Chronic anterior shoulder instability following a first time shoulder dislocation reduced and treated conservatively varies in incidence from 100% to 0.24%, depending upon variables like capsular laxity, competitive or non-competitive athletes and bony defects acquired during the prior dislocation.
The chronic anterior shoulder instability can be very much and painful to the patient and leads to fear in sing the affected arm in overhead activities. Surgery is indicated if patients are unable or unwilling to change their occupation or avoid participating in high-risk sports or they have recurrent dislocations.
Surgical options vary from simple labral reattachment, capsular plication or capsular shaft procedures arthroscopic or open. With new surgical techniques and improved anchor design the outcome has improved much better or equal to traditional open surgeries.
But in patients with high recurrence or fracture following capsular procedures is associated pre-operatively like bony bankarts lesion, large hill sachs lesion etc. where the bony defect has to be addressed for the success. The procedure for failed capsular procedure and high risk category procedure of choice is to modify latarject.
In our hospital past one and half year, we have done three cases of modified latarjet, where all the patients had a history of dislocation of the shoulder. More than 20 times previous years and has radiologic evidence of bony bankarts, lesion in one, large hill sachs lesion in one and combined in one.
All these patients have been operated by modified latarjets procedure in which a 7cm incision in the anterior shoulder and coracoid bone block with short head Coracobrachialis biceps is transferred to the prepared anterior inferior glenoid and fixed with two screws along with repair of the anterior-inferior shoulder capsule with coracoaromial ligament. In this procedure, we get extended glenoid surface for translation of humeral head.
Coracobrachialis biceps acting as a dynamic sling in the anterior inferior part when joint is in abduction and external rotation position and reinforcement of anterior capsule by the corache acromial ligament.
