The aim of this study was to determine if the extent of the glenoid and humeral bone loss affects the rate of recurrent instability and the functional outcome following the Latarjet procedure. 161 patients underwent open Latarjet procedure during the period 2006–2015 (Mean age 30.0 years, 150t (93.2%) Male, 118 (73.3%) primary procedure). Functional outcome was measured using the Western Ontario Shoulder Instability Index (WOSI) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDash) score at a mean of 4.7 years post-operatively. All patients underwent computed tomographic (CT) imaging pre-operatively. Using three-dimensional reconstruction, the glenoid bone loss, Hill-Sachs lesion and ‘Glenoid Track’ status was recorded. Radiographically-confirmed redislocation was rare (1.2%), but 18.5% (n=23/124) reported ongoing subjective shoulder instability. Fifty-two shoulders (32.3%) were classified as “Off-Track”. The median Quick DASH and WOSI scores were 2.27 (IQR 9.09; range 0–70.45) and 272.0 (IQR 546.5; range 0–2003), respectively. There were no significant differences observed between overall Quick DASH scores or WOSI scores for either On-Track or Off-Track groups (p=0.7 and 0.73, respectively). Subjective instability was not influenced by the degree of glenoid bone loss (p=0.82), the overall size of the Hill-Sachs lesion (p=0.80), or the presence of an ‘Off-Track’ lesion (p=0.84). Functional outcome and recurrent instability following the Latarjet procedure do not appear to be influenced by the extent of glenohumeral bone loss prior to surgery

Purpose:. We aimed to assess the short and medium term complications of patients who had undergone Latarjet procedures. We also compared this to a group of patients who over a similar period underwent an open Bankhart procedure to assess the complication profiles between the two groups. Method:. We retrospectively reviewed the notes and X-rays of all patients identified by surgical log books and or operation codes for instability. Eighty seven patients (88 shoulders) underwent Latarjet procedures between 2002 and 2010. Patients were phoned to obtain a telephonic Oxford shoulder score. There were 44 patients with 46 shoulders in the open Bankhart group. Results:. Complications were seen in 27 patients in the Latarjet group. These included: 5 nerve injuries (3 axillary nerves, 1 musculocutaneous nerve, 1 possible suprascapular nerve) 4 of which resolved; 6 screw related complications and 7 early recurrences of the instability. There was a total reoperation rate of 8%. Patients who developed complications had an average post op Oxford score at last follow up of 36.1, while those without complications had an average score of 14.8. In the group of patients who underwent Bankhart procedures there were no recorded short or medium term complications. We specifically did not look at recurrence rates in either group as we felt our follow up times would not reflect this adequately. Conclusion:. Modified Latarjet procedure appears to have a higher short and medium term complication rate compared to the open Bankhart procedure. Once a complication occurs following a Latarjet reconstruction outcomes are significantly worse

The Latarjet procedure utilises the coracoid as a vascularised bone autograft to augment the glenoid in patients with shoulder dislocation, especially where there is a bony lesion affecting the glenoid. A modification of the Latarjet procedure, pioneered in Cape Town, South Africa, rotates the coracoid so that its curved under-surface matches that of the glenoid. The aim of this study was to measure the radii of curvature of the glenoid and the coracoid to see how well the curved under-surface of the coracoid matches the glenoid’s surface curvature. An initial study of 210 cadaveric scapulae was performed in which the radii of curvature of the surface of the glenoid and the curved under-surface of the coracoid were measured. We found that the curves are very similar. The glenoid’s surface had a median curvature of 30mm (inter-quartile range from 25mm to 30mm) and the coracoid had a median curvature of 22.5mm (inter-quartile range from 20mm to 25mm). The curvature of the glenoid in these dry specimens was slightly larger than the corresponding coracoid curvature. In life this difference would be minimised by articular cartilage, labrum and the attachment of capsule (another Cape Town modification). A further parallel CT based study was set up at Derbyshire Royal Infirmary in England. The same radii of curvature where measured and compared using 3D CT reconstruction on a further 20 scapulae from living patients. These measurements also support the cadaveric similarities with a mean glenoid curvature of 23.9mm and coracoid of 25.4mm respectively. Using a paired t-test no statiscally significant difference was found between the corresponding data (p=0.2488). This study confirms the native anatomy of the coracoid is perfectly suited for this modification of the Latar-jet procedure

