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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 characterized by recurrent shoulder dislocations often is managed via the 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 the Latarjet procedure includes the sling effect of the conjoint tendon and the bone block effect of the coracoid graft. In patients in whom complications occur after the Latarjet procedure, a number of options are available for revision, one of which involves using a bone allograft to replace the coracoid process. This video describes the rationale and surgical technique for using fresh distal tibial allograft for revision of a failed Latarjet procedure. Methods: The video discusses the case presentation of a 34-year-old man with a 15-year history of shoulder dislocations, three of which occurred in the past month, most recently while sleeping. Instability occurred anteriorly, and the patient was able to self-reduce the dislocation. The patient underwent two prior open shoulder surgeries, the most recent of which occurred in 2003. MRI revealed considerable glenoid bone loss with a small Hill-Sachs lesion. The patient underwent the Latarjet procedure. At a follow-up of 6 weeks, radiographs demonstrated a fracture of the coracoid bone graft. Revision surgery was indicated, and a fresh distal tibial allograft was selected. This video discusses the advantages of this type of graft and the surgical technique for its implantation. Results: Radiographs obtained 6 weeks postoperatively demonstrated good graft positioning with screw fixation. Good healing of the fresh distal tibial allograft was confirmed at a follow-up of 5 months postoperatively. In general, the outcomes of the revision Latarjet procedure with the use of fresh distal tibial allograft are good, with low rates of recurrent instability, no loss of range of motion, and no complications at short-term follow-up. Complications include disease transmission from the graft, recurrent instability, nonunion, and hardware-related complications. Conclusion: Surgical management of recurrent posterior shoulder dislocations is associated with a risk for complications. This video demonstrates the use a fresh distal tibial allograft for a revision Latarjet procedure. In general, the clinical outcomes of posterior shoulder instability are good, with a low rate of instability recurrence, no loss of range of motion, and no short-term complications.