What Is the Latarjet Procedure for the Shoulder?

The Latarjet procedure is a specialized type of shoulder surgery that helps prevent recurrent shoulder dislocations. During the procedure, the surgeon repositions a small section of bone known as the coracoid process to the front of the shoulder. This extra bone support improves shoulder stability, especially in patients with significant bone loss.

At Total Orthopedics and Sports Medicine, our fellowship-trained surgeon, Dr. Charles Ruotolo, performs the Latarjet procedure using advanced imaging. During surgery, he protects the surrounding shoulder muscles, ligaments, and attached tendons to support healing. Our team also guides you through a structured recovery plan with regular follow-up care to lower the risk of re-dislocation. Call 855-321-6784 to book an appointment.

How Does the Latarjet Procedure Work for Shoulder Instability?

The Latarjet procedure reconstructs the anterior glenoid socket to improve shoulder stability. During this surgical procedure, the surgeon uses arthroscopic techniques to make a small incision at the front of the shoulder. Then, they remove the detached or transferred coracoid process (small hook-like process) with its attached tendon from the shoulder blade. After that, the surgeon places this piece of bone at the front of the shoulder joint to support the glenoid cavity.

In addition, the attached tendon provides the following “triple block” effect that helps prevent repeated shoulder dislocation:

• Dynamic Sling Effect: The conjoined tendon tightens during arm movement and helps hold the long arm bone securely within the socket.
• Capsular Repair Effect: The repaired capsule and cartilaginous rim strengthen the front of the shoulder joint and lower the risk of recurrent instability.
• Bone Block Effect: The coracoid graft restores missing bone at the front of the glenoid cavity and provides additional stability.

In fact, a study published in the Journal of Shoulder and Elbow Surgery followed 118 patients after Bristow-Latarjet repair for more than 15 years. The study reported a 98% patient satisfaction rate only 2 years after surgery. At the 15-year follow-up, 76% of patients were satisfied with their surgical results. Researchers also found that only one patient required revision surgery because of recurrent instability.

Similarly, another long-term ScienceDirect study reviewed 68 Latarjet procedures nearly 20 years after surgery. Researchers found that the average Rowe shoulder score improved from 37.9 before surgery to 89.6 after recovery. The study also reported a low recurrent instability rate of only 5.9% after surgery.

What Causes Chronic Shoulder Instability in Active Adults?

Previous shoulder dislocation and repeated overhead activities, such as swimming or weightlifting, can lead to chronic shoulder instability. In some cases, natural joint hypermobility and structural issues can lead to frequent dislocations. Long-term shoulder conditions, such as labral tears and a Bankart lesion (tear in the cartilage around the socket), can also reduce shoulder joint support. In fact, an NIH research found that 87% to 100% cases of shoulder dislocations are associated with a Bankart lesion.

In addition, the following conditions can weaken shoulder stability and increase the risk of repeated dislocations:

Hill-Sachs Lesions

A Hill-Sachs lesion develops when the shoulder bone hits the edge of the glenoid (shoulder socket). This impact creates a small dent in the top of the humerus (upper arm bone). As a result, the shoulder may shift out of place more easily during movement. This structural damage often causes recurrent instability during fast or forceful arm movements.

Weak or Imbalanced Rotator Cuff

According to the Journal of Clinical Orthopedics and Trauma, the rotator cuff muscles help maintain shoulder stability and proper glenohumeral joint function during arm motion. Weakness in these shoulder muscles can reduce joint control and stability. Muscle imbalance may also place extra stress on the shoulder joint.

Improper Workout Techniques

Poor training habits and improper exercise form can place extra pressure on the shoulder joint. For example, heavy lifting with incorrect posture may strain the ligaments and shoulder muscles. Similarly, overtraining the chest muscles can lead to poor muscle balance and uneven shoulder support. This imbalance can affect shoulder alignment, joint positioning, muscle coordination, and shoulder stability.

Incomplete Healing of Prior Injuries

If you return to sports too early after a shoulder injury, the supporting tissues may not heal properly. As a result, the shoulder joint may lose strength and coordination during heavy lifting or intense activity. Over time, continuous stress on the injured tissues may lead to recurrent instability and chronic shoulder disorder.

Which Sports Increase the Risk of Shoulder Dislocations?

Football, rugby, and skiing carry a high risk of shoulder dislocation due to strong collisions, hard falls, or sudden force on the shoulder joint. Wrestling, gymnastics, and rock climbing also place heavy stress on the shoulder capsule during intense movement. Beyond these sports, recurrent instability may also increase from repetitive overhead movements and high-impact activities such as:

• Basketball: Reaching overhead, blocking shots, or falling on the shoulder
• Volleyball: Repeated spiking and serving movements
• Tennis: Forceful overhead swings and fast arm rotation
• Baseball: Repetitive pitching that places extreme stress on the shoulder joint

Moreover, research from the National Electronic Injury Surveillance System reported more than 89,000 sports-related shoulder dislocations in the United States. Basketball players accounted for 24.1% of these injuries, while football players accounted for 21%. The study also found a 7.1% rate of recurrent dislocation among both soccer and baseball players. Other than that, weightlifting contributed to another 3.3% of reported shoulder dislocation cases.