The Latarjet procedure is a successful primary and revision option for anterior shoulder instability; however recent reports have highlighted varying complication rates. Our aim was to prospectively study clinical, functional and radiological outcomes of patients undergoing this procedure. 50 consecutive patients underwent a Latarjet coracoid transfer between 2006 and 2012. Mean age was 27 years (17–63), 48 were male. Pre-/post-operative imaging, Oxford Shoulder Instability Score (OISS), American Shoulder & Elbow Surgeons score (ASES), Subjective Shoulder Value score (SSV) and clinical evaluation were documented. Mean follow up was 32 months (6–74). There were no dislocations or revision procedures. Subluxation occurred in one patient only. 95% of shoulders were subjectively graded “excellent” or “good;” 5% “fair;” and none as “poor”. The mean pre-op ASES was 58(50–66) and 95(92–98) post-operatively (p< 0.001). The mean pre-operative OISS was 19(18–22) and 43(41–45) post-operatively (p<0.001). The mean SSV increased from 46% to 89% (p < 0.001). 98% of patients considered their surgery to be “successful” and 95% would recommend the procedure to a friend. 82% returned to sport at their previous level. There were no infective or metalwork-related complications. Five experienced transient neurological symptoms all of which resolved within three months. These results suggest that the Latarjet procedure is safe and reliable with low complication rates

The Latarjet procedure is a successful primary and revision option for anterior shoulder instability; however recent reports have highlighted varying complication rates. Our aim was to prospectively study clinical, functional and radiological outcomes of patients undergoing this procedure. 50 consecutive patients underwent a Latarjet coracoid transfer between 2006 and 2012. Mean age was 27 years (17–63), 48 were male. Pre-/post-operative imaging, Oxford Shoulder Instability Score (OISS), American Shoulder & Elbow Surgeons score (ASES), Subjective Shoulder Value score (SSV) and clinical evaluation were documented. Mean follow up was 32 months (6–74). There were no dislocations or revision procedures. Subluxation occurred in one patient only. 95% of shoulders were subjectively graded “excellent” or “good;” 5% “fair;” and none as “poor”. The mean pre-op ASES was 58(50–66) and 95(92–98) post-operatively(p<0.001). The mean pre-operative OISS was 19(18–22) and 43(41–45) post-operatively(p<0.001). The mean SSV increased from 46% to 89%(p < 0.001). 98% of patients considered their surgery to be “successful” and 95% would recommend the procedure to a friend. 82% returned to sport at their previous level. There were no infective or metalwork-related complications. 5 experienced transient neurological symptoms all of which resolved within 3 months. These results suggest that the Latarjet procedure is safe and reliable with low complication rates

To evaluate the efficacy of using a novel button-suture construct in place of traditional screws to provide bone block fixation for the Latarjet procedure. Four paired cadaveric shoulders (n=8) were denuded, with the exception of the conjoint tendon on the coracoid, and were potted. A 15% anterior glenoid bone defect was simulated. Right and left specimens were randomised into two groups: double-screw versus quadruple-button Latarjet reconstruction techniques. A uniaxial mechanical actuator loaded the Latarjet reconstructed glenoid articular surface via a 47mm diameter metallic hemisphere. Cyclic loading between 50–200N was applied to the glenoid at a rate of 1Hz for 1000 cycles. Testing was repeated three times for conjoint tendon loads of 0N, 10N and 20N. The relative positions of three points on the inferior, central and superior edges of the coracoid bone fragment were optically tracked with respect to a glenoid coordinate system throughout testing. Screw and button constructs were compared on the basis of maximum relative displacement at these points (RINF, RCENT, RSUP). Statistical significance was assessed using a paired-samples t-test in SPSS. When conjoint tendon loading was not present the double screw and quadruple button constructs were not significantly (P>0.779) different (0N: RINF: 0.11 (0.05)mm vs. 0.12 (0.03)mm, RCENT: 0.12 (0.04)mm vs. 0.12 (0.03)mm, RSUP: 0.13 (0.04)mm vs. 0.12 (0.03)mm). Additionally, the double screw construct was not found to differ (P>0.062) from the quadruple button in terms of resultant coracoid displacement for all central and superior points, regardless of conjoint loading (10N: RCENT: 0.11 (0.03)mm vs. 0.19 (0.05)mm, RSUP: 0.11 (0.01)mm vs. 0.18 (0.04)mm; 20N: RCENT: 0.13 (0.01)mm vs. 0.30 (0.13)mm, RSUP: 0.13 (0.03)mm vs. 0.26 (0.14)mm). It was only for the inferior point with conjoint loading of 10N and 20N that the double screw construct began to produce significantly lower displacements than the quadruple button (10N: RINF: 0.11 (0.03)mm vs. 0.23 (0.05)mm, P=0.047; 20N: RINF: 0.12 (0.02)mm vs. 0.39 (0.15)mm, P=0.026). The results of the screw and button constructs when conjoint tendon loading was absent suggest that the button may be a suitable substitute to the screw when the coracoid is used as a bone block. Due to the small resultant displacements (max: screw = 0.19mm, button = 0.52mm), it is suggested that buttons may also act as a substitute to screws for Latarjet procedures, provided conjoint tendon overloading is minimised during the post-operative graft healing period. These in-vitro results support the in-vivo results of Boileau et al (2015) that demonstrated the suture-button technique to be an excellent alternative to screw fixation Latarjet, with graft healing in 91% of their subjects

