is the balloon like structure that can get stretched with multiple episodes of shoulder instability. Once we open the capsule, we clean off the front part of your socket to receive the coracoid as the bone block. The coracoid is held in place with two screws. The capsule is then tightened slightly to help with the stability, and the incision is closed with a sterile dressing is applied. Occasionally we use a drain in the shoulder to help remove some of the swelling. The drain is typically removed the next day. Your arm is placed in a sling and pillow device for immobilization. It is very important that you stay in the sling and pillow and adhere to the rehabilitation protocol.
Sometimes we move the shoulder very quickly after the procedure, but other times we keep you in the sling for a couple of weeks prior to even moving the shoulder. This will be explained to you after the procedure and very specific instructions will be given to you and your therapist.
Once your pain is under control, you are eating and keeping food down, and you are medically stable, you can be discharged home. You will get a full set of instructions of Do’s and Don’ts. Basically make sure to keep your incision clean and dry. No showering until your postoperative visit. If you have any questions on what you should be doing or not doing to your shoulder, make sure to ask your surgeon or the nurses/residents. You will be seen in the office for a check up and to remove any staples or sutures in 7 – 10 days after surgery. You will also be given a pain medication prescription. Please take the pain medication as directed. Eat a healthy diet and get plenty of rest. Also remember that ICE is a form of pain relief and you should ice the shoulder regularly.
Typically you are in the sling for 6 weeks after surgery but are coming out of the sling for very prescribed movements that you will be taught. Physical therapy is an important part of the rehabilitation but depending on how bad your instability was, your therapy may be delayed so your bone can heal.
We hope this provides a bit more insight into your surgical procedure for Latarjet shoulder reconstruction. As always, if you have any questions, please contact all our office at 248-988-8085.