Who Is the Best Candidate for a Latarjet Surgery?

Our experienced surgeon, Dr. Charles Ruotolo, recommends Latarjet surgery for young athletes and active patients with recurrent dislocations and significant bone loss. He may also advise surgery if previous soft-tissue shoulder stabilization fails to provide shoulder stability. In some cases, patients with hypermobile joints who continue to suffer from recurrent shoulder instability may benefit from this procedure. However, our shoulder surgeon, Dr. Charles Ruotolo, does not recommend Latarjet surgery in the following conditions:

Voluntary Shoulder Dislocation

Voluntary shoulder dislocation usually occurs without severe damage to the glenoid bone or shoulder ligaments. In such cases, Latarjet surgery may not address the underlying cause of repeated shoulder slipping. Instead, it leads to chronic stiffness, limited range of motion, nerve injury, or damage to the humerus (the upper arm bone).

Uncontrolled Epilepsy

After Latarjet surgery, repeated seizures may cause muscle spasms around the shoulder joint. These sudden movements can damage the bone graft or bend the fixation screws used during surgery. It can also lead to post-surgical complications such as bone fracture, screw failure, recurrent instability, or repeated shoulder dislocation. In fact, PubMed research found that the postoperative re-dislocation rate after Latarjet surgery was 45% in epilepsy patients, compared to 14% in non-epilepsy patients.

Generalized Hyperlaxity

Generalized hyperlaxity results in extremely loose connective tissue throughout the body. For example, conditions such as Ehlers-Danlos syndrome can lead to recurrent instability of the shoulder joint. Similarly, Marfan syndrome can weaken joint support and increase the risk of recurrent dislocation during movement. This excessive joint laxity can reduce the long-term success of shoulder stabilization procedures.

Irreparable Rotator Cuff Tears

Our surgeon, Dr. Charles Ruotolo, may not recommend a Latarjet procedure if the rotator cuff tendons are severely damaged and cannot be repaired. In these cases, the shoulder may lose proper muscle coordination and stable movement during daily activity. As a result, the procedure may not restore proper shoulder strength, arm elevation, or smooth shoulder movement. In such cases, we may recommend the following treatments to treat shoulder instability:

• Tendon transfer surgery: Uses nearby tendons to improve shoulder movement and lifting strength
• Reverse shoulder replacement: Replaces the damaged joint to restore arm support and movement control

When Is a Latarjet Recommended Instead of a Bankart Repair?

Doctors advise the Latarjet procedure instead of a Bankart repair if you have significant glenoid bone loss (usually over 20%). Doctors may also recommend this procedure for athletes after a failed Bankart repair or repeated shoulder dislocation. In these cases, Latarjet surgery can provide stability and reduce the risk of anterior dislocation. However, surgeons determine the appropriate treatment approach based on the following factors:

• History of failed Bankart repair
• Participation in contact sports
• Frequency and severity of recurrent instability
• Condition of the shoulder ligaments and labrum
• Age and activity level of the patient

How Do Orthopedic Surgeons Assess Bone Loss Before Surgery?

Before Latarjet surgery, our surgeon, Dr. Charles Ruotolo, uses a 3D CT scan to evaluate the glenoid surface, glenoid rim, and bone defects. If needed, he may order MRI scans to detect a torn labrum, rotator cuff damage, and other soft-tissue injuries affecting shoulder stability.

During assessment, he carefully reviews prior shoulder dislocations, activity level, contact-sports history, and symptoms causing instability in the ball-and-socket joint. He also performs a detailed physical exam, such as apprehension and relocation tests, to identify posterior or anterior shoulder instability.

Moreover, our shoulder specialist, Dr. Charles Ruotolo, may use the following advanced measurement techniques to determine the exact amount of glenoid bone loss:

PICO and Surface Area Methods

According to a Europe PMC study, the PICO method helps quantify bone defects as a percentage of bone area and as square millimeters of damage. These methods calculate the amount of missing bone along the glenoid surface and glenoid rim. This detailed measurement helps select the most appropriate shoulder reconstruction or coracoid graft procedure.

Glenoid Height-to-Width Ratio

In this method, doctors compare the normal glenoid height with the damaged glenoid width. Since the glenoid height is usually preserved, they use it to estimate the original socket size. Then, they compare the healthy measurement with the damaged glenoid surface. This process helps identify significant bone loss, which can lead to instability and further dislocations.