Between 1996 and 2001 we used a modification of the Latarjet procedure to treat 70 patients with bony insufficiency of the glenoid. Our modification involves detaching a long piece of coracoid and rotating it to match its concave inferior surface with the surface of the glenoid. The coracoid graft is placed extra-articularly and the capsule repaired with bone anchors to the edge of the glenoid. Postoperatively no sling is applied and rehabilitation is started early. At a mean of 24 months (9 to 72) patients were clinically reviewed and assessed on the Walch-Du Play score. The results were excellent in 68%, moderate in 6% and poor in 1%. There were no redislocations. The results were most satisfactory in this group of patients, most of whom participated in contact sports, where soft tissue procedures (e.g., open and arthroscopic Bankarts) carry unacceptable failure rates

Over a six-year period, one surgeon operated on 46 men with instability associated with antero-inferior glenoid loss. Thirty-three of them played rugby at a competitive level. The mean number of preoperative dislocations was five (2 to 22). Modifications included a change in orientation of the coracoid bone block and the addition of capsular closure. A Walch-Duplay score for instability was calculated at follow-up. The mean follow-up was 38 months with a minimum of 6 months. Only one patient had recurrent instability. Thirty-one returned to sport at the same level. Walch-Duplay scores were excellent in 70%, good in 25%, mild in 3.75% and poor in 1.25%. Complications included two fibrous unions (excellent outcome), three broken screws (excellent outcome) and two fixation failures owing to patient non-compliance. There was no decrease in the range of internal rotation. Eight patients had mild restriction in forward flexion (mean 5°) and 20 patients had mildly reduced external rotation at 90° abduction (mean 5°). All but one patient with recurrent dislocation rated the outcome excellent and would have the operation again. The Latarjet procedure confers outstanding stability and gives excellent subjective and objective outcomes

Aim: The aim of the present study was to evaluate the functional results of the Latarjet procedure. Moreover we analysed the prevalence of glenohumeral OA after this intervention. Patients and Methods: Forty patients were included in the study. All the patients were clinically evaluated according to the system of Rowe, Duplay and Constant. X-ray evaluation was useful to detect bony lesions, to evaluate the position and the evolution of the graft, and according to the system of Samilson the grade of glenohumeral OA. Results: At follow-up none of the patients had recurrent dislocation. Only two patients reported occasional subluxation, and 1 case had a positive apprehension test. The average score for strenght according to the system of Constant was 16 points (min/max: 9/22) for the operated shoulder and 19 points (min/max: 12/24) for the uninvolved side. Pre-op radiographs demonstrated a bony lesion in 37 cases (90%): in 35 cases was discovered a lesion of the glenoid rim and in 36 shoulder was detected an Hill-Sachs lesion. In only one case was detected a Samilson grade 1 degeneration. Post-op radiographs showed a correct positioning of the coracoid graft in 32 cases, too lateral in 5 cases and too medial in 3 cases. Glenohumeral OA: 2 cases Samilson grade 2; 1 case Samilson grade 1. Conclusion: Our data confirm that Latarjet technique is an efficient procedure in chronic anterior shoulder instability in sportsmen so to allow to more than 80% of our patients to return to sport activities

