The Latarjet procedure is a coracoid-transfer operation for recurrent anterior glenohumeral instability, particularly when there is glenoid bone loss or an engaging Hill-Sachs lesion. The tip of the coracoid process (with the attached conjoint tendon) is osteotomised and transferred to the deficient anteroinferior glenoid, where it is fixed with screws. It was described by Michel Latarjet of Lyon in 1954. The related Bristow procedure transfers a smaller coracoid tip; the family is often called Bristow-Latarjet.

Indications - choosing Latarjet over arthroscopic Bankart. The central decision in anterior instability is soft-tissue (Bankart) repair versus a bony (Latarjet) procedure; bone loss, high demand and a high recurrence-risk profile push toward Latarjet:

• Glenoid bone loss. Historically a "critical" threshold of about 20-25% (the inverted-pear glenoid) defined when arthroscopic Bankart fails; more recent work lowers this to a "subcritical" ~13-15%.
• Glenoid track / engaging Hill-Sachs. A Hill-Sachs lesion whose medial margin lies outside the glenoid track is off-track and will engage the rim. An off-track or bipolar lesion is a strong indication.
• ISIS greater than 6. The Instability Severity Index Score predicts recurrence after arthroscopic repair; a score over 6 favours a bony procedure.
• Other factors: collision/contact athletes, failed prior soft-tissue stabilisation, a fragmented bony Bankart, and hyperlaxity.

The coracoid and conjoint tendon:

• The coracoid process projects from the anterior scapular neck. Its tip gives origin to the conjoint tendon (short head of biceps and coracobrachialis), with pectoralis minor attaching medially and the coraco-acromial (CA) ligament laterally.
• Its undersurface provides a curved bony surface that can be apposed to the decorticated glenoid neck (the basis of the congruent-arc modification).

How the Latarjet stabilises the shoulder - the triple effect of Patte:

The Latarjet is performed through the deltopectoral approach:

• Interval: between deltoid (axillary nerve) laterally and pectoralis major (medial and lateral pectoral nerves) medially. The cephalic vein marks the interval and is usually retracted laterally with the deltoid.
• Internervous plane: the approach exploits the plane between the axillary nerve (deltoid) and the pectoral nerves (pectoralis major), so no single nerve supplies muscles on both sides of the interval.
• Deeper: the conjoint tendon is retracted medially to expose subscapularis, behind which lies the capsule and glenoid. The musculocutaneous nerve (entering the conjoint muscles a few centimetres distal to the coracoid) and the axillary nerve (along the inferior subscapularis and through the quadrilateral space) are the structures most at risk; the brachial plexus and axillary vessels lie medial to the conjoint tendon and are protected by retracting it laterally rather than medially.

• Position: beach-chair (semi-sitting) with the head secured and the arm free-draped to allow rotation; some surgeons use a lateral arm holder.
• Anaesthesia: general anaesthesia, frequently combined with an interscalene block for analgesia (counsel the patient about transient nerve effects of the block).
• Setup: the operated shoulder is positioned off the edge of the table to allow extension; image intensifier available if screw position confirmation is desired. Antibiotic prophylaxis is given, recognising that Cutibacterium acnes is the classic indolent shoulder organism.

According to PubMed, a systematic review of Bristow-Latarjet procedures reported an overall complication rate of about 30%, although recurrent dislocation (about 3%) and unplanned reoperation (about 7%) were low [Griesser 2013].

• Neurological injury - the musculocutaneous and axillary nerves are most at risk; most deficits are transient but they are the headline complication.
• Graft problems - malposition (lateral causes arthritis, medial causes recurrence), nonunion / fibrous union, resorption / osteolysis, graft fracture.
• Hardware problems - screw breakage, prominence or irritation, sometimes requiring removal.
• Recurrent instability - uncommon, usually graft malposition or a missed humeral lesion.
• Glenohumeral arthropathy - dislocation arthropathy develops over time even in successful repairs.
• Loss of external rotation - partly intended (the sling) but excessive loss is a problem.
• Infection (consider indolent Cutibacterium acnes) and stiffness.

No single guideline dictates Bankart versus Latarjet - selection follows the bone-loss and recurrence-risk principles above (glenoid bone loss, the glenoid track, and the ISIS). International consensus statements (for example from ISAKOS and shoulder-society instability working groups) have moved toward earlier use of a bony procedure when there is subcritical glenoid bone loss or an off-track Hill-Sachs, rather than waiting for the historical 20-25% threshold.

Registry and large-series evidence:

• National shoulder-instability registries and large comparative series consistently report a lower rate of recurrent instability and revision-for-instability after Latarjet than after isolated arthroscopic Bankart repair, particularly in young contact athletes and with bone loss.
• This is balanced against a higher overall complication burden (the ~30% figure from systematic review) - so the trade-off, not a blanket preference, should be discussed with each patient.

Global practice variation:

• The Latarjet originated in France (Lyon) and has long been favoured in much of Europe; North American practice was historically weighted toward arthroscopic soft-tissue repair. Practice has converged with the bone-loss and glenoid-track paradigm.
• For very large defects or a failed Latarjet, free bone-block reconstruction (iliac-crest Eden-Hybinette or distal tibial allograft) is used where available; graft availability influences the choice between these in different settings.