Editorial Commentary: Arthroscopic Bone Grafting Using Suspensory Fixation for Anterior Glenohumeral Fixation with Bone Loss May Supersede Latarjet Using Coracoid Transfer.

Abstract

The Latarjet procedure, including coracoid transfer, is indicated for anterior glenohumeral instability and significant bone loss. However, even in experienced hands, the Latarjet procedure is associated with potential complications including neurovascular injury, graft resorption leading to painful or broken hardware and secondary subscapularis damage, prominent hardware, and graft non-union. An adjustable suture button technique may minimize hardware complications, and show low rates of non-union and resorption. (Perhaps, overly rigid fixation of the coracoid using screws contributes to the resorption.) Coracoid transfer may be avoided using various graft sources including iliac crest bone grafting. Despite loss of the "sling effect" provided by coracoid and conjoined tendon transfer, the procedure shows good outcomes with low recurrent instability for indicated patients. While technically complex, bone graft and suspensory fixation may be performed arthroscopically. Time will tell if this technique may supersede the Latarjet.