Latarjet procedure (transfer of coracoid process to the anterior glenoid rim) has been widely used for severe anterior shoulder instability. The purpose of the present study was to investigate the intraarticular stress distribution after this procedure to clarify the pathomechanism of its postoperative complications. CT-DICOM data of the contralateral healthy shoulder in 10 patients with unilateral anterior shoulder instability (9 males and 1 female, age: 17–49) was used for the present study. Three-dimensional finite element models of the glenohumeral joint was developed using software, Mechanical Finder (RCCM, Japan). In each shoulder, a 25% bony defect was created in the anterior glenoid cavity, where coracoid process was transferred using two half-threaded screws. The arm position was determined as 0-degree and 90-degree abduction. While medial margin of the scapula was completely constrained, a standard compressive load (50 N) toward the centre of the glenoid was applied to the lateral wall of the greater tuberosity. A tensile load (20N) was also applied to the tip of coracoid process along the direction of conjoint tendon. Then, elastic analysis was performed, and the distribution pattern of Drucker-Prager equivalent stress was investigated in each model. The proximal half of the coracoid represented significantly lower equivalent stress than the distal half (p < 0.05). In particular, the lowest mean equivalent stress was seen in its proximal-medial-superficial part. On the other hand, a high stress concentration newly appeared in the antero-inferior aspect of the humeral head exactly on the site of coracoid bone graft. We assumed that the reduction of mean equivalent stress in the proximal half of the coracoid was caused by the stress shielding, which may constitute one of the pathogenetic factors of its osteolysis. A high stress concentration in the humeral head may eventually lead shoulder joint to osteoarthritis

The proximity of neural structures to the coracoclavicular ligaments limits the amount of coracoid process that can be harvested. The purpose of this study of 100 dry human scapulae was to define the anatomic limitations.

We found the mean measurement of the horizontal arm of the coracoid process anterior to the conoid tubercle was 21.5 mm (SD 0.9 mm). In 10% of the scapulae, it was larger than 30 mm. In 66%, the posterior aspect of the conoid fused with the vertical ramus and the lateral lip of the suprascapular notch.

This amount of coracoid appears to be large enough to expand the glenoid vault, and to hold two AO small fragment screws. It can be safely harvested if the conoid ligament is respected. Partial sacrifice of the trapezoid ligament is unavoidable, but does not compromise coracoclavicular stability. If the coracoid osteotomy is extended medial to the conoid tubercle it encroaches on the vertical ramus of the coracoid and can damage the suprascapular nerve. Posterior advancement of the osteotomy can extend onto the anterosuperior glenoid.

Aims. To systematically review the predominant complication rates and changes to patient-reported outcome measures (PROMs) following osteochondral allograft (OCA) transplantation for shoulder instability. Methods. This systematic review, following PRISMA guidelines and registered in PROSPERO, involved a comprehensive literature search using PubMed, Embase, Web of Science, and Scopus. Key search terms included “allograft”, “shoulder”, “humerus”, and “glenoid”. The review encompassed 37 studies with 456 patients, focusing on primary outcomes like failure rates and secondary outcomes such as PROMs and functional test results. Results. A meta-analysis of primary outcomes across 17 studies revealed a dislocation rate of 5.1% and an increase in reoperation rates from 9.3% to 13.7% post-publication bias adjustment. There was also a noted rise in conversion to total shoulder arthroplasty and incidence of osteoarthritis/osteonecrosis over longer follow-up periods. Patient-reported outcomes and functional tests generally showed improvement, albeit with notable variability across studies. A concerning observation was the consistent presence of allograft resorption, with rates ranging from 33% to 80%. Comparative studies highlighted similar efficacy between distal tibial allografts and Latarjet procedures in most respects, with some differences in specific tests. Conclusion. OCA transplantation presents a promising treatment option for shoulder instability, effectively addressing both glenoid and humeral head defects with favourable patient-reported outcomes. These findings advocate for the inclusion of OCA transplantation in treatment protocols for shoulder instability, while also emphasizing the need for further high-quality, long-term research to better understand the procedure’s efficacy profile. Cite this article: Bone Jt Open 2024;5(7):570–580

