Original Latarjet Technique

The Latarjet procedure is a very common and popular operation for anterior shoulder instability. There are many variations and adaptations of the technique, attributed to Prof Latarjet. Below is the original description translated and kindly provided by Paul Guyver:

"During my last two operations, I have sectioned the coracoid with a chisel between the insertions of the coraco-brachialis and the pectoralis minor. By using a periosteal elevator to elevate the most anterior fibres of the coraco-acromial ligament, and by freeing the deepest adherence of the subscapularis, one can then move two muscles with the coracoid on which they are attached. One then obtains a very broad opening of the anterior face of the subscapularis which still hides the neck of the scapula and the joint.

The arthrotomy of the shoulder then becomes easy. One can do it transversally (which then allows to shorten the subscapularis during the closing) or longitudinally, parallel to the muscle fibres. One then has an excellent view of the glenoid, the damaged labrum, and the neck of the scapula covered by connective tissue that one can easily resect. 

Admittedly, the positioning of the coracoid complex remains delicate, since one wants it perfectly orientated and solid. But this can be avoided if the neck is perfectly exposed.

Finally I indicate that in both operations when I resected the coracoid, it seemed natural to me to use this “bone beak” as the material for the construct. The drilling for the screw is created prior to cutting the bone which then offers a solid support for the drilling of the glenoid. After arthrotomy and cleaning of the neck, it is easy to fix the coracoid solidly in a good place. It constitutes a solid construct together with the muscles that have been preserved. The subscapularis and the capsule are reconstituted by suture around the construct which is left outside the joint."

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