Latarjet procedure addresses anterior instability, but is not ‘panacea’ treatment
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The Latarjet procedure is a safe and effective surgical procedure to manage shoulder instability, a prominent orthopaedic surgeon from Lyon, France, said when he gave the Erwin Morscher Honorary Lecture at the Virtual EFORT Congress.
“Latarjet procedure is a safe and reliable procedure to address recurrent anterior instability,” Gilles Walch, MD, said.
During the lecture, Walch incorporated the concepts of diversity and harmonization, which constitute the main theme of this year’s congress, into his message about anterior shoulder instability, saying diversity for him means having and using a variety of treatments to address the same shoulder pathology.
“We cannot say today that one procedure is better than the other one,” he said.
“Concerning harmonization, harmonization for the instability, you could say that it’s probably patient selection because patient selection should not be different from one surgeon to another surgeon. It’s so important to have good patient selection, good contraindications, sometimes. Trying to reach a consensus regarding indication and contraindication is probably the harmonization of treating shoulder instability,” Walch said.
The two main indications for the Latarjet procedure are recurrent dislocation or subluxation of the shoulder and primary dislocation of the shoulder in a professional contact-sport athlete, he said.
Regarding durability of the procedure, Walch mentioned a female patient that he examined 50 years after she underwent the procedure because her shoulder was “popping out.” Walch discovered Michel Latarjet, MD, who developed the Latarjet procedure expressly for patients with recurrent shoulder dislocations, operated on this patient.
“We see that even with 50-year follow-up, we can achieve good results with this operation. However, this Latarjet procedure should not be considered as a universal panacea to believe that it resolves any kind of instability of the shoulder at all. It’s not possible to do that, and we should not do the Latarjet procedure in the older group,” Walch said, noting there are many other contraindications for the Latarjet procedure that should also be considered.
According to Walch, among these are prosthetic instability, painful shoulders, rotator cuff incarceration and locked anterior dislocations, the latter of which he said is better treated with reverse shoulder arthroplasty.
Walch also discussed special indications for the Latarjet procedure, which are beyond the “typical” indications and cases in which he may modify the Latarjet procedure somewhat.
For example, when a patient presents with multidirectional directional hyperlaxity or “loose shoulder” and has external rotation that is greater than 90°, Walch said he combines the Latarjet procedure with a capsulorrhaphy to decrease the axillary pouch.
In other special cases, such as for large glenoid fractures, he may enhance the surgery and its success by performing a reconstruction that uses iliac crest bone graft and includes a coracoid transfer.
Walch concluded by mentioning the arthroscopic Latarjet methods, which other two well-known French shoulder surgeons Laurent LaFosse, MD, and Pascal Boileau, MD, have described.
“No doubt, in the future, many methods of the Latarjet procedure will be performed under arthroscopy,” he said.
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Walch G. Reproduce the diversity in treatment of anterior shoulder instability. Presented at: Virtual EFORT Congress; Oct. 28-30, 2020.
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