At the Royal North Shore Shoulder Symposium
Dr Kenneth Cutbush spoke at the 2024 Royal North Shore Shoulder Symposium in Sydney, presenting on the arthroscopic Latarjet procedure with labral repair and reporting outcomes from 330 cases.
The arthroscopic Latarjet with labral repair
A shoulder that has dislocated repeatedly often loses bone from the front rim of the socket, and the labrum and capsule at the front are stretched or detached. Once enough bone has gone, a repair of the soft tissue alone has little to hold against. The Latarjet operation addresses this by moving a small piece of bone, the coracoid process, with its attached tendon to the front of the socket and fixing it there, which restores the rim and adds a restraining effect from the transferred tendon. The arthroscopic version performs that transfer through keyhole portals rather than through an open approach, and adding a repair of the labrum at the same time restores the soft tissue rim in front of the transferred bone. Individual results vary.
Why the Latarjet is debated
There are two established ways of dealing with a shoulder that keeps dislocating. One repairs and tightens the labrum and capsule, sometimes with a remplissage to address a dent in the humeral head. The other transfers bone to rebuild the rim of the socket. The two carry different risks and fail in different ways, and the choice depends on how much bone has been lost, how many dislocations there have been, the patient's age and the sport or work they intend to return to. Where the answer is clear most surgeons agree; the argument is about the cases in the middle. Individual results vary.
The battle rounds
A highlight of the meeting was the battle rounds, including a debate on the Latarjet procedure. A formal debate format is a useful way of handling questions where the evidence genuinely does not settle the matter, since it forces the strongest version of each position to be stated.