Latarjet-Patte Procedure

Area of Focus: Shoulder & Upper Extremity. In 1954, the French surgeon Michel Latarjet first described the coracoid bone block procedure. Four years later, Helfet described the Bristow procedure. Latarjet then suggested that the horizontal limb of the coracoid process be fixed with a screw flush to the anteroinferior margin of the glenoid, making an horizontal incision through the fibers of the subscapularis. Latarjet's procedure is constantly being improved, notably by Didier Patte, who suggested suturing the articular capsule to the coracoacromial ligament stump preserved on the coracoid. The term bone block used to describe the Latarjet-Patte procedure is misleading as it is essential to avoid articular overhanging of the coracoid, which may lead to arthrosis.
The success of the intervention is explained by a triple effect: the glenoplasty effect - enlargement or reconstruction of the anteroposterior glenoid surface; the hamac effect - preservation of the musculotendinous fibres of the inferior third of the subscapularis, which is maintained at the lower part of the joint by the conjoined tendon and acts as a sling reinforcing the inferior capsular ligamentous complex; and, the Bankart effect - suturing of the lateral capsular flap to the medial one centimeter of the coraco-acromial ligament which remains attached to the coracoid. A precise understanding of the surgical technique is crucial to avoiding complications related to the use of metal within the joint. With proper patient selection and systematic surgical technique, instability can be eliminated without loss of external rotation in more than 98 per cent of cases.