Latarjet / Bristow





Non-anatomical bony block 

- transfer of coracoid process through subscapularis

- dynamic anteroinferior musculotendinous sling

- provides subscapularis tenodesis

- preventing lower portion from displacing proximally as arm abducted

- when shoulder in vulnerable position abduction and ER


BristowBristow CT




1.  Contact Sportsman

- sportsman who will return to dislocating action and loss of ER not a problem

- football, basketball


2.  Large bony bankart

- > 25 - 30%


Large Bony Bankart CT0001Large Bony Bankart CT0002


Glenoid bony defect



Large Bony BankartInverted Pear Glenoid


3. Large Hill Sachs

- prevent engagement


Large Hill SachsEngaging Hill Sachs


4.  Poor soft tissue

- multiple dislocations

- anterior labrum very poor quality


5.  Revision surgery

- i.e. failed arthroscopic or open soft tissue bankart




1.  Loss of ER 12-20°

- problem if throwing athlete

- subscapularis is relatively shortened 


2.  Screw problems 2-14%


3.  Instability 1-20%

- does not address bankart pathology

- difficult to revise with scarring in abnormal positions 


4.  Injury MCN





- correct positioning of transferred coracoid process critical to success 

- must be near but not over anterior glenoid rim


Good results can be correlated with


1. Coracoid process < 5 mm medial to glenoid rim

2. Coracoid positioned inferior to transverse equator of glenoid

3. Bony union develops between coracoid & scapula

4. Fixation screw purchases posterior glenoid cortex

5. Screw does not penetrate articular surface




Difference from Bristow


Transfers larger fragment

- allows 2 x screw fixation of coracoid to neck of scapula


Latarjet APLatarjet Lateral



- large > 20-25% bony Bankart

- revision surgery

- contact athlete


CT Large Bony Bankart



- ? throwing athlete

- can lose considerable ER






Deltopectoral approach

- divide clavipectoral fascia at lateral edge of conjoint




Identify coracoid

- use fang retractor on superior surface to identify entire coracoid

- strip Coracoacromial ligament off lateral coracoid

- take pectoralis minor off medially


Divide coracoid

- 3 cm long

- use 90o oscillating blade on microsagittal saw 100

- medial to lateral


Prepare coracoid

- release conjoint for length, identify and protect MCN

- pect minor surface will be placed onto glenoid

- remove cortex with burr

- opposite side clear soft tissue with diathermy

- hold coracoid with Kocher forceps

- make 2 indentations with small burr where 2 x drill holes will be

- stops drill spinning off, ensures drill holes are sufficiently far apart

- 2 x 2.5 mm drill holes, tap, countersink


Deep Approach



- identify 3 sisters inferiorly


A.  Divide muscle transversely at inferior 1/3 of SSC

- at muscle is easier to take off capsule

- also want to be inferior

- do so by inserting scissors and opening blades vertical

- use sponge to separate from capsule

- insert fang superiorly / blunt homan medially for view


B.  Take down superior half of SSC

- repair later



- feel joint line

- 2 x stay sutures 2 ethibond superiorly and inferiorly

- these must be medially over glenoid

- then divide capsule vertically with knife medial to stay sutures

- want maximum amount of capsule length to repair to anterior glenoid

- this prevents IR contracture


Dissect capsule from SSC

- inferiorly

- medially

- will have a free medial edge to repair to anterior edge glenoid

- may be easier to do this after osteotomy coracoid

- use scissors to dissect capsule superiorly

- beware inferiorly as AXN here



- remove retractorr

- insert fukuda to expose humeral head, joint, glenoid

- again use fang / blunt homan superiorly and medially for exposure


ORIF Bone Block


Bone block

- clear glenoid 3 - 6 o'clock

- need medial area to place bone

- can use burr

- place bone on glenoid using Kockers to hold

- 2 x drill bits, leave first one insitu

- bone must not overhang medially

- bicortical, tap, typically 30 - 40 mm partially threaded cancellous


Latarjet Scapular LateralLatarjet Axillary LateralLatarjet AP


Capsule repair


Remove Fucuda

- find capsue with stay sutures

- insert 2 x 3 mm absorbable anchors 3 and 5 o'clock

- pass in mattress formation through capsule

- can use Depuy Mitek Suture grasper

- pass this through capsule lateral to medial, grasp suture

- tie capsule down, ensure knot goes down past bone block to glenoid




Burkhart et al Arthroscopy 2007

- 102 procedures for patients with the inverted pear glenoid +/- engaging Hill Sachs

- 4.7% recurrence rate

- 5o loss or ER


Boileau et al Arthroscopy 2010

- arthroscopic Latarjet

- 6/47 had to be converted to open

- no recurrence of instability at 16 months

- 1 bony block fracture and  7 migrations

- potentially dangerous and difficult procedure




Failure of fixation


Non union of coracoid

- need to carefully prepare both surfaces

- good compression


Suprascapular nerve injury

- screws too long, or too superior



- bone block too medial



- too high, can dislocate under bone block

- too low, can dislocate over bone block


Failed Latarjet APFailed Latarjet Lateral