It is widely held that in cases of shoulder instability all efforts should be made to diagnose the pathology and offer a procedure that addresses the anatomical deficiencies found. When anatomical repair is not possible it may be necessary to reconstruct, for example using bone graft. However, the Latarjet procedure, despite being non-anatomical, has seen a dramatic rise in popularity over the past decade. So much so, that many now recommend it as the first operation in certain high-risk patients such as collision athletes. To hear debate at conferences one might conclude that it is the answer to most difficult and recurrent cases of anterior dislocation of the shoulder. An article in this journal raised a question mark over its use in patients with epilepsy (Ref1), the authors reporting a redislocation in more than 40%. Other papers and presentations have reported failure rates that are not insignificant. I was therefore interested to read a systematic review on the subject (Ref 2) which gives an overview of where we are with this procedure, which is one of the latest to be the subject of an industry developing special instruments to allow it to be performed arthroscopically? We may not have the panacea, it seems. Griesser et al report an overall reported complication rate of 30%, though recurrence rates are laudable at 3% for open procedures and 6% for arthroscopic, the latter also resulting in a greater loss of external rotat ...
Mr David Limb, Consultant Orthopaedic Surgeon, Leeds Teaching Hospitals Trust, UK
1. Raiss P, Lin A, Mizuno N, Melis B, Walch G. Results of the Latarjet procedure for recurrent anterior dislocation of the shoulder in patients with epilepsy. J Bone Joint Surg [Br] 2012;94-B:1260-1264.
2. Griesser MJ, Harris JD, McCoy BW, et al. Complications and reoperations after Bristow-Latarjet shoulder stabilization: a systematic review. J Shoulder Elbow Surg 2013;22:286-92.