1

LATARJET Open Surgical technique

Steps
A. Exposure
B. Preparation of coracoid holes
C. Cutting the coracoid
D. Fixing the Double Cannula to the coracoid
E. Exposure of both sides of Subscapularis
F. Split of Subscapularis

G. Passing the Coracoid Process through the Subscapularis split

H. Positioning of the shoulder and positioning the Double Cannula
I. Fixing the coracoid process to the glenoid

1. Exposure
This is NOT a standard pectoral approach but more medial one finger breadth inferior and medial to the
coracoid, to the anterior axillary crease. This is a vertical incision. Dissect laterally to the cephalic vein
which is then protected and retracted laterally with the deltoid muscle.
The coracoid process is then exposed with the Pec Minor located medial, the CA ligament located lateral,
and the conjoint tendon presents inferiorly. The anterior lateral border of the CA ligament end of the
conjoint tendon is separated from the deltoid facia. Homan retractor is placed as far superior on the
coracoid as possible.
The arm is positioned in anterior flexion to access easily the upper border of the coracoid.
The Pec Minor is dissected free from the medial border of the conjoint tendon. This will allow the Pec Minor
inferior border to be identified. The surgeon should be aware that the musculocutaneous nerve is just
below, posterior to the pectoralis minor.
This is why the detachment of the Pec Minor must be performed along the medial border of the coracoid.
There are several strategies for manageing the CA ligament. The CA ligament may or may not be used to
attach to the anterior capsule in the open approach at the end of the transfer. Once the surgeon has
determined his preference for managing the CA ligamet and it is released, attention is then directed towards
the prepared the coracoid.

2a

2. Establishing the Coracoid Holes

2a. Introduce the Coracoid Drill Guide (#285365)
Place the Coracoid Drill Guide flush on top of the
Coracoid. The guide is parallel to the coracoid,
between the medial 1/3 and the lateral 2/3 of the
bone

2b
2b. Introduce the Coracoid K wires (#285260) thru
the and holes The lpha distal hole should be 1
cm away from the tip of the coracoid process. The
end of the K -Wire should be seen after its exit.

Instruments
Coracoid drill guide
(Cat # 285365)

Instruments
150mm K wires
(Cat #285260 )

2c. Locate the final position of the hole relative to

the axis and drill the Coracoid K. Wire through the
Coracoid Drill Guide in the position.
Image shows
150mm K wires through the
Coracoid drill guide

2d. Check position of both K- Wires and do not

hesitate to replace them if needed
2e. Remove the Coracoid Drill Guide (leave the
Coracoid K- Wires in the and holes)
2f. Drill the lpha hole, over the Coracoid K. Wire,
down to the depth stop using the Coracoid Step Drill
(#285240).

2f

Instruments
Coracoid Step Drill
(Cat# 285240)

CONTINUED

2. Establishing the Coracoid Holes

2h

2g. Remove the Coracoid Step Drill and

Coracoid K. Wire from the lpha hole and
remove the K- Wire.

2j
Instrumetnts
Coracoid Step Tap (Cat# 285245)

2h. Drill the hole over the Coracoid

K- Wire to the depth stop in the same manner.
2i. Thread the Coracoid Step Tap (#285245)
inside the lpha hole and then the hole

- Put Top Hats in Alpha and Beta holes 2k

Instruments
Top Hat Screwdriver (Cat# 285295)

2k. Screw in the Top Hats using the Top Hat

Screw Driver in the lpha hole and hole.
Instruments
Screws and Top Hats (Cat# 285110, 285115,
285120, 285125, 285130,285135,285140)

3. CUTTING THE CORACOID

Cut the Coracoid using a 90 Degree oscillating saw blade.

4. The Subscap Split

Place the coracoid medially (cover with sterile sponge) to optimize exposure for the subscap spilt.
4a. Locate the superior and inferior border of the subscap. Locate the bicipital groove which marks the lateral
border of the subscapularis. Locate and protect the axillary nerve.
4b. Find the The three Sisters (anterior humeral circumflex, and the associated two veins). This will
determine the location of the subscap split: 2/3 superior and 1/3 inferior

4c. With the curved mayo scissor, initiate the split and use a sponge to develop the plane between the
subscap and capsule.
4d. Place the curved Gelpi retractor into the subscap split.
4e. Make a 1.5 to 2cm VERTICAL capsulotomy at the level of the glenohural joint Not laterally. Introduce
the Fekuda retractor to displace posteriorly the humeral head and expose the anterior border of the glenoid.
This will decrease the ante version of the glenoid which is essential for optimal screw placement/direction
4f. Remove a trapezoidal segment of the labrum at the level of the coracoid transfer site. The trapezoidal
segment should be at least as large as the bony component of the coracoid transfer. Decorticate the bone at
the transfer site. The inferior level of the graft should be at the 5 oclock position.

