Chronic Shoulder Dislocations

What is meant by Chronic Shoulder Dislocations?

For those patients who have had a long standing history of chronic shoulder dislocations, they tend to have Glenoid Bone Loss (GBL). This occurs from chronic anterior shoulder dislocations that have been sustained numbers times. Each time the shoulder comes out of the socket it is rubbing over the leading edge of the socket and wearing it down. Eventually this causes chronic instability and excessive shoulder dislocations from very simple tasks like reaching for something out and away from the body. Typically, these patients have also attempted previous labral repair surgeries. Labral repair surgeries are performed to help restore the native function of the labrum or “bumber” of the shoulder. If someone continues to have shoulder dislocations following a repair and the tissue becomes unrepairable they should consider a Latarjet procedure. Those patients who have been living with shoulder dislocations and have developed “GBL” should also consider this procedure.

Latarjet Procedure

The Latarjet procedure is becoming a preferred method of treatment for anterior shoulder instability. I typically perform this surgery as an open procedure versus an arthroscopic technique. Performing this procedure open gives me the best visualization and the most accuracy and in the grand skim of healing, a larger incision versus several arthroscopic incisions doesn’t exactly translate to a slower healing time. The surgery is performed by using your own bone instead of donor bone. We use part of the coracoid (a bone process in the shoulder) to create a larger surface area of the socket.

Patients receiving this treatment typically have significant bone deficiency from the front of the glenoid (socket) region, 20% or more. The most common causes of the deficiency are due to congenital deformity, trauma, or recurrent dislocation. There are three main effects that create stability through this procedure but one is the most important that you should know. The coracoid transfer restores the glenoid surface by essentially deepening the socket or making it wider and providing more surface area so the ball doesn’t slide off the front. The other two main effects are all soft tissue reconstructions that will be performed on our way out from performing the coracoid transfer. This procedure is successful approximately 80-95% of the time in eliminating recurrent dislocations.