The original Arthroscopic Latarjet procedure pioneered by Dr Lafosse ablates the anterior capsule and does not include repair of the anterior labrum. It is possible with a modification to the initial exposure to preserve the anterior capsule and labrum allowing repair of the labrum once the coracoid process has been transferred and fixed to the anterior glenoid.
Dr Cutbush has developed this technique of preserving the anterior labrum and repairing it in all the arthroscopic latarjets that he performs. He currently is undertaking a study to demonstrate the technique’s advantages
The initial capsular exposure is shown in this video. A radially directed split is made at the level of the superior margin of the subscapularis. The capsule and labrum is divided at this level to the margin of the glenoid. This tissue is then grasped and taken from superomedial progressively to inferolateral.
Once the coracoid process has been transferred to the anterior glenoid the capsule and labrum can be retrieved from the inferior joint space and repaired over the coracoid bone block to the anterior glenoid. The repair achieved is equivalent to a primary bankart repair.
Biomechanical testing has shown that the sling effect of the conjoined tendon that inserts into the tip of the coracoid process is the most important stabilising structure of the latarjet procedure. The bone block and the labral repair both contribute to the stability of the reconstructed shoulder to a significant degree. The effect of the sling is demonstrated in this intraoperative video.