Arthroscopic Latarjet—learning curve, results, and complications
The Latarjet procedure was developed by the French surgeon Michel Latarjet in 1954 to treat recurrent glenohumeral instability and provides enhanced stability through a triple-blocking mechanism: reconstruction of glenoid bone loss through the coracoid bone block, a “sling-effect” of a lowered subscapularis, and a bumper mechanism through a labral repair. It is typically indicated in cases of significant glenoid bone loss and can also be used effectively in other high-risk patients (young, hyper-lax, contact or competitive sports) or in the revision setting. It has classically been performed through an open approach but since 2007 has also been performed arthroscopically. Multiple grafts can be used (autograft coracoid, autograft iliac crest, allograft) with many modes of fixation (one or two bicortical screws, cortical button, suture anchor, or implant-less). While the arthroscopic procedure is technically demanding and a learning curve has been demonstrated, it can be completed successfully with good union rates and minimal complications in these complex patients. Benefits of the arthroscopic technique generally include decreased bleeding, less post-operative pain, ability to treat concomitant pathology, and better cosmesis. However, the most important benefit to the arthroscopic Latarjet may be the improved intra- and extra-articular visualization, which allows excellent bone graft positioning and protection of neurovascular structures. In this review article, we discuss findings associated with the learning curve, results, and complications of the arthroscopic Latarjet procedure.