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Modified Boneless Latarjet Procedure for Recurrent Anterior Shoulder Dislocation

February 19, 2016

Contributors: Pierlui Serlorenzi, MD; Daniele Mazza, MD; Cosma Calderaro, MD; Lorenzo Proietti, MD; Domenico Lupariello; Andrea Redler, MD; Andrea Ferretti, MD; Antonio Vadala, MD; Antonio Vadala, MD

Nowadays the Latarjet procedure is the most widespread open procedure performed for recurrent anterior shoulder dislocation. However it is definitely a non-anatomical procedure, and its potential intraoperative complications are quite high. In this video we show a modification of the Latarjet procedure in which we perform a Bankart repair of the damaged anterior capsule along with a transposition of the only conjoined tendon. Different than the classic Latarjet procedure, this technique is based on the reconstruction of the anterior glenohumeral capsule through the harvest of the conjoined tendon without the tip of the coracoid. After closing the Bankart lesion as performed in classical capsulorraphy techniques, we focus on the conjoined tendon in order to improve the anterior wall of the joint and provide the patient with a stronger soft tissue construct. Basically we perform a Latarjet procedure without performing the osteotomy of the tip of the coracoid, thus avoiding all the complications related to this surgical step, such as fractures or risks of harvesting a small amount of bone block. With this modification of the Latarjet procedure, we aim to benefit from the "tendon sling effect" provided by the transposition of the conjoined tendon in addition to the Bankart repair. What's more this modification of the Latarjet technique may be classified as an anatomical technique, since it only works with soft tissue, and its main benefits are basically represented by the repair of the Bankart lesion along with a transposition of the conjoined tendon which works as reinforcement of the medial and inferior gleno-humeral ligaments. We have surgically treated eight patients. All patients were involved in sports activities, even though none of them was a professional. All patients were clinically followed up at a mean of nine months. The mean WOSI score was 92 and the mean ROWE score was excellent in six patients and good in two. Range of motion was complete in seven patients. None of them reported intra-or postoperative complications. They all began resuming physical activities five months after the operation. Despite the short follow up so far available, this modification of the Latarjet technique seems to provide a very satisfactory shoulder stability. It benefits from the sling effect provided by the transposed conjoined tendon.

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