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Revision Latarjet Procedure with Fresh Distal Tibial Allograft and Conjoint Tendon Transfer

March 01, 2017

Contributors: Amos Dai, BS; Guillem Gonzalez-Lomas, MD; Laith M Jazrawi, MD; Daniel James Kaplan, BA; Robert J Meislin, MD; David Goodwin, MD; David Goodwin, MD

Purpose: Anterior shoulder instability as characterized by recurrent shoulder dislocations is often treated with a Latarjet procedure, in which the coracoid process and its associated conjoint tendon is transferred from its native location to the anteroinferior aspect of the glenoid rim. The biomechanical advantage of Latarjet procedure includes the sling effect of the conjoint tendon and the bone block effect of coracoid graft. When complications of the Latarjet procedure occur, there are a number of options for revision, one of which is using a bone allograft to replace the coracoid process. The purpose of this video is to describe the rationale and surgical technique of using fresh distal tibial allograft for revising a failed Latarjet procedure. Methods: We present a 34-year-old male with a 15-year history of shoulder dislocations, three in the last month most recently while sleeping. Instability occurs anteriorly and he is able to reduce the dislocation himself. He had had two prior open surgeries on this shoulder, most recently in 2003. MRI demonstrated significant glenoid bone loss with a small Hill-Sachs lesion. The patient underwent Latarjet procedure. At six-week follow up, x-rays demonstrated a fracture of the coracoid bone graft. Patient was indicated for revision surgery, and fresh distal tibial allograft was chosen. The video explains the advantages of this type of graft as well as the surgical technique for its implantation. Results: Six-week post-op x-rays show good graft positioning with screw fixation. Five-month post-op confirm good healing of the distal tibial fresh allograft. Outcomes are generally good with low rates of recurrent instability, no loss in ROM, and no complications at short-term follow up. Complications include disease transmission from graft, recurrent instability, nonunion, or hardware-related complications. Conclusion: Surgical treatment of recurrent posterior shoulder dislocations holds a risk for complications. In this video we use a fresh distal tibial allograft to revise complications of a prior Laterjet procedure. Clinical outcomes of posterior shoulder instability are generally good with low instability recurrence, no loss of range of motion, and no short term complications.