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Commentary and Perspective   |    
The Latarjet Procedure: The Patient Population Makes All the DifferenceCommentary on an article by Anup A. Shah, MD, et al.: “Short-Term Complications of the Latarjet Procedure”
Stephen C. Weber, MD
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Disclosure: The author did not receive payments or services, either directly or indirectly (i.e., via his institution), from a third party in support of any aspect of this work. He, or his institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. The author has not had any other relationships, or engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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This article was chosen to appear electronically on February 7, 2012, in advance of publication in a regularly scheduled issue.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Mar 21;94(6):e37 1-1. doi: 10.2106/JBJS.K.01594
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This retrospective review with Level-IV evidence represents the experience of a highly skilled and experienced physician group with the Latarjet procedure. They report a substantial 25% complication rate for this procedure, including a 6% infection rate, an 8% instability recurrence rate, and a 10% rate of neurologic injury. The recurrence rate is especially worrisome, given the very short minimum follow-up duration of only six months. Two axillary nerve injuries were persistent at the time of the final follow-up. It should be remembered that complications reported for coracoid process transfer in the early 1990s resulted in that operation falling into some disfavor in the United States1.
It is difficult to compare this candid study with other reports that show far fewer complications. Emami et al., in contrast, recently reported no neurovascular complications in a series of thirty cases2. Burkhart et al. reintroduced the Latarjet procedure to many American surgeons but provided no information regarding the outcome of the procedure3. Allain et al. reported only a 7% complication rate, with no neurologic injuries and no recurrent dislocations, in a series of fifty-eight shoulders followed for a mean of fourteen years4.
Rather than reflecting on the skill of the surgeons, it would seem that the primary difference between this current study and those previously reported is the complex, revision nature of the procedure in the patient population studied by Shah et al. Seventy-three percent had undergone prior surgery, with 25% having undergone more than one procedure. In a recent review of failed reconstructive surgery for shoulder instability of all types, Shah et al. noted that “revision procedures remain technically demanding.”5 The authors’ choice of a subscapularis muscle-splitting approach over the originally described detachment of the subscapularis tendon may also make exposure more difficult, especially in revision cases, and thus lead to more complications. Approximately 15% of the patients were smokers, and approximately 10% had Workers’ Compensation claims; the Workers’ Compensation group had a twelve-fold greater complication rate compared with the non-Workers’ Compensation group in this study.
In summary, this paper represents the results of a skilled shoulder group with the Latarjet procedure as it is commonly used in the United States: as a procedure of second choice for revision shoulder instability treatment or for patients with complex issues of glenoid bone loss. The surgeon contemplating use of the Latarjet procedure in such a patient population would be wise to reflect on the results shown here, rather than on the results of this procedure reported by European surgeons who often use this procedure for primary glenohumeral instability of all types in patients with much less complex conditions.
Young  DC;  Rockwood  CA  Jr. Complications of a failed Bristow procedure and their management. J Bone Joint Surg Am.  1991;73:969-81.[PubMed]
 
Emami  MJ;  Solooki  S;  Meshksari  Z;  Vosoughi  AR. The effect of open Bristow-Latarjet procedure for anterior shoulder instability: a 10-year study. Musculoskelet Surg.  2011;95:231-5.[PubMed][CrossRef]
 
Burkhart  SS;  De Beer  JF;  Barth  JR;  Cresswell  T;  Roberts  C;  Richards  DP. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy.  2007;23:1033-41.[PubMed][CrossRef]
 
Allain  J;  Goutallier  D;  Glorion  C. Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am.  1998;80:841-52.[PubMed][CrossRef]
 
Shah  AS;  Karadsheh  MS;  Sekiya  JK. Failure of operative treatment for glenohumeral instability: etiology and management. Arthroscopy.  2011;27:681-94.[PubMed][CrossRef]
 

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References

Young  DC;  Rockwood  CA  Jr. Complications of a failed Bristow procedure and their management. J Bone Joint Surg Am.  1991;73:969-81.[PubMed]
 
Emami  MJ;  Solooki  S;  Meshksari  Z;  Vosoughi  AR. The effect of open Bristow-Latarjet procedure for anterior shoulder instability: a 10-year study. Musculoskelet Surg.  2011;95:231-5.[PubMed][CrossRef]
 
Burkhart  SS;  De Beer  JF;  Barth  JR;  Cresswell  T;  Roberts  C;  Richards  DP. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy.  2007;23:1033-41.[PubMed][CrossRef]
 
Allain  J;  Goutallier  D;  Glorion  C. Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am.  1998;80:841-52.[PubMed][CrossRef]
 
Shah  AS;  Karadsheh  MS;  Sekiya  JK. Failure of operative treatment for glenohumeral instability: etiology and management. Arthroscopy.  2011;27:681-94.[PubMed][CrossRef]
 
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