Understanding Open Shoulder Stabilization (Bankart, Laterjet, or Graft)
If you’ve experienced repeated shoulder dislocations, especially if there’s damage to the bone of your shoulder socket, your doctor might discuss a surgical procedure called the Bristow or Latarjet procedure. These are types of open stabilization surgery designed to prevent your shoulder from dislocating again by adding bone support to your shoulder joint.
What’s Going On with Your Shoulder Instability?
Your shoulder is a ball-and-socket joint. The “socket” part, called the glenoid, is actually quite shallow, and a rim of cartilage called the labrum helps deepen it. However, with repeated dislocations, especially if they are forceful, the front edge of this shallow socket can get chipped or worn away. This is called a bone loss defect in the glenoid. When there’s not enough bone to support the “ball” (the head of your upper arm bone), the shoulder can more easily slip out of joint, even after other types of repair.
Standard soft tissue repairs (like a Bankart repair) fix the torn labrum, but if there’s significant bone loss, these repairs might not be enough to keep the shoulder stable.
How Does Bristow or Latarjet Surgery Help?
The Bristow and Latarjet procedures are similar surgeries that address shoulder instability by transferring a piece of bone to the front of your shoulder socket. This effectively rebuilds the missing bone and adds a “bony block” to prevent the shoulder from dislocating forward. Both procedures use a small piece of bone from the coracoid process, which is a hook-like bone located on your shoulder blade.
- Bristow Procedure: This typically involves cutting the very tip of the coracoid process, along with its attached muscles and ligaments, and then reattaching this bone block to the front edge of the glenoid (shoulder socket) with a single screw.
- Latarjet Procedure: This is a slightly different technique that involves transferring a larger section of the coracoid process with its muscle attachments (the conjoined tendon). This bone block is then fixed to the front of the glenoid with two screws. The attached muscles then lie in front of the joint, providing an additional “sling” effect when the arm is abducted and externally rotated (positions where the shoulder is vulnerable to dislocation).
- Graft procedure: Occasionally, the bone loss is too severe and an allograft (cadaver bone) may be required to fix the defect.
Both procedures aim to:
- Replace lost bone: They physically extend the front of the glenoid socket.
- Provide a “bony block”: The transferred bone acts as a barrier, making it harder for the humerus (arm bone) to slip forward.
- Create a “sling effect”: The muscles transferred with the bone can also provide dynamic stability.
These are “open” surgeries, meaning a single, larger incision is made to allow the surgeon direct access to the joint.
Life After Bristow or Latarjet Surgery:
After a Bristow or Latarjet procedure, physical therapy is extremely important for a successful recovery and to regain the full range of motion and strength in your shoulder. Your physical therapist will guide you through a structured rehabilitation program, which typically includes:
- Protecting the Repair: Initially, your arm will be immobilized in a sling to allow the transferred bone to heal and for the soft tissues to recover.
- Gradual Movement Restoration: As healing progresses, you’ll begin carefully controlled exercises to slowly regain the range of motion in your shoulder, being mindful of the surgical repair.
- Progressive Strengthening: Your therapist will introduce strengthening exercises for your rotator cuff, shoulder blade muscles, and arm muscles to improve overall shoulder stability and function.
- Functional Return: As you progress, your therapist will help you gradually return to your daily activities, work tasks, and sports, with careful attention to protecting the newly stabilized joint.
Recovery from a Bristow or Latarjet procedure is a significant process that requires patience and dedication, often taking several months for a full return to demanding activities, especially overhead or contact sports. Following your physical therapist’s instructions closely is crucial for achieving the best possible outcome and preventing future dislocations.