Bone defects are frequently observed in anterior shoulder instability. Over the last decade, knowledge of the association of bone loss with increased failure rates of soft-tissue repair has shifted the surgical management of chronic shoulder instability. On the glenoid side, there is no controversy about the critical glenoid bone loss being 20%. However, poor outcomes have been described even with a subcritical glenoid bone defect as low as 13.5%. On the humeral side, the Hill-Sachs lesion should be evaluated concomitantly with the glenoid defect as the two sides of the same bipolar lesion which interact in the instability process, as described by the glenoid track concept. We advocate adding remplissage to every Bankart repair in patients with a Hill-Sachs lesion, regardless of the glenoid bone loss. When critical or subcritical glenoid bone loss occurs in active patients (> 15%) or bipolar off-track lesions, we should consider anterior glenoid bone reconstructions. The techniques have evolved significantly over the last two decades, moving from open procedures to arthroscopic, and from screw fixation to metal-free fixation. The new arthroscopic techniques of glenoid bone reconstruction procedures allow precise positioning of the graft, identification, and treatment of concomitant injuries with low morbidity and faster recovery. Given the problems associated with bone resorption and metal hardware protrusion, the new metal-free techniques for Latarjet or free bone block procedures seem a good solution to avoid these complications, although no long-term data are yet available.

Cite this article: Bone Joint J 2024;106-B(10):1100–1110.

The Latarjet procedure is a well described method to stabilize anterior shoulder instability. There are concerns of high complication rates, one of these being a painful shoulder without instability due to screw irritation. The arthroscopic changes in the shoulder at time of screw removal compared to those pre-Latarjet have not been described in the literature. We conducted a retrospective review of arthroscopic videos between 2015 and 2022 of 17 patients at the time of their Latarjet screw removal and where available (n=13) compared them to arthroscopic findings at time of index Latarjet. Instability was an exclusion criterion. X-rays prior to screw removal were assessed independently by two observers blinded to patient details for lysis of the graft. Arthroscopic assessment of the anatomy and pathological changes were made by two shoulder surgeons via mutual consensus. An intraclass correlation coefficient (ICC) was analyzed as a measure for the inter-observer reliability for the radiographs. Our cohort had an average age of 21.5±7.7 years and an average period of 16.2±13.1 months between pre- and post-arthroscopy. At screw removal all patients had an inflamed subscapularis muscle with 88% associated musculotendinous tears and 59% had a pathological posterior labrum. Worsening in the condition of subscapularis muscle (93%), humeral (31%) and glenoid (31%) cartilage was found when compared to pre-Latarjet arthroscopes. Three failures of capsular repair were seen, two of these when only one anchor was used. X-ray review demonstrated 79% of patients had graft lysis. Excellent inter-rater reliability was observed with an ICC value of 0.82. Our results show a high rate of pathological change in the subscapularis muscle, glenoid labrum and articular cartilage in the stable but painful Latarjet. 79% of patients had graft lysis with prominent screws on X-ray

The function of the upper extremity is highly dependent on correlated motion of the shoulder. The shoulder can be affected by several diseases. The most common are: rotator cuff tear (RCT), shoulder instability, shoulder osteoarthritis and fractures. Rotator cuff disease is a common disorder. It has a high prevalence rate, causing high direct and indirect costs. The appropriate treatment for RCT is debated. The American Academy Orthopaedic Surgeons guidelines state that surgical repair is an option for patients with chronic, symptomatic full-thickness RCT, but the quality of evidence is unconvincing. Thus, the AAOS recommendations are inconclusive. We are performing a randomized controlled trial to compare surgical and conservative treatment of RCT, in term of functional outcomes, rotator cuff integrity, muscle atrophy and fatty degeneration. Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. Shoulder instabilities have been classified according to the etiology, the direction of instability, or on combinations thereof. The Thomas and Matsen classification, which is currently the most commonly utilized classification, divides shoulder instability events into the traumatic, unidirectional, Bankart lesion, and surgery (TUBS) and the atraumatic, multidirectional, bilateral, rehabilitation, and capsular shift (AMBRI) categories. The acquired instability overstress surgery (AIOS) category was then added. Surgical procedures for shoulder instability includes arthroscopic capsuloplasty, remplissage, bone block procedure or Latarjet procedure. Reverse total shoulder arthroplasty (RTSA) represents a good solution for the management of patients with osteoarthritis or fracture of the proximal humerus, with associated severe osteoporosis and RC dysfunction

