Overview
The Latarjet procedure transfers the horizontal limb of the coracoid process, with the conjoined tendon still attached, to the anteroinferior glenoid rim. It treats recurrent anterior glenohumeral instability associated with glenoid bone loss. The bone block widens the glenoid so it can resist axial load over a larger diameter. It also lengthens the glenoid articular arc, which keeps a Hill–Sachs lesion from engaging. (Campbell)
Rockwood describes a renewed interest in bony reconstructive procedures for traumatic anterior instability, particularly after a failed stabilization. These include the Bristow–Latarjet coracoid transfer and iliac crest (Eden–Hybbinette) or allograft bone block augmentation. Redislocation rates after Latarjet are generally lower than those reported for arthroscopic or open Bankart repair. (Rockwood)
Indications
Recurrent anterior instability with an "inverted pear" glenoid and an engaging Hill–Sachs lesion. In Campbell's experience the Latarjet alone is usually adequate for this combined bone deficiency. (Campbell)
A moderate (20%–30%) humeral head lesion, where the procedure is used to reconstruct an "on-track" shoulder. An arthroscopic remplissage may be added for a moderate Hill–Sachs lesion to further reduce the risk of recurrence. (Campbell)
Rockwood authors' preferred algorithm:
Subcritical-to-critical bone loss is quoted as 13.5% to 17.3% of the glenoid. Choosing 13.5% or 17.3% as the cutoff between arthroscopic stabilization and open Latarjet depends on activity level, sport (collision vs noncontact) and patient expectations, through shared decision-making.
Below that range, with an on-track lesion: arthroscopic or open Bankart repair.
Below that range, with an off-track (engaging) Hill–Sachs lesion: Bankart repair plus remplissage. Latarjet is an alternative.
Bone loss above 17.3% but below 30%: open Latarjet.
Bone loss beyond what Latarjet can restore: anterior glenoid grafting with iliac crest autograft or distal tibia allograft. (Rockwood)
Revision after failed soft-tissue repair when there is significant glenoid bone loss. (Rockwood)
Preoperative assessment: 3D-reconstructed CT to quantify anterior glenoid bone loss, measure the Hill–Sachs lesion and determine on-track/off-track status. (Rockwood)
Technique 52.6: Latarjet (Walch and Boileau) (Campbell)
Positioning and approach
Under general endotracheal anesthesia, place the patient in the beach-chair position.
Put a small pillow behind the scapula so the glenoid surface lies perpendicular to the operating table.
Prepare and drape the neck, chest, axilla and entire arm free.
Make a 4- to 7-cm skin incision starting below the tip of the coracoid process.
Open the deltopectoral interval and retract the cephalic vein laterally with the deltoid.
Place a self-retaining retractor in the interval and a Hohmann retractor on top of the coracoid.
Harvest and preparation of the bone block
With the arm in 90 degrees of abduction and external rotation, divide the coracoacromial ligament 1 cm from the coracoid.
Adduct and internally rotate the arm. Release the pectoralis minor insertion from the coracoid.
Expose the base of the coracoid with a periosteal elevator so the "knee" of the process can be seen.
With an osteotome or small angled saw, osteotomize the coracoid from medial to lateral at the junction of its horizontal and vertical parts.
Return the arm to abduction and external rotation, and release the coracohumeral ligament from the lateral coracoid.
Grasp the graft firmly and free it from its deep attachments.
Dissect only the lateral part of the conjoined tendon. Avoid the medial side, where the musculocutaneous nerve is at risk.
Evert the graft and decorticate its deep surface with a cutting rongeur or saw.
Drill two parallel holes in the deep surface for fully threaded solid cortical or cancellous screws, which will be used in lag fashion.
Measure the graft thickness with a caliper.
Park the graft under the pectoralis major. The self-retaining retractor holds it there and keeps the interval open.
Subscapularis split, capsulotomy and glenoid exposure
With the arm in full external rotation, identify the superior and inferior margins of the subscapularis.
Split the muscle in line with its fibers at the junction of the superior two thirds and inferior one third, using electrocautery and then Mayo scissors. Obtain hemostasis at each step.
Carry the split down to the white capsule.
Extend the split medially by inserting a sponge into the cleavage plane to expose the subscapular fossa, and laterally as far as the lesser tuberosity. Place a Hohmann retractor in the subscapular fossa.
Bring the arm to neutral rotation and make a 1.5-cm vertical capsulotomy at the level of the anteroinferior glenoid margin. A posteriorly directed force on the humeral head helps identify the joint line.
Internally rotate the arm fully and insert a humeral head retractor (Fukuda) so it rests on the posterior glenoid rim.
