At the Challenging Shoulder Symposium
A weekend of good discussion at the Challenging Shoulder Symposium in Sydney, pictured here with Paul Favorito of Cincinnati and David Weinstein of New York, with Richard Page in the background.
The session on Latarjet stabilisation
The previous day's session covered Latarjet stabilisation for the unstable shoulder. Two themes dominated: the relative advantages of arthroscopic versus open approaches, and the indications for the procedure.
What the Latarjet procedure does
In a shoulder that dislocates repeatedly, bone is often progressively lost from the front rim of the socket, which is already shallow. Once enough bone has gone, repairing the soft tissues alone may not be enough to keep the joint in place. The Latarjet procedure addresses this by transferring a piece of bone, the coracoid process, together with its attached tendon, to the front of the socket. This deepens and lengthens the socket and adds a further restraint across the front of the joint.
Expanding indications
A point of discussion was that the indications for the Latarjet procedure appear to be widening. Where it was once reserved for shoulders with substantial bone loss, many surgeons at the meeting considered it appropriate even where glenoid bone loss is small, particularly in contact athletes, on the basis that the demands placed on those shoulders make a soft tissue repair alone more likely to fail. This remains a matter of surgical judgement and debate rather than settled practice.
Related information
See our shoulder instability page for the condition and the range of treatment options, and shoulder anatomy for the structures involved. Our post on labral tears and recurrent shoulder instability covers why instability can return after a repair.