Arthroscopic guided Latarjet

Background: Anterior shoulder instability associated with glenoid bone deficiency is frequently managed via the Latarjet procedure. Although this coracoid transfer provides stabilization through a triple-locking mechanism—comprising a static bone block, a dynamic sling effect, and capsular repair—traditional screw fixation is associated with significant complications. These include graft malposition, hardware-related morbidity such as screw pullout or breakage, and potential neurovascular injury during arthroscopic or open implementation.

Objective: This article describes a standardized arthroscopic Latarjet technique utilizing a guided approach and cortical-button fixation to improve the accuracy of graft placement and reduce complications associated with conventional metal screws.

Key Points: The technique employs specific coracoid and glenoid guides to ensure the bone block is positioned flush to the glenoid surface and below the equator. Fixation is achieved using a double cortical-button device and a sliding-locking Nice knot, which provides compression while mitigating risks of graft resorption or hardware failure. The five-step surgical protocol includes coracoid and glenoid preparation, a subscapularis split, graft transfer, and a concomitant Bankart repair. Arthroscopic visualization enhances the safety of the procedure by allowing direct inspection of neurovascular structures and facilitating the treatment of associated labral or capsular pathology. Clinical data from 76 patients demonstrated accurate graft positioning, reproducible bone union at six months, and an absence of neurological or hardware-related complications.

Conclusion: The guided arthroscopic Latarjet technique with suture-button fixation offers a reproducible alternative to traditional screw fixation. By optimizing graft orientation and eliminating rigid hardware, this method addresses technical challenges and improves safety in the management of recurrent anterior shoulder instability.