The title of this topic is often written as “Laterjet,” but the correct medical term is Latarjet procedure. In my practice, I often see patients with repeated shoulder dislocation who have already tried rest, medicines, or basic exercise, yet the shoulder still feels unstable. For some of these patients, especially when there is repeated anterior shoulder dislocation with bone loss or failure of previous soft-tissue stabilization, the Latarjet procedure may be an important surgical option. [1][2]
One important point I want Bangladeshi patients to understand is that not every dislocated shoulder needs this operation. Many first-time shoulder dislocations can be treated without surgery, depending on age, activity level, associated damage, and recurrence risk. However, when the shoulder keeps slipping out, feels unreliable, or has structural damage, the treatment plan changes. [1][3]
In Dhaka and across Bangladesh, delayed treatment is common because people try to “manage around” the instability. They may stop lifting overhead, avoid sports, sleep carefully on one side, or depend on family help during pain flares. But repeated dislocations can damage the labrum, capsule, and bone, making the shoulder harder to stabilize later. [1][2]
What Is the Latarjet Procedure?
The Latarjet procedure is a shoulder stabilization surgery used mainly for recurrent anterior shoulder instability. In simple terms, it helps make the front of the shoulder socket more stable by transferring a small piece of bone from the coracoid process to the front edge of the glenoid. This adds bone support and also creates a dynamic stabilizing effect from the attached muscles. [2][4]
I usually explain to my patients that this is not a routine surgery for every shoulder problem. It is most often considered when:
– the shoulder has dislocated repeatedly
– there is bone loss from the front of the glenoid
– there is a failed previous Bankart repair or similar surgery
– the patient has high-risk instability patterns
– the patient is young and active with frequent recurrence
The goal is to reduce the chance of the shoulder slipping out again and to restore more confident, functional use of the arm.
Why Shoulder Dislocation Becomes Recurrent
The shoulder is the most mobile major joint in the body, but that also makes it more vulnerable to instability. The humeral head sits in a relatively shallow socket, and stability depends on soft tissues such as the labrum, capsule, ligaments, and surrounding muscles. [1]
First Dislocation Can Damage Important Structures
A first traumatic dislocation can injure:
– the labrum, such as a Bankart lesion
– the joint capsule and ligaments
– the glenoid edge
– the humeral head, such as a Hill-Sachs lesion
If the damage is significant, the shoulder may become unstable again and again. [1][3]
Why Repeated Dislocation Matters
Every repeat dislocation is not just painful. It can also add more damage to the stabilizing structures. In young active patients, athletes, and people doing physical work, the risk of recurrence may be high. That is why recurrent instability should not be treated as a minor inconvenience.
When the Latarjet Procedure May Be Recommended
Not every unstable shoulder needs a Latarjet procedure. Careful evaluation is essential.
Common Situations Where It Is Considered
I think more seriously about this operation when:
– the shoulder dislocates repeatedly after a previous injury
– imaging shows significant bone loss at the front of the socket
– there is an engaging Hill-Sachs lesion with instability risk
– a previous arthroscopic stabilization has failed
– the patient has persistent apprehension and instability during daily activities or sports
Why Bone Loss Changes the Plan
In some patients, a soft-tissue repair alone may not be enough because the socket itself has lost supportive bone. In that situation, the Latarjet procedure can be more reliable because it reconstructs stability with both bone and soft-tissue effect. [2][4]
Symptoms That May Suggest Significant Shoulder Instability
Patients do not always describe the problem as “dislocation.” Some say:
– “My shoulder slips”
– “I feel it is about to come out”
– “I cannot trust this arm overhead”
– “I avoid fast movement because it feels loose”
Other common symptoms include:
– repeated dislocation episodes
– shoulder pain after instability events
– fear during overhead activity
– difficulty with sports, lifting, or throwing
– weakness after repeated injury
– disturbed sleep because of certain shoulder positions
In Bangladesh, I also see people limit prayer posture, travel bags, bus or rickshaw positioning, and household lifting because of this instability.
How I Evaluate a Patient Before Recommending Surgery
When I evaluate patients with repeated shoulder dislocation, I look at the full clinical picture, not just the last event.
Clinical History
I ask:
– how the first dislocation happened
– how many times the shoulder has dislocated
– whether it relocates spontaneously or needs assistance
– whether there is pain between episodes
– whether the patient plays sports or does manual work
– whether there was previous surgery
– whether the patient has numbness or weakness after dislocation
Physical Examination
The physical examination helps identify instability pattern, range of motion, muscle control, and associated pain. I also evaluate the neck and surrounding structures because shoulder symptoms are not always isolated.
Imaging
Imaging is very important in recurrent instability. X-rays may show dislocation-related changes, but CT or MRI may be needed to assess bone loss, labral injury, and other associated problems. These findings are often what help decide whether a Bankart-type repair is enough or whether a Latarjet procedure is more appropriate. [1][2]
What Happens During the Latarjet Procedure?
The operation involves transferring the coracoid bone with its attached tendon to the front of the shoulder socket. This improves stability in more than one way:
– it increases the bony support at the front of the glenoid
– it reinforces the front of the joint
– it adds a sling effect that helps resist forward dislocation when the arm is raised and rotated