Retract the superior two thirds of the subscapularis superiorly with a Steinmann pin impacted into the superior scapular neck. Retract the inferior part with a Hohmann retractor passed under the scapular neck between the capsule and the subscapularis. A Bankart retractor on the medial glenoid neck can improve exposure.
Inspect the labrum, cartilage and glenohumeral ligament insertion. Resect the medial capsular flap together with damaged labrum or fracture fragments.
Expose the anteroinferior glenoid margin with a scalpel and decorticate it with a curette or osteotome. A motorized burr may be used carefully to create a flat reciprocal bed for the bone block.
Fixation of the bone block
Pass the bone block through the subscapularis split and place it flush with the anteroinferior glenoid margin.
Check the position with the arm internally rotated:
Never accept lateral overhang into the joint. It can lead to rapid degenerative joint disease. If overhang occurs, burr the graft flush with the native glenoid.
A slightly medial position, no more than 2 mm, is acceptable.
Drill through the inferior graft hole into the glenoid neck in an anteroposterior and superior direction, parallel to the articular surface.
Temporarily reflect the block and measure the depth with a depth gauge.
Insert a 3.5- or 4.0-mm solid cortical or cancellous screw into the posterior cortex. Tighten it loosely so the superior part of the block can still be rotated into its final position.
Insert the second screw through the superior hole and tighten both screws firmly. The result is bicortical fixation.
Closure
With the arm in external rotation, repair the coracoacromial ligament remnant to the lateral capsular flap with two interrupted absorbable sutures.
Remove the sponge from the subscapular fossa and take the shoulder through a full range of motion.
Coat the cut surface of the coracoid with bone wax and close the superficial layers.
Technical points from Rockwood
At least 1.5 cm of coracoid should be harvested, cut from medial to lateral at its base with a 90-degree sagittal saw.
The undersurface of the coracoid is flattened with the saw so it can be transferred to the anterior glenoid rim.
Placing a guide on the coracoid base helps retract or rotate the scapula, so that drill holes are parallel to the glenoid fossa.
The first inferior hole in the glenoid neck is predrilled about 5 to 6 mm medial to the articular margin.
The coracoid surface should end flush with the glenoid fossa.
Two parallel screws are emphasized. In a study of failed Latarjet procedures, fixation with a single screw was associated with clinical failure. (Rockwood)
Postoperative Care
Sling or shoulder immobilizer for 2 weeks.
Forward flexion from 2 weeks.
External rotation from 6 weeks.
Strengthening from 8 weeks.
Return to sport once radiographic union is confirmed (usually by CT) and functional testing is passed. (Campbell)
Complications
Recurrent instability. Lower than after soft-tissue repair. A meta-analysis cited by Rockwood found redislocation of 9.5% after Bankart repair vs 5.0% after Latarjet. In a 360-patient series it was 13% after arthroscopic Bankart repair vs 1% after Latarjet. A systematic review reported 9.8% recurrent instability (dislocation or subluxation) after Latarjet. (Rockwood)
Overall complication rate. Open procedures carry higher rates than arthroscopic Bankart repair: open Bankart 4.3%, open Latarjet 10.6%–15%, bone block 17.6%. (Rockwood)
Graft complications. Graft fracture, lysis and nonunion. A systematic review of 1,904 shoulders found an overall nonunion rate of 9.1%. A stable fibrous union may still give a good functional result without reoperation. (Rockwood)
Neurologic injury. Rates are about 1.8% after open procedures vs 0.2% after arthroscopic ones. The musculocutaneous and axillary nerves are most at risk, and most injuries are transient. Evaluate with CT to check screw and graft position, follow up at 6 weeks and 3 months, obtain EMG if there is no recovery by 3 months, and refer to a brachial plexus specialist if there is no recovery by 6 months. (Rockwood)
Loss of motion. A mean loss of about 11.5 degrees of external rotation has been reported. It rarely needs further surgery. (Rockwood)
Glenohumeral arthrosis. Estimated at about 42% after bone augmentation. Malpositioned (lateralized) grafts and intra-articular implants contribute, so the graft must be placed flush. (Rockwood)
References
Lamplot JD, Brolin TJ. Recurrent dislocations. In: Azar FM, Sawyer JR, Throckmorton TW, eds. Campbell's Operative Orthopaedics. 15th ed. Philadelphia: Elsevier; 2026. Chapter 52, Technique 52.6.
Glenohumeral instability. In: Tornetta P III, Ricci WM, Ostrum RF, McKee MD, Ollivere BJ, de Ridder VA, eds. Rockwood and Green's Fractures in Adults. 10th ed. Wolters Kluwer; 2024. Chapter 35 (Turkish edition: Erişkin Kırıkları).