Hill-Sachs Interval and Glenoid Track

NIH research reports that Hill-Sachs lesions occur in more than 67% of anterior shoulder dislocations. In these cases, surgeons use the Hill-Sachs interval and glenoid track assessment to examine bone damage in the humerus (upper arm bone) and glenoid. This assessment also helps identify bone defects that may lock during shoulder movement. Based on these measurements, doctors classify shoulder instability into the following types:

• On-Track (HSI ≤ GT): Lower risk of recurrent instability
• Off-Track (HSI > GT): Higher risk of recurrent dislocation

Best-Fit Circle Method (Sugaya)

To measure the amount of glenoid bone loss, surgeons place a circular outline over the healthy lower part of the glenoid surface on a 3D CT scan. Then, they compare the missing bone width with the circle’s full diameter to calculate the percentage of bone loss. They may also measure the surface area of the damaged glenoid rim to evaluate irregular bone defects.

How Long Does the Latarjet Shoulder Procedure Take?

The Latarjet shoulder procedure usually takes 60 to 90 minutes. However, surgery time may increase depending on the severity of damage or the presence of scar tissue from previous shoulder surgery. For example, arthroscopic Latarjet procedures may take longer due to their surgical complexity and extensive joint repair. In contrast, standard outpatient shoulder stabilization procedures may take less time if the joint damage is less severe. Beyond this, surgical preparation and general anesthesia can also increase the total time spent in the operating room.

What Is Recovery Like After Latarjet Shoulder Surgery?

Recovery after Latarjet shoulder surgery usually takes about 4 to 6 months and follows structured healing phases. During the first 4 to 6 weeks, you will wear a sling to protect the healing coracoid graft and support shoulder stability. Once imaging scans show stable healing, you can begin motion exercises and gradual strengthening. In most cases, patients regain full shoulder strength and return to sports activities around six months post-surgery.

Here is the structured recovery timeline after Latarjet shoulder surgery:

Immobilization & Protection

During the first few weeks, you must apply ice packs and wear a sling during daily activities. This helps protect the coracoid graft and promote healing around the shoulder joint. During this phase, you should avoid heavy lifting, overhead reaching, and active shoulder movement. However, you can perform neutral rotation and gentle hand, wrist, and elbow motion exercises to ensure a smooth recovery. In most cases, patients with desk jobs can return to work within one to two weeks while wearing the sling.

Restoring Shoulder Motion

Around weeks 6 to 12, you may gradually stop using the sling as healing improves. At this stage, you can perform active range-of-motion exercises such as arm raises, gentle shoulder rotation, and controlled stretching movements. These exercises help improve shoulder flexibility without placing excess stress on the graft. You may also begin light daily activities and light weight training during this phase to improve muscle coordination and shoulder control.

Strength and Conditioning

Doctors may order imaging scans 3 to 5 months after surgery to examine bone graft healing. Once healing progresses, you can perform strengthening exercises for the shoulder muscles and surrounding tendons. You can also perform the following resistance exercises to improve arm control and shoulder function during movement:

• Resistance band exercises for controlled shoulder movement
• Light dumbbell lifting for shoulder muscle strengthening
• Internal and external shoulder rotation exercises
• Wall push-up exercises for shoulder stability
• Scapular strengthening exercises for shoulder blade control
• Elastic band rows for upper back support
• Controlled arm raises for movement coordination
• Light resistance training for gradual strength recovery

Return to Sports

Around six months post-surgery, many patients return to contact sports and unrestricted physical activity. You can also begin heavy lifting and demanding shoulder movements after full graft healing. However, recovery time may vary depending on surgical complexity and overall healing progress. For this reason, surgeons may recommend regular follow-up visits to monitor long-term shoulder stability, shoulder strength, and joint function.

Can Latarjet Surgery Be Revised If It Fails?

Yes, Latarjet shoulder surgery can be revised if the initial procedure fails to restore long-term shoulder stability. For example, if the shoulder ligaments or soft tissues stretch again, doctors may recommend revision shoulder reconstruction. They may also recommend revision surgery if a new traumatic shoulder injury damages the previous surgical repair and causes further dislocations. However, before planning revision surgery, surgeons carefully examine the exact cause of failure. Then, they may use bone grafting or soft-tissue repair procedures to restore shoulder stability and reduce pain.

Book an Appointment with Dr. Charles Ruotolo for Latarjet Surgery in NYC!

Shoulder instability can lead to sudden dislocations during daily activities or sports. In such cases, even simple arm movements or overhead activities may trigger pain, weakness, or loss of shoulder control. Without treatment, repeated instability can lead to further joint damage and long-term discomfort.

At Total Orthopedics and Sports Medicine, our experienced surgeon, Dr. Charles Ruotolo, performs advanced Latarjet surgery for recurrent instability and failed stabilization procedures. He also provides structured recovery planning, sling guidance, and step-by-step exercise programs to improve healing. Moreover, we accept a wide range of insurance plans to ensure affordable treatment. Call 855-321-6784 or visit our clinic in East Meadow for personalized treatment.

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