The document summarizes a study on the mini-open Latarjet procedure for patients with failed arthroscopic Bankart repair for recurrent shoulder instability. 24 patients underwent the mini-open Latarjet procedure and were followed for a minimum of 2 years. Results found satisfactory range of motion, functional outcomes, and low recurrence rates. Complications were minor. The study concludes the mini-open Latarjet is an effective option for challenging cases of recurrent instability after failed soft tissue repair due to significant bone loss.

1. Results Of Mini-Open Latarjet
Procedure In Failed Arthroscopic
Bankart repair
– A Retrospective analysis
Dr Rahul Kumar
Sports Injury centre, Safdarjung Hospital

2. DISCLOSURE
The authors have no financial conflicts to
disclose

3. INTRODUCTION
Anterior shoulder instability is most common type of
shoulder instability.
Arthroscopic bankart repair has become the
procedure of choice of primary recurrent anterior
shoulder instability
However, failures of stabilization can and do occur.

4. INTRODUCTION
Recurrent instability after Bankart
repair is a difficult problem for both
the patient and treating physician.
• Open procedure: 10%
• Arthroscopic procedure:
0-43%.
Recurrence
rates

5. CAUSES OF FAILURES
GLENOID BONE LOSS
• Re-Dislocation
- no bone loss 4% recurrence
- inverted pear 61% recurrence
(>25% Glenoid Bone loss)
Burkhart SS, De Beer JF. Traumatic Glenohumeral bone defects and their relationship to
failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the
humeralengaging Hill-Sachs lesion. Arthroscopy 2000;16:677-694.)

6. Humeral head bone defects
Engaging Hill sach’s lesion

7. Glenoid Tracking
Yamamoto at al. JSES 2007
mapped track of glenoid on
humeral head through
simulated motion started in
max ER Varied Abduction
from 0 degree to 60 degree.

8. Humeral head defect -
outside the glenoid
track - high risk for
engaging (OUT-E).
Humeral head defect
– inside the track –
Non engaging ( IN-NE)

9. ORIGINAL
LATARJET
Developed and reported in 1954 using
Standard delto-pectoral approach
Transfers a large segment of the coracoid (2.5
to 3 cm in length) as bone graft to the anterior
inferior glenoid rim.
Latarjet M. Traitement de la luxation récidivante de l’épaule. Treatment of
recurrent dislocation of the shoulder. Lyon Chirurgical. 1954; 49:994–997.

10. Mini open Latarjet
Limited delto-pectoral approach
Skin incision: 1 cm above the tip
of the coracoid extending 4-5 cm
toward the axillary fold.
Slightly medial to coracoid, so
that anterior inferior glenoid
neck is exposed easily.

11. Materials and Methods
Study design: Retrospective study
Sample size : 24
Study period: June 2010 – May 2012
Inclusion criteria: Patients who had undergone arthroscopic
Bankart repair for recurrent anterior shoulder instability who
presented with persistent instability after surgery with positive
apprehension test.
Exclusion Criteria: Primary latarjet procedures were excluded
from the study.

12. Pre-op workup
Clinical and radiological
evaluation done.
• Size of Hill sach’s
lesion
• Glenoid Bone Loss
3D CT was
performed

13. Surgical Technique

14. Surgical Technique

15. Post op Rehabilitation
Shoulder immobiliser upto 2 weeks
Shoulder pendulum exercises are started from
day 1.
Passive abduction & forward elevation upto 900
and External rotation upto 300 is initiated from
3rd week after suture removal.

16. Follow Up
Minimum Follow up: 2 years
Radiographic assessment
• AP view
• scapular Y view
Functional results
• American shoulder and elbow score(ASES)
• Western Ontario shoulder instability score(WOSI).
Range of motion
• Loss of mean forward elevation
• Loss of external rotation

17. Follow Up
Data Analysis
•Range
•Mean
•Student’s T-test with statistical
significance set at p value < .05

18. RESULTS
All patients were Male.
Mean age of patients was 31.8 years (range: 21-37
years).
The right shoulder was involved in 13 cases (54.17 %),
and the dominant arm was affected in 11 patients
(45.83 %).
Average glenoid bone loss was 21% as assessed by
three dimensional computed tomography (range ; 15-
29%).

19. CAUSE OF FAILURE
GLENOID BONE LOSS
HUMERAL HEAD DEFECT
TRAUMATIC
8 9
7

20. RESULTS
RANGE OF MOTION
180
160
140
120
100
80
60
40
20
0
mean forward
elevation
mean external
rotation
preop
postop
Loss of 3.1 degree
Loss of 6.4 degree

21. FUNCTIONAL RESULTS
100
90
80
70
60
50
40
30
20
10
0
ASES WOSI
PREOP
POSTOP
92.5
76.84%
52
34.76%

22. COMPLICATIONS
Shoulder pain was found in 6 patients (32%) (4
with mild pain and 2 with moderate pain)
One patient had hardware complication in terms of
screw backing out from the plate. The implant was
removed after 15 months of surgery.
One patient had superficial wound infection which
responded to irrigation and oral antibiotics.

23. LITERATURE REVIEW
POST OP ROM
Our study
• Flexion: 164.8
degree + 2.0
degree
• External
rotation: 45.6
degree + 3.0
degree
Burkhart and De
beer
• Flexion:179.6±
2.0°
• external
rotation:
50.2±12.6°
Allain et al
• Abduction:
42±17°
• external
rotation:
48±18°
Burkhart S, De Beer J, Barth J, et al. Results of modified Latarjet reconstruction in patients with
anteroinferior instability and significant bone loss. . Arthroscopy.2007; 23(10):1033–1041. doi:
10.1016/j.arthro.2007.08.009.
Allain J, Goutallier D, Glorion C. Long-term results of the latarjet procedure for the treatment of
anterior instability of the shoulder. Journal of Bone and Joint Surgery A. 1998; 80(6):841–852.

24. LITERATURE REVIEW
Redislocation & Subluxation
10
9
8
7
6
5
4
3
2
1
0
Our study Hill et al Allain et al Hovelius et al
Redislocation
Subluxation
26 mths 58 mths 14.3 yrs 15 yrs

25. Literature review
Arthroscopic vs open Latarjet
There is superior stabilization effect of the
open Latarjet technique in the ABD
position(Abduction with neutral rotation)
- anterior capsular repair
In the ABER position, no difference
Johanna Schulze-Borges, Dr.Eng: Arthroscopy: Vol 29, No 4 (April), 2013: pp 630-637
Biomechanical Comparison of Open and Arthroscopic Latarjet Procedures:

26. LIMITATIONS
Small sample size
Short follow up – effect of bone graft
on gleno-humeral degenerative
arthritis could not be assessed.

27. CONCLUSION
The mini-open Latarjet procedure provides satisfactory
outcome and stabilization in this extremely challenging
category of patients who present with dramatic bone
loss and failed soft tissue reconstruction.
We recommend this procedure for young active
patients with recurrent anterior inferior shoulder
instability even after Arthroscopic Bankart repair.

28. CASE 1: 21yrs/Male Preop Radiographs and CT

29. Post op Radiographs
AP view Scapular Y view Scapular Y view at 6 months