On the faculty in Sydney
Invited as faculty to the Arthrex Mega Shoulder Conference in Sydney in May 2017, presenting the arthroscopic Latarjet procedure.
What being on the faculty involves
Faculty at a surgical conference are the surgeons who teach rather than the ones who attend. The role usually combines short lectures with case discussion, operative video annotated step by step, and often supervision in a laboratory where delegates practise on models or cadaveric specimens. Teaching surgeons who already operate is a different exercise from explaining a procedure to a patient, because the questions are about sequence, instrument choice, and what to do when a step has not gone as planned.
Recurrent instability in contact sport
Recurrent anterior dislocation following an initial injury in contact sport is one of the settings in which the Latarjet procedure is considered. Repeated dislocations progressively remove bone from the front rim of the socket, and once enough has gone, a soft tissue repair alone may not hold the joint. Transferring the coracoid as a bone block rebuilds the socket and adds a further restraint.
Whether a bone block or a soft tissue repair is appropriate depends on how much bone has been lost and on the demands placed on the shoulder, and is an individual decision. Individual results vary.
What the Latarjet procedure is
The shoulder is a shallow joint, which is what allows it to move so freely and also what allows it to dislocate. In a Latarjet procedure the coracoid, a small hook of bone at the front of the shoulder blade, is cut free and moved to the front rim of the socket, where it is held with screws. It does two things at once. It replaces missing bone, so the socket is deeper and the ball has further to travel before it can slip out, and the tendons still attached to the transferred bone pass across the front of the joint and act as an additional restraint when the arm is raised and rotated outwards.
It can be performed open, through an incision at the front of the shoulder, or arthroscopically through small portals using a camera, which was the subject of this presentation. Either way it is a bone procedure, followed by protected movement and a structured rehabilitation programme. Assessment beforehand usually includes imaging to measure how much bone has been lost. Individual results vary.