Arthroscopic Latarjet may provide good short-term clinical, radiologic outcomes

Jeffrey S. Abrams, MD

The Latarjet procedure has become an important treatment modality for patients with recurrent anterior shoulder instability, associated with bone loss and capsular deficiency. Commonly performed soft tissue repairs in patients with glenoid bone loss may be insufficient to restore shoulder stability, particularly in collision athletes. The question for many surgeons is whether a Latarjet surgical procedure should be performed as open surgery or arthroscopically. The choice of surgical approach relies on the surgeon’s experience, familiarity with anatomic variations and the ability to modify the surgical technique to best correct the anatomic deficiency. Many surgeons undergo a learning curve whether they choose the open or arthroscopic approach. As many of us have experienced, the arthroscope has provided greater detail with visual magnification, ability to treat multiple quadrants within the shoulder, and reduce risk of infection and stiffness. The open techniques can potentially assist with palpating, retracting vascular structures, make it easier to reposition the arm during surgical steps and create a safe zone for postoperative motion that does not stress the repair.

This study and others suggest that the arthroscope can be successful in reducing surgical time and reduce the number of complications aligned with the number of instability surgeries being performed. Complications and potential additional operations performed are affected by the number of cases studied in the surgeon’s experience. Some studies suggest 30 cases; others suggest 10 where there is a crossover.

Depending on the volume of patients who require Latarjet stabilization for each individual surgeon, it may require years to achieve and maintain proficiency. Surgeons who have the ability to practice on cadavers are clearly at an advantage to improve their technique. Additionally, experienced surgeons performing this procedure can be helpful to identify surgical pearls to streamline the procedure and create more predictable outcomes.

The arthroscope has replaced many open techniques for the reasons mentioned above. Treating associated pathology (in SLAP tears) and optimizing graft position fixation are worthy goals which would promote continued interest in arthroscopy performed procedures. The learning curve is real, and individuals should select the best approach in their hands to repair the affected shoulder with the lowest potential complication rate.