The laterjet procedure was developed in France by Dr. Laurent Lafosse and has been used to treat chronic shoulder instability for about 40 years. This procedure is performed when then repair of the labrum in the shoulder is not possible. Indications for this procedure are shoulder dislocation associated with:
• Glenoid bone fracture
• A large Hill Sach’s fracture of the humeral head
• An engaging Hill Sach’s fracture
• Previous shoulder reconstruction, labrum repair or stabilization surgery.
• Chronic or recurrent shoulder instability
• Participation in contact sports
When performing the procedure the patient is placed in a “beach chair” position with the affected shoulder in abduction and full external rotation. The pectoralis minor and coraco-acromial ligaments are released. The tendons of the small head of the biceps and coracobrachialis remained attached. Subscapularis tendon is divided to gain access to the joint. Finally, the coracoid process of the scapula is screwed into the anterior glenoid.
Post- operative Physical Therapy – 4 Phases
Phase I – Weeks 1-4
Phase II – Weeks 5-9
Phase III – Weeks 10-15
Phase IV – Weeks 16-20
With the Latarjet procedure, early post-op therapy must protect the subscapularis and the developing bony merging of the coracoid process. This typically takes around 6-8 weeks and the biceps and coracobrachialis must be protected during this time. Aggressive shoulder extension and external rotation is not encouraged. External rotation will be gradual allowing the anterior part of the reconstructed shoulder to heal. Due the position of the shoulder during surgery there should be minimal to no loss of active external rotation.
Because of surgical technique and early immobilization, the subscapularis is affected in terms of strength, flexibility, and proprioception. Later, specific therapy directed towards the subscapularis is imperative.
This type of procedure can be a great alternative for athletes and the very active population.
We treat patients with shoulder problems in the 34711 area!