Coracoid fractures during screw insertion and graft osteolysis are serious concerns with standard screw fixation techniques in Latarjet procedure. This study tends to evaluate the outcome of mini open Latarjet using Arthrex mini-plate for coracoids graft fixation. We did retrospective analysis of 30 patients with recurrent anterior shoulder instability after arthroscopic Bankart's repair. A low profile wedge plate (Arthrex) with two low profile screws was used for fixation of the coracoid graft. CT analysis was performed at final follow up to see graft union and results were evaluated using American shoulder and elbow score (ASES) and Western Ontario shoulder instability score (WOSIS). Mean follow up time was 24 months. Postoperatively, mean forward elevation was 162.8 degrees and external rotation was 44.6 degrees. All patients returned to their previous occupation. None reported to be having any recurrent subluxation post-surgery. The mean ASES score was 92.5 while the mean WOSIS score was 76.84%. Only one patient had screw backing out from the plate. There was no case of coracoid graft osteolysis. The mini-open Latarjet procedure with graft fixation with Arthrex mini-plate provides satisfactory outcome and stabilization in patients who present with dramatic bone loss and failed soft tissue reconstruction. It not only ensures early rehabilitation but also minimum loss of external rotation. The only drawback is the relatively high cost of the implant

Recurrent anterior shoulder instability (RASI) is related to progressive bone loss on the glenoid and on the humeral head. Bone deficit magnitude is a well-recognized predictor of recurrence of instability after an arthroscopic Bankart surgery, but the best way to measure it is unknown. In this study, we want to determine which measurement method is the best predictor of recurrence of instability and function. For 10 years now, all patients undergoing surgery for RASI in 4 centers are included in a prospective study: the LUXE cohort. Patients with a pre-operative CT-scan and a minimum of 1-year follow-up were included. ISIS score was used to stratify patients. WOSI and Quick-Dash questionnaires were used to characterise function. Bone defects were assessed using the Clock method, the Glenoid Ratio, the Humeral Ratio, the Glenoid Track method and the angle of engagement in the axial plane. A total of 262 patients are now included in the LUXE study. One hundred and three patients met the inclusion criteria for analysis with a majority of male (79%) and a mean age is 28 years old. The median number of dislocations prior to surgery was 6. Seventy patients had an arthroscopic Bankart repair and 33 patients underwent an open Latarjet procedure. The ISIS score for these groups were of 2.7 and 4.8 respectively (p<0.001). The mean bone defect on the glenoid was of 1h51 with the Clock method (range: 0h-4h48; SD=1h46) and of 9% for the glenoid ratio (0–37%, 10%). On the humeral side, the bone defect was of 1h59 (0h-4h08; 0h49) for the Humeral clock method, 15% (0–36%; 6%) with the ratio method and 71 degrees of external rotation (SD=30 degrees) with the angle of engagement measurement. On the combined evaluations, 53 patients presented an off-track lesion, with mean combined hours of 3h53 (SD= 2h13). The greatest correlation obtained was between the glenoid ratio and the glenoid clock method (r=0.919, p<0.001). Eighteen patients had a recurrence of shoulder dislocation after the initial surgery, leading to a recurrence rate of 23% in arthroscopic surgery versus six percent after a Latarjet (OR= 4.6, p=0.034). No bone defect was correlated to Latarjet failure. For the arthroscopic group, the risk of recurrence was related to a smaller angle of engagement of the Hill-Sachs (p=0.05), a smaller Humeral clock measurement (p=0.034) and a longer follow-up (p=0.006). No glenoid or combined measurements were correlated with arthroscopic procedure failure. Recurrence of dislocation was associated to worst function according to the WOSI (1036 vs 573, p=0.002) and DASH (32 vs 15, p=0.03). Even with lower ISIS score, arthroscopic procedures are still leading to high risk of recurrence in this “all comer” consecutive cohort study AND it is related to humeral side parameters. Recurrence is also affecting daily function and creating higher anxiety related to the shoulder

This study retrospectively reviewed the pathology after the first traumatic incident of shoulder subluxation or dislocation in 12 male and four female patients with a mean age of 14.9 years (12 to 16). All had undergone surgery and were seen over a five-year period. Patients seen after a second traumatic dislocation were excluded. All patients had been treated conservatively for between 4 and 18 months. When conservative treatment failed, all patients underwent examination and shoulder arthroscopy. All 16 had Hill-Sachs lesions of varying degrees. Bankart repairs were done in 14 patients with Bankart lesions. Two patients had more than 25% bone loss of the glenoid, and Latarjet procedures were undertaken. One SLAP-III and three SLAP-II repairs were done. The follow-up period varied from three months to five years. All patients were either examined or interviewed by telephone. Failures were defined as recurrence of symptoms or redislocations. All patients resumed their sporting activities at similar or higher levels. Two patients with multidirectional shoulder laxity had further possible subluxations but were treated conservatively. One sustained a massive bony Bankart lesion a year after a Bankart repair and a Latarjet procedure was subsequently performed. Patients in this age group should be considered at high risk for recurrence. If intensive short-term rehabilitation fails, they should be managed surgically immediately

