Arthroscopic Latarjet: Transition from Open to All Arthroscopic.

Background: The Latarjet technique is the gold standard for treatment of anterior shoulder instability with glenoid bone loss or hyperlaxity. Since its initial description by Latarjet in 1954, the procedure has undergone significant evolution. While existing literature describes each of the various advances and alterations in technique, there is no existing literature that describes the complete history of the Latarjet procedure.

Questions/purposes: The purpose of this study is to provide a comprehensive review of the evolution of the Latarjet procedure, while highlighting the underlying biomechanical principles of the technique.

Methods: This study was performed as a systematic review of literature aimed at characterizing the history and rationale of the open Latarjet procedure as well as its initial outcomes and its subsequent evolution of technique.

Results: Long-term studies of the open Latarjet procedure have consistently demonstrated low rates of recurrent instability, high patient satisfaction, and high rates of return to sport. Though a reliable procedure, complication rates have been reported between 7-35%. The arthroscopic Latarjet was first described in 2007 and combined the benefits of minimally invasive arthroscopic surgery with the reliability of the open procedure, though with an initial learning curve. Finally, Boileau et al described the utilization of low-profile cortical buttons for fixation in place of the traditional screws. Subsequent analysis has demonstrated no significant biomechanical differences in the two techniques with proposed benefits of improved graft union and positioning as well as decreased rates of neurologic injury.

Conclusion: The Latarjet procedure has remained a reliable technique to address anterior shoulder instability. The initial technique has undergone several iterations in an effort to improve outcomes, minimize complications, and capitalize on the benefits of minimally invasive techniques. As technology and techniques improve, we anticipate that the all-arthroscopic Latarjet will become more commonly performed to address anterior shoulder instability.