Latarjet/Bone Block

Individuals with recurrent shoulder dislocations and significant glenoid bone loss are suitable candidates for these procedures. These surgeries might also be considered for patients who have experienced a failed Bankart repair or those with specific conditions that make them more prone to dislocations, such as ligamentous laxity.

Both procedures are performed under general anesthesia.

Latarjet Procedure

• An incision is made at the front of the shoulder between the deltoid and pectoralis muscles.
• A small piece of bone from the scapula, known as the coracoid process, along with the attached muscles, is detached.
• This bone fragment is then moved to the front of the glenoid to replace the bone defect, and secured with metal screws, effectively broadening the shoulder socket and preventing further dislocations.
• The capsule of the shoulder is then reattached, providing extra stability.

Bone Block Procedure

• As in the Latarjet procedure, an incision is made at the front of the shoulder between the deltoid and pectoralis muscle.
• A bone graft is obtained, either from the patient’s own body (autograft), usually from the iliac crest of the hip, or from a donor (allograft), usually a distal tibia to provide cartilage.
• The bone graft is shaped to match the defect in the glenoid and then fixed into position with metal screws.
• The capsule of the shoulder is also reattached to provide extra stability.

Recovery times can vary but typically patients can return to light-duty work within a few weeks following surgery. However, a return to sports or heavy manual work may take between 4-6 months, as it takes time for the transferred bone to heal securely in its new location.

Following the surgery, your shoulder will be in a sling to limit movement while the bone heals. You will go home the same day from surgery. You will have some pain after surgery, but pain medications will be prescribed to help manage any postoperative discomfort.

Postoperative therapy plays a key role in the recovery process:

• Early Stage (Weeks 1-6): Goals include managing pain, reducing inflammation, and gradually restoring passive range of motion.
• Middle Stage (Weeks 6-12): Active range-of-motion exercises and gentle strengthening exercises are introduced as healing progresses.
• Late Stage (Weeks 12 and beyond): This phase includes more advanced strengthening exercises and sport-specific or work-related exercises to prepare for a return to regular activities.

As with any surgery, these procedures have potential risks:

• Infection: Occurs in less than 1% of patients. Antibiotics are given before and after surgery to minimize this risk.
• Nonunion or malunion: In some cases, the transferred bone may not heal properly or may heal in the wrong position, potentially leading to continued instability or reduced range of motion.
• Nerve injury: The axillary and musculocutaneous nerves lie close to the surgical site, and while rare, there is a risk of damage during the procedure.
• Hardware complications: Issues with the screws used in the surgery can sometimes occur, such as loosening or breakage.
• Continued pain: Even with surgery, you may still have some continued pain due to the damage that was done from the dislocations. Often there is cartilage damage that leads to arthritis, which is not fixable with this surgery.

If your shoulder surgeon Dr. Ben Mayo recommends these procedures and you choose not to undergo surgery, there are potential risks:

• Recurrent dislocation: Without repair, your shoulder may continue to dislocate, potentially causing further damage to the shoulder joint. It often becomes easier to dislocate over time with each new dislocation.
• Joint degeneration: Repeated dislocations and ongoing instability can lead to wear and tear of the shoulder joint, potentially causing osteoarthritis in the long term.
• Limited function: Persistent instability can impact your ability to perform daily activities and participate in sports or physical hobbies.