Latarjet Coracoid Transfer Procedure: Indications for Critical Glenoid Bone Loss
In short
The Latarjet procedure stabilizes shoulders with severe glenoid bone loss. Discover the triple blocking effect, surgical indications, and biomechanics.
In this guide (4 sections)
The Latarjet coracoid transfer procedure, first described by French orthopedic surgeon Dr. Michel Latarjet in 1954, is the gold standard surgical solution for recurrent anterior shoulder instability associated with substantial glenoid bone loss. When repeated traumatic dislocations fracture or erode the anterior-inferior glenoid rim, standard soft-tissue labral repairs (such as the Bankart procedure) suffer unacceptably high failure rates exceeding 50 percent. The Latarjet procedure addresses this mechanical deficiency by transferring the patient coracoid process, along with its attached conjoint tendon, onto the deficient anterior-inferior glenoid neck, fundamentally restoring skeletal architecture and dynamic joint stability.
High-Impact Kabaddi Collisions, Motorcycle Trauma, and Bone Loss in India
In India, patients requiring a Latarjet procedure frequently present with a chronic history of neglected dislocations. In contact sports like kabaddi and rugby, athletes frequently experience initial dislocations that are managed by local bone setters without diagnostic imaging. Returning to play with an unstable shoulder results in dozens of recurrent subluxations over subsequent years, each episode grinding away more glenoid bone. Similarly, victims of motorcycle crashes who sustain an initial bony Bankart fracture and resume manual labor or gym workouts without treatment develop severe glenoid rim deficiency. When these patients finally present to a specialist, bone loss frequently exceeds 20 percent, making bony reconstruction mandatory.
Critical Bone Loss Thresholds and The Triple Blocking Effect Biomechanics
The primary indication for a Latarjet procedure is anterior glenoid bone loss exceeding the critical threshold of 15 to 20 percent, or an engaging Off-Track Hill-Sachs lesion that cannot be stabilized by soft-tissue repair alone. The biomechanical genius of the Latarjet technique lies in its patented Triple Blocking Effect. First, the osseous coracoid bone block extends the anterior-posterior diameter of the glenoid articular surface by 8 to 10 millimeters, converting an inverted-pear glenoid back into a stable platform. Second, the transferred conjoint tendon (short head of biceps and coracobrachialis) creates a dynamic sling across the lower third of the subscapularis muscle, tightening as the arm elevates into abduction and external rotation. Third, the coracoacromial ligament stump is repaired to the capsule, reconstructing the anterior capsular barrier.
Surgical Precision: Osteotomy, Bicortical Fixation, and Nerve Protection
During the operation, the coracoid process is osteotomized from the scapular base, preserving the conjoint tendon attachment while releasing the pectoralis minor. The subscapularis muscle is split horizontally along the junction of its upper two-thirds and lower one-third, strictly preserving the lower subscapular nerve. The coracoid graft is prepared, contoured, and secured flush to the anterior-inferior glenoid rim utilizing two cannulated bicortical titanium screws. Precise graft placement is essential: placing the graft too lateral leads to rapid humeral head chondral erosion, whereas placing it too medial fails to restore articular track width.
Active-Assisted External Rotation in Adduction (Starting Week 4)
Objective: Gently restore external rotation within safe limits while protecting the coracoid graft and subscapularis split
- 1Sit upright in a comfortable chair with your back well-supported and a small towel roll placed under your elbow.
- 2Keep your affected elbow bent at a 90-degree angle and tucked securely against the towel roll by your side.
- 3Hold a light walking stick horizontally across your waist with both hands, palms facing each other.
- 4Use your uninjured hand to gently push the stick sideways, slowly guiding the affected forearm outward into external rotation.
- 5Stop immediately when reaching 30 degrees of external rotation or feeling mild tightness, hold for 5 seconds, and return to center.
| Stabilizing Mechanism | Anatomical Component and Surgical Technique | Biomechanical Action and Stability Contribution |
|---|---|---|
| 1. Bony Augmentation | Coracoid bone block transferred flush to anterior-inferior glenoid neck and secured with two bicortical screws | Restores glenoid surface arc and concavity; widens glenoid track by 8-10 mm, converting off-track lesions to on-track |
| 2. Dynamic Musculotendinous Sling | Conjoint tendon (short head of biceps and coracobrachialis) crossing through split lower third of subscapularis | Tightens mechanically as arm abducts and externally rotates, actively buttressing the humeral head against forward translation |
| 3. Capsular Repair / Reconstruction | Coracoacromial ligament stump attached to the graft is sutured directly to the native anterior joint capsule | Reconstructs a robust anterior-inferior capsuloligamentous barrier, sealing the joint cavity and restoring fluid pressurization |
| Subscapularis Split Preservation | Horizontal split between upper 2/3 and lower 1/3 of muscle fibers rather than complete muscle detachment/tenotomy | Preserves innervation of lower subscapularis; allows early active internal rotation rehabilitation without muscle retraction |
The musculocutaneous nerve enters the conjoint tendon approximately 3 to 8 centimeters distal to the coracoid tip. Over-zealous medical retraction of the conjoint tendon during graft positioning can cause nerve stretch neuropraxia, leading to loss of biceps sensation and elbow flexion weakness.
Frequently Asked Questions
Can the screws placed in the shoulder during a Latarjet procedure loosen or require removal?
The bicortical screws are designed to remain permanently in the bone once solid osseous union between the coracoid and glenoid is achieved (typically by 8 to 12 weeks). Screw removal is required in fewer than 5 percent of cases, usually only if a screw backs out slightly and causes mechanical friction against the subscapularis.
Do I need a doctor referral to see a shoulder instability physiotherapist on BookPhysio.in?
BookPhysio.in does not require a physician prescription. Under the National Commission for Allied and Healthcare Professions (NCAHP) Act 2021, patients across India enjoy direct access to autonomous registered physiotherapists. Through BookPhysio.in, you connect directly with verified clinicians and pay per session with transparent fees, completely free from advance package commitments, commission markups, or platform subscription charges.
Related condition guides
Related recovery guides & articles
BookPhysio.in Editorial Team
The BookPhysio.in editorial team writes and maintains this content, checking it against reliable clinical sources. Content follows our medical review policy: general information only, and no page claims a clinical review until a named registered physiotherapist has signed it off.
Read our medical review policy