In severe anterior shoulder instability and in cases were the shoulder has dislocated numerous times, the soft tissues of the anterior shoulder may be damaged to an extent that it is not possible to anatomically restore the supporting structure. The joint is extremely unstable particularly if the anterior edge of the joint cup is missing a piece of bone. The situation can be compared to a golf ball on top of a tee missing an edge: the ball will fall off.
The bony edge and the stability of the joint must be restored. The latest innovations include the arthroscopic transfer of the so-called coracoid process in front of the joint cup to restore the bone. Not only is the piece of bone transferred but also the biceps tendon which is attached to the coracoid process. The tendon transfer creates good functional support for the joint. The Latarjet procedure effectively eliminates the anterior dislocation of the shoulder. The operation is non-anatomical and therefore I personally prefer to perform this operation only when restoring the normal anatomy is not possible any more. However, in many places in Europe the operation is used even for first-time dislocations.
Our operation is arthroscopic and done under general anesthesia. The patient is discharged from the hospital the same day.
Postoperative treatment
The patient wears a sling for four weeks. This is to make sure that the moved bone block heals properly in place. The patient is allowed to do light rotatory movements and passive lifting of the arm depending on the severity of the pain. The patient is allowed to write, use a computer, make coffee, eat, etc. However, the patient must take care not to harm the reconstruction. The sling is removed after four weeks and active rehabilitation can begin 4 weeks after surgery. Taking care not to harm the reconstruction by using the arm too early is crucial. The patient is permitted to engage in heavy labor 3 months and sports 4–6 months after surgery.