Recurrent shoulder instability in those with bony defects is a difficult surgical problem to resolve. Burkhart and De Beer described an unacceptably high recurrence rate for arthroscopic Bankart repair in the presence of an inverted-pear glenoid with or without an engaging Hill-Sachs lesion, with suggestions that an open modified Latarjet procedure should be recommended in such patients. The Congruent-Arc Latarjet is a modification of the Latarjet open bony stabilisation for shoulder instability developed by Burkhart and De Beer. It involves rotation of the coracoid so the curved under-surface lies congruent with the glenoid. At the Royal Derby Hospital, UK, this procedure has been adopted by our four shoulder surgeons, two of whom undertook fellowship training with De Beer, we studied the outcomes of the patients who had undergone the modified Congruent-Arc Latarjet procedure in our department. Fifty-two consecutive patients were identified over a five-year period at the Royal Derby Hospital or Derbyshire Royal Infirmary between 2006 and 2010 inclusive. With the approval of the clinical audit department, the data was collected using theatre records and clinical coding information to identify the patient group. A review of the case notes and local PACS system was undertaken to establish pre and post-operative examination findings, radiology findings regarding Hill-Sachs defects and glenoid bone loss, re-dislocation rates and post-operative function with return to normal activity. The endpoints of this study were aimed at finding out whether patients did return to normal function, were able to continue doing activity that would have provoked dislocation prior to surgery, and how many of the cases re-dislocated. No surgeon consultant had a patient who re-dislocated after this procedure. The follow-up period was from 1 year to 6 years post-operatively. The complications of this procedure were found to be the dislodgement of bone anchors in 2 patients, who required further arthroscopy to remove the suture anchor from the gleno-humeral joint. One patient had prolonged functionally limiting loss of external rotation, which resolved after intensive physiotherapy at 7 months follow up. We will provide graphical representation of the pre and post operative functional scores. We have demonstrated that the Congruent-Arc Latarjet is a reproducible procedure in the hands of surgeons other than the original authors, particularly when comparing our current 0% re-dislocation rate with the published literature, which suggests that 3.9% of patients undergoing this procedure with greater than 25% bone loss of the glenoid or an engaging Hill-Sachs will re-dislocate post-operatively, and this is better than the 6% re-dislocation rate of the standard Bristow-Latarjet procedure

Purpose: Surgical treatment of anterior shoulder instability relies heavily on the Latarjet procedure which uses a coracoid block fixed to the anteroinferior rim of the glenoid. The procedure is technically difficult, leading to a substantial number of intraoperative complications, block nonunions and partial lysis, and most importantly long-term scapular osteoarthritis. Nevertheless, in certain cases, complete lysis or removal of the block does not alter stability. Furthermore, the current technique requires partial section or discision of the subscapular fibres, the only healthy element which persists anteriorly. The question is thus whether the greatest stabilising effect arises from the hammock effect of the coracobiceps on the subscapular. We report our experience with a prospective series. Material and methods: We initiated a prospective study in 1997 in a series of patients treated by simple section of the coracobiceps, leaving the acromiocoracoid, coracoid, and subscapular ligaments totally intact. We used a reinforcement ligament passing by the roatator interval and fixed on the glenoid at the Latarjet site which tied the subscapular and was fixed to it with four sutures. The assemble was then covered with the coracobiceps which was fixed to the subscapular ligament. Our prospective series included 65 patients with shoulder instability and recurrent pure anterior dislocation. All patients were reviewed at 3 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 years. A telephone interview was then made every year. Outcome was assessed with the Duplay score. Results: The postoperative period was uneventful and time to recovery was shorter than with the traditional Latarjet procedure. There were no signs of reaction to the terephthalate polyethylene. At last follow-up the Duplay score was 23.6/25 for daily or sports activities, 23.6/25 for stability, 22.9/25 for pain, and 23.6/25 for motion giving a final score of 93.71/100. Discussion: This technique has been particularly attractive for revision surgery. It appears that the block itself does not have a stabilising effect but that the predominant effect arises from the coracobiceps hammock. We are currently studying this technique with an arthroscopic approach which could be used to complement pure capsular techniques