Latarjet Procedure

The Latarjet procedure is a surgical treatment for recurrent shoulder dislocations, especially in patients with significant bone loss at the front of the shoulder socket (glenoid). Originally described by French surgeon Michel Latarjet in 1954, this procedure has evolved over the decades and is now considered one of the most reliable techniques for restoring shoulder stability in active patients. It works through the “triple blocking” mechanism: bony augmentation, dynamic sling effect, and soft tissue reinforcement.

How Common It Is and Who Gets It? (Epidemiology)

The Latarjet procedure is commonly recommended for individuals with recurrent shoulder dislocations who have significant bone loss in the glenoid, typically exceeding 20%. This condition is often seen in athletes, particularly contact sports players, as well as patients who have experienced previous failed surgeries, such as Bankart repair. The procedure is especially useful for patients with shoulder instability related to seizure disorders or poor-quality anterior soft tissues.

Why It Happens – Causes (Etiology and Pathophysiology)

Recurrent shoulder dislocations often result from bone loss in the glenoid, typically due to repeated injury or traumatic events. This bone loss reduces the ability of the shoulder joint to stay stable, leading to frequent dislocations. In these cases, soft tissue repairs alone (such as the Bankart procedure) may not be effective. The Latarjet procedure helps restore stability by transferring a piece of bone (the coracoid process) to the glenoid to act as a bony block.

How the Body Part Normally Works? (Relevant Anatomy)

The shoulder joint is a ball-and-socket joint, where the humeral head (ball) fits into the glenoid (socket) of the scapula. The glenoid is normally stabilized by the labrum, a ring of cartilage that deepens the socket and helps keep the humeral head in place. In cases of significant bone loss, the stability of the joint is compromised, and the humeral head is prone to dislocating. The Latarjet procedure addresses this issue by adding bony support to the front of the glenoid, which helps prevent recurrent dislocations.

What You Might Feel – Symptoms (Clinical Presentation)

Patients with recurrent shoulder dislocations often experience pain, instability, and a feeling of the shoulder “giving way.” They may have difficulty with overhead activities, throwing, or lifting. These symptoms are particularly noticeable in contact athletes or those who engage in repetitive overhead motions. The instability typically worsens with activity, leading to recurrent dislocations and worsening pain over time.

How Doctors Find the Problem? (Diagnosis and Imaging)

Diagnosis of recurrent shoulder dislocations and glenoid bone loss involves a detailed physical examination and imaging studies. X-rays and 3D CT scans are essential to assess the degree of bone loss in the glenoid and to plan for surgery. CT scans also help guide the surgical placement of the coracoid graft. MRI or MR arthrogram may be used to assess the integrity of the rotator cuff and soft tissues around the shoulder.

Classification

The Latarjet procedure is typically indicated for patients with significant anterior shoulder instability, especially when glenoid bone loss exceeds 20%. Patients with failed prior soft tissue repairs, such as Bankart repair, are also candidates for this procedure. The surgery is particularly beneficial for athletes and active individuals who are at high risk of recurrent dislocations due to bone loss.

Other Problems That Can Feel Similar (Differential Diagnosis)

Other conditions that may mimic the symptoms of recurrent shoulder dislocations include rotator cuff tears, labral tears, and shoulder impingement syndrome. A thorough clinical evaluation and imaging studies are necessary to differentiate between these conditions and determine if the Latarjet procedure is appropriate.

Treatment Options

Non-Surgical Care

• Physical therapy to strengthen the rotator cuff and improve shoulder stability
• Anti-inflammatory medications or corticosteroid injections to manage pain
• Activity modification to avoid further instability

Surgical Care

• Latarjet procedure: Involves transferring the coracoid process to the front of the glenoid to act as a bony block, stabilizing the joint and preventing recurrent dislocations
• Bankart repair: Soft tissue repair used when there is no significant bone loss
• Reverse shoulder replacement: Used for patients with extensive rotator cuff damage and instability

Recovery and What to Expect After Treatment

Post-surgery recovery begins with wearing a sling to immobilize the shoulder, followed by gentle physical therapy to restore range of motion. Strengthening exercises are introduced after a few weeks. Patients can typically return to work within 2 months and sports within 2.5 months, though full recovery, including overhead activity, may take 6 months to a year.

Possible Risks or Side Effects (Complications)

Complications of the Latarjet procedure can include infection, nerve injury (particularly to the axillary or musculocutaneous nerves), graft failure or non-union, and hardware-related issues such as screw irritation or migration. Patients may also experience postoperative instability or stiffness, particularly if the coracoid graft does not heal properly.

Long-Term Outlook (Prognosis)

The long-term prognosis after a Latarjet procedure is generally positive, especially for patients with significant glenoid bone loss. Clinical studies have shown high rates of success, with fewer redislocations and better shoulder stability compared to soft tissue repairs. However, as with any surgical procedure, long-term outcomes depend on patient adherence to rehabilitation and the extent of bone loss and soft tissue damage.

Out-of-Pocket Costs for Treatment

Medicare

CPT Code 23462 – Latarjet Procedure (Arthroscopic or Open Shoulder Stabilization Surgery): $253.13

Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield usually cover that 20%, significantly reducing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans work alongside Medicare to fill the coverage gap and reduce patient costs.

If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans generally cover any remaining coinsurance or small deductibles, which typically range from $100 to $300, depending on your plan and provider network.

Workers’ Compensation

If your Latarjet procedure is required due to a work-related injury, Workers’ Compensation will cover all medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.

