Table 1.

Indications, Contraindications, Risks, Tips, Pearls, Pitfalls, and Key Points

Indications

Recurrent anterior shoulder instability after previous arthroscopic or open anterior soft-tissue stabilization without significant anteroinferior glenoid bone loss (<15%)

Contraindications

Evidence of muscle patterning instability or significant glenoid bone loss

Risks

The risks are similar to those of the arthroscopic Latarjet procedure, although fewer, smaller portals are used, less soft-tissue damage is caused, and the risks of bone block nonunion or resorption and metalwork complications are avoided.

Tips

Infiltrate local anesthetic with 1:200,000 epinephrine under the coracoid to reduce bleeding.

Use percutaneous portals wherever possible to reduce turbulence.

Consider using a 70° arthroscope to visualize the glenoid neck because this can improve the field of view.

Pearls

Keep the size of the coracoid fragment small to ease passage into the socket.

Complete the soft-tissue release of the coracoid after the osteotomy using the cinch suture for traction.

Pitfalls

Risk of losing bone if osteoporotic

Risk of pushing too far through the posterior cortex and engaging the button in the infraspinatus

Risk to the suprascapular nerve if the drill is aimed too cranially

Risk to the musculocutaneous nerve if excessive traction is placed on the conjoint tendon during transfer

Key points

Preparation of the conjoint tendon and coracoid without exteriorization minimizes traction on the musculocutaneous nerve.

Suspensory and interference fixation of the graft is used.

Complete labral repair is performed with a capsular shift.

No bone blocks are used, avoiding the risk of resorption and prominent metalwork.