The Benefits of Open Latarjet in Treating Instability: A Conversation with Dr. Albert Lin
Editor’s note: During the upcoming Critical Concepts in Shoulder & Elbow Surgery course, Dr. Albert Lin will present on the topic, Open Latarjet. We asked Dr. Lin to preview the key points of this talk.
FORE, the Foundation for Orthopaedic Research and Education: One of your presentations will address the use of open Latarjet to treat shoulder instability with bone loss. Why is this an important topic to include in the agenda for Critical Concepts in Shoulder & Elbow Surgery?
Albert P. Lin, MD: Shoulder instability is a complex topic with a wide spectrum of treatments. These treatments depend on a variety of factors, including demographic and anatomic risk factors.
The open Latarjet is the tried-and-true, classic bony reconstructive procedure, especially in the setting of glenoid and humeral-sided bone loss in primary and revision situations. Newer bone graft options are available; however, the open Latarjet remains the gold standard for which all grafting options are compared against. It also has the longest track record of all glenoid grafting procedures worldwide.
Although it can be a technically challenging surgery, a well-performed Latarjet can provide excellent outcomes in terms of recurrent instability and return to sport. For all surgeons who treat instability, the open Latarjet is critical to have in the arsenal of treatments.
FORE: What are your indications for performing an open Latarjet procedure? And the contraindications?
Dr. Lin: My absolute indication for the open Latarjet is any situation in which the patient has recurrent anterior instability with 20% or greater glenoid bone loss. I would consider a Latarjet reconstruction for less than 20% bone loss in other situations, such as bone loss of 10-20% in a young collision athlete or in a patient with multiple prior dislocations, for example. As mentioned above, the decision to proceed with soft tissue or bony reconstructive procedures can be quite complex and depends on many factors.
My contraindication for open Latarjet is glenoid bone loss of more than 30% in which the coracoid transfer would not convert an off-track Hill-Sachs lesion to an on-track one. In these instances, free bone grafts, in which one has control over the dimensions of the bone graft, is probably necessary in my opinion.
FORE: What outcomes have you observed in patients who have undergone open Latarjet to treat shoulder instability with bone loss? What is the success rate for this surgery – and how do you define “success” in these patients?
Dr. Lin: When an open Latarjet is performed technically well for the right reasons, excellent outcomes can be achieved. This is borne out in the literature: Although no shoulder stabilization procedure is perfect, the open Latarjet still has the lowest recurrence rates with long-term follow up compared with all other procedures.
Outside of the US, open Latarjet is the most popular surgery even for minimal bone loss because of the recurrence rates. In the US, most of us do not jump straight to the Latarjet in instances of minimal bone loss because of the complication rates, which are real. Complications like nerve injury to the musculocutaneous nerve or axillary nerve are rare, but they are not zero. All of us who have been in practice for a while and do this frequently have experienced complications, which occur in even in the most technically gifted hands.
That said, when open Latarjet goes well, it typically goes very well. Success, which I would define as preventing recurrent instability and successful return to sports, is near 90%, depending on what literature you read.
FORE: What are the key points you want attendees to take away from your presentation?
Dr. Lin: The open Latarjet needs to remain within your repertoire if you want to be a complete shoulder instability surgeon. It is still the tried-and-true, battle-tested procedure for instability with glenoid bone loss. A good Latarjet can provide you with very successful outcomes that are durable. It is critical that you dedicate time to learning the nuances of this technique and the pearls and pitfalls so that you can increase your chances of a successful surgery.
ABOUT THE EXPERT
A board-certified orthopaedic surgeon, Albert P. Lin, MD, is professor and vice chair of education, program director of the University of Pittsburgh Medical Center (UPMC) Orthopaedic Residency, chief of the shoulder service and associate chief of sports medicine, and co-director of the Pittsburgh Shoulder Institute at UPMC and the University of Pittsburgh School of Medicine. Dr. Lin has published more than 130 peer-reviewed articles and 300 abstracts and book chapters and regularly presents his research as invited faculty and visiting professor at international, national, and local meetings and webinars.
ABOUT THE COURSE
Dr. Lin is among the 29 faculty members of the completely redesigned Critical Concepts in Shoulder & Elbow Surgery, taking place November 14-16, 2024, at FIVE Labs Las Vegas.
This is the only course where you’ll learn how to do shoulder and elbow procedures by actually doing them. We aren’t going to tell you how to address a rotator cuff tear, or tackle shoulder instability, or expose the glenoid and humerus for anatomic shoulder replacement. We’re going to show you, and then we’re going to coach you as you perform the techniques on anatomic specimens in our brand-new, state-of-the-art bioskills lab.
Click here for more information and to register for the course.