5. FIXING THE DOUBLE CANNULA TO THE CORACOID

5a Insert the 2 Coracoid 3.5mm Screws in the two
sleeves of the double cannula
5b. Thread the Coracoid 3.5mm Screw over the 2 Top
Hats through the Double Cannula into the and
holes
5c. Screw the Coracoid 3.5 Screws thru the and
holes of the Coracoid until the screws end will be seen
on the distal side of the Coracoid Process.

Instruments
Coracoid 3.5mm Screws (Cat# 285255)

Instruments
Double Cannula (found in Cat#
285180, disposable kit)

5d Abrade and flatten the posterior aspect of the

coracoid transfer to match the recipient site.

6. CORACOID TRANSFER THROUGH THE SUBSCAPULARIS

Positioning of the shoulder and positioning of the double cannula
6a Fullly expose the glenoid neck. Mobilize the coracoid process
and make sure the CT (Conjoint Tendon) is fully released from the
PM (Pec Minor).
6b.Transfer the Coracoid Process through the split of the
subscapularis. Place the Coracoid Process in its desired position on
the anterior rim of the Glenoid. Verify the location is at the 5 Oclock
position. The coracoid should be flush to the glenoid surface
6c. The assistant should pull the scapula backward with the Fukuda
in order to decrease the glenoid ante-version and internally rotate
the humeral head to decrease the tension of the subscapularis
muscle.
6d. The surgeon pushes the entrance of the Double Cannula
medially to get a good axes for the screws, as parallel to glenoid
surface as possible.

Instruments
Glenoid K-Wires (found in Cat#
285180, disposable kit)

7. CORACOID GLENOID FIXATION

7a. Start from the lpha hole: Insert a long Glenoid K-Wire
(Found in Cat# 285180, disposable kit) through the
Coracoid 3.5mm Screw and drill across the glenoid.
The Glenoid K- Wire should exit the skin and be firmly
clamped on the posterior side of the shoulder.
It is essential at this stage to be at a maximum of 20
degrees angulation based on the glenoid plain.

7.a

7b. Drill the Glenoid K-Wire and check that they are
parallel
7c. Remove the Coracoid 3.5mm Screw from the lpha
hole.

7.b

7 d. Drill the Glenoid thru the lpha hole using the

Glenoid 3.2mm Drill (Cat# 285300) over the Glenoid
K- Wire and through the Coracoid Positioning
Cannula.
Once the Glenoid 3.2mm Drill has gone across the
the Glenoid, use the scale that is marked on the
Glenoid 3.2mm Drill to determine the length of the
required Screw.

7.d

Instruments
Glenoid 3.2mm Drill (Cat# 285300)

Measurement markings will be

both on the distal and proximal
ends of the drill bit

CONTINUED

7. CORACOID GLENOID FIXATION

Instruments
Bristow-Latarjet Cortical Screws (Cat# 285110,
285115, 285120, 285125, 285130,285135,285140))

7.e
7e. Thru the alpha hole, load the Latarjet
Cortical Screw over the Glenoid K- Wire and
insert into down thru the cannula.

7f. Thread the screw into the glenoid using the

2.5mm Cannulated Screwdriver (Cat# 285220).
Do not over tighten the Screw.

7.f

Instruments
2.5mm Cannulated Screw Driver (Cat# 285220)

Repeat all 6 steps for the hole

(from 7.a to 7.f) and check from different
portals good placement of the graft

7g. Remove both Glenoid K. Wires by pulling them

from the posterior part of the shoulder.

7h. Remove the Double Cannula.

7i. Tighten both Bone Screws using the Solid
Screwdriver (Cat# 285325, red handle).

Instruments
2.5mm Solid Screw Driver
(Cat# 285325)

7.i