No-Fault Insurance

If your shoulder instability requiring the Latarjet procedure is due to an automobile accident, No-Fault Insurance will typically cover the full cost of your treatment, including surgery and postoperative care. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your policy.

Example

Michael Scott needed a Latarjet procedure (CPT 23462) to treat shoulder instability after multiple dislocations. His estimated Medicare out-of-pocket cost was $253.13. Since Michael had supplemental insurance through AARP Medigap, his remaining balance was fully covered, leaving him with no out-of-pocket expenses for the procedure.

Frequently Asked Questions (FAQ)

Q. What is the Latarjet procedure?
A. The Latarjet procedure is a surgical technique used to treat recurrent shoulder dislocations, especially in patients with bone loss on the glenoid side.

Q. When is the Latarjet procedure recommended?
A. It is recommended for patients who have recurrent shoulder instability, failed previous stabilization surgeries, or have significant bone loss of the glenoid rim.

Q. How does the Latarjet procedure stabilize the shoulder?
A. The procedure transfers the coracoid process with the attached muscles to the front of the glenoid to prevent further dislocations and provide a sling effect.

Q. What type of anesthesia is used for the Latarjet procedure?
A. The surgery is performed under general anesthesia, often combined with a regional nerve block.

Q. How long does the Latarjet procedure take?
A. The procedure typically takes about one to two hours to complete.

Q. What is the typical hospital stay after the Latarjet procedure?
A. Most patients are discharged on the same day or the day after surgery.

Q. What is the recovery timeline after a Latarjet procedure?
A. Recovery typically involves sling immobilization for a few weeks, followed by physical therapy, with return to sports around 4 to 6 months.

Q. What kind of rehabilitation is required after the Latarjet procedure?
A. Rehabilitation includes gradual range-of-motion exercises, strengthening, and functional training under supervision.

Q. Are there risks associated with the Latarjet procedure?
A. Risks include infection, nerve injury, nonunion of the graft, hardware issues, and recurrent instability.

Q. Can the Latarjet procedure be done arthroscopically?
A. Yes, the Latarjet procedure can be performed using arthroscopic or open techniques depending on surgeon preference and patient condition.

Q. What is the success rate of the Latarjet procedure?
A. The procedure has a high success rate in preventing recurrent dislocations and restoring shoulder stability.

Q. Is hardware used during the Latarjet procedure?
A. Yes, screws are typically used to fix the transferred coracoid process to the glenoid.

Q. Can athletes return to sports after the Latarjet procedure?
A. Yes, many athletes are able to return to their previous level of activity following a full recovery.

Q. What are signs of complications after the Latarjet procedure?
A. Signs include increased pain, swelling, fever, weakness, or limited motion, which should be evaluated by a surgeon.

Q. How does bone loss affect the choice of the Latarjet procedure?
A. Significant bone loss of the glenoid often necessitates the Latarjet procedure for effective stabilization.

Summary and Takeaway

The Latarjet procedure is an effective and reliable solution for patients with recurrent shoulder dislocations and significant glenoid bone loss. By providing bony support through the transfer of the coracoid process, this procedure restores stability and prevents further dislocations, making it particularly useful for athletes and individuals with high activity demands. While the procedure carries some risks, its long-term success rates make it a valuable option for those with severe shoulder instability.

Clinical Insight & Recent Findings

A recent study reviewed the outcomes of the Latarjet procedure, specifically focusing on its effectiveness in treating recurrent anterior shoulder instability, particularly in patients with significant glenoid bone loss.

The study found that the procedure, when performed with the congruent arc modification, resulted in a low redislocation rate (1.1%) and a high return-to-sport rate (94.3%), making it highly effective for restoring shoulder stability. However, complications such as graft fragmentation and screw malposition were noted, emphasizing the importance of precise surgical technique and preoperative planning.

This study supports the Latarjet procedure’s role as a reliable treatment for shoulder instability, particularly in athletes and those with substantial bone loss. (“Study on Latarjet procedure – see PubMed.”)

Who Performs This Treatment? (Specialists and Team Involved)

Orthopedic surgeons specializing in shoulder reconstruction and joint stabilization perform the Latarjet procedure. A rehabilitation team, including physical therapists, plays a key role in post-surgery recovery and rehabilitation.

When to See a Specialist?

Consult a specialist if you experience recurrent shoulder dislocations, particularly if you have significant bone loss in the glenoid or have failed previous shoulder surgeries.

When to Go to the Emergency Room?

Seek emergency care if you experience a dislocation or instability that causes severe pain or if you develop signs of infection, such as fever or redness at the surgical site.

What Recovery Really Looks Like?

Post-surgery recovery involves wearing a sling initially, followed by a gradual return to physical therapy and strengthening exercises. Most patients can return to work and light activities within a couple of months, with full recovery taking several months to a year.

What Happens If You Ignore It?

If left untreated, recurrent shoulder dislocations can lead to chronic pain, instability, and permanent damage to the shoulder joint, which may require more invasive surgery or joint replacement in the future.

How to Prevent It?

Maintaining shoulder strength and stability through targeted exercises and proper technique during physical activities can help prevent shoulder dislocations and support recovery after surgery.

Nutrition and Bone or Joint Health

Eating a balanced diet rich in calcium, vitamin D, and omega-3 fatty acids supports joint health and may help reduce inflammation, aiding in recovery after surgery.

Activity and Lifestyle Modifications

Avoiding high-impact activities or repetitive movements that stress the shoulder joint can help prevent further dislocations and improve long-term shoulder health.