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Steps

A. Exposu re

B. Preparation of coracoid holes

C. Cutt ing the cor acoid

D. Fix ing the Double Cannu la to the coracoid

E. Exposu re of both s ides of Subscapular is

F. Spli t of Subs capu lar is

G. Pass ing the Coracoid Process through the Subscapular is sp l i t

H. Posi t ioning o f the shoulder and posi t ioning the Double Cannula

I. Fix ing the coracoid pro cess to the glenoid

LATARJET Open Surgical technique

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1. Exposu reThis is NOT a standard p ectoral approach but m ore medial one f inger breadth infer ior and m edial to the

co racoid, to the anter ior axi l lary crease. This is a vert ical incis ion. Dissect lateral ly to the ceph al ic vein

which is then p rotected and ret racted lateral ly wi th the del to id mu scle.

The coracoid process is then exposed w i th the Pec Minor located medial, the CA l igament located lateral ,

and the co njoint tendon presents infer ior ly . The anter ior lateral border of the CA l igament end of the

con joint tendon is separated f rom the del to id facia. Homan ret ractor is p laced as far sup er ior on the

coraco id as poss ib le.

The arm is po si t ioned in anter ior f lex ion to access easi ly the upp er border of the c oracoid.The Pec Minor is dissected f ree f rom the medial border of the conjoint tendo n. This wi l l al low the Pec Mino

nfer ior border to be ident i fied. The surgeon shou ld be aware that the muscu locutaneous nerve is just

below, poster ior to the pectoral is mino r .

This is why th e detachment of the Pec Minor mu st be per formed along the medial border of the coracoid.

There are several st rategies for m anageing the CA l igament . The CA l igament m ay or m ay not be used to

at tach to the anterior capsule in the op en approach at the end of th e t ransfer . Once the surg eon has

determined his p reference for m anaging the CA l igamet and i t is released, at tent ion is then di rected to ward

he prepared the co racoid.

2a. Introdu ce the Coracoid Dri l l Guide (#285365)

Place the Coracoid Dr i ll Guide f lush o n top of the

Coracoid. The guide is paralle l to the coracoid,

betw een the medial 1/3 and th e lateral 2/3 of th e

bone

2b. Int rodu ce the Coracoid K wires (#285260) thru

the and holes The lpha dista l hole should b e 1

cm away from the t ip of th e coracoid proc ess. The

end o f the K -Wire shou ld be seen after i ts exi t .

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.

2d. Check pos i t ion of both K- Wi res and do not

hesi tate to replace them if n eeded

2e. Remov e the Coracoid Dri l l Guide (leave the

Co raco id K -Wires in the and holes)

2f. Dri l l the lpha ho le, over th e Coracoid K . Wire,

dow n to the depth stop using the Coracoid Step Dr il l

(#285240).

Establ ishing the Coracoid Holes

Inst ruments

Coracoid dr i l l guide

(Cat # 285365)

Inst ruments

Coracoid Step Dri l l

(Cat# 285240)

2a

2b

2f

Inst ruments

150mm K w ires(Cat #285260 )

Image shows

150mm K wires through th

Coracoid dr i l l guide

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2g. Remove the Coracoid Step Dr i l l and

Coraco id K. Wire f rom the lpha hole and

remove the K- Wire.

2h. Dri l l the hole over the Coracoid

K- Wire to the depth stop in the same manner .

2 i . Thread the Coracoid Step Tap (#285245)inside the lpha hole and then the hole

Cut the Coracoid using a 90 Degree osc i l lat ing s aw blade.

CONTINUED 2. Establis hin g the Coraco id Holes

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

Screw Driver in the lpha hole and hole.

Put Top Hats in Alpha and Beta holes -

Inst rumetnts

Coracoid Step Tap (Cat# 285245)

2j

Inst ruments

Top Hat Screwdriver (Cat# 28529

2k

2h

Instruments

Screws and Top Hats (Cat# 285110, 285115,

285120, 285125, 285130,285135,285140)

CUTTING THE CORACOID

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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 later

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. Introduc

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 a

the transfer site. The inferior level of the graft should be at the 5 oclock position.

4. The Subscap Spli t

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5a Inser t the 2 Coracoid 3.5mm Screws in the two

sleeves of th e doub le cannu la

5b. Thread the Coracoid 3.5mm Screw o ver the 2 Top

Hats throu gh the Double Cannulainto the and

holes

5c. Screw the Coracoid 3.5 Screws thru the and

holes of the Coracoid unt i l the screws end w i l l be seen

on the d istal side of the Coracoid Process.

5d Abrade and f lat ten the poster ior aspect of the

coracoid transfer to match the recipient si te.

5. FIXING THE DOUBLE CANNULA TO THE CORACOID

Instruments

Coracoid 3.5mm Screws (Cat# 285255

InstrumentsDouble Cannula (found in Cat#

285180, dispo sable k it)

6a Ful l ly expose the glenoid neck. Mobi l ize the coracoid process

and make su re the CT (Con joint Tendon) is ful ly released from th e

PM (Pec Minor).

6b.Transfer the Coracoid Process throug h the spl i t of the

subs capular is. Place the Coracoid Process in i ts desired posi t ion on

the anter ior r im of th e Glenoid. Verify the location is at the 5 Oclock

pos i t ion. The coracoid should be f lush to the glenoid sur face

6c. The assistant shou ld pul l the scapula backward with the Fukudain order to decrease the glenoid ante-vers ion and internal ly rotate

the hum eral head to decrease the tension o f the su bscapular is

muscle.

6d. The surgeon push es the entrance of the Double Cannula

medial ly to g et a good axes for the screws, as paral lel to glenoid

surface as poss ible.

6. CORACOID TRANSFER THROUGH THE SUBSCAPULARISPosi t ion ing of the shoulder and posi t ion ing of the double cannula

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7. CORACOID GLENOID FIXATION InstrumentsGlenoid K -Wires (found in Cat#

285180, dispo sable k it)

7a. Start from the lpha hole: Inser t a long Glenoid K-Wire

(Foun d in Cat# 285180, dispo sable kit) through the

Coracoid 3.5mm Screw and d r i l l across the glenoid.

The Glenoid K- Wire should ex i t the sk in and be f irmly

clamped on the p oster ior side of the shou lder .

It is essential at this stage to be at a maximum o f 20

degrees angulat ion based on the glenoid pla in .

7b. Dril l the Glenoid K-Wire and check that they are

parallel

7c. Remov e the Coraco id 3.5mm Screw from the lpha

hole.

7.a

7.b

Instruments

Glenoid 3.2mm Dri l l (Cat# 285300)

Measurement m arkings wi l l be

both on the distal and proxim al

ends of the d r i l l bi t

7 d. Dr i ll the Glenoid thru the lpha hole using the

Glenoid 3.2mm Dri l l (Cat# 285300) over the Glenoid

K- Wire and through the Coracoid Pos i tion ing

Cannula.

Once the Glenoid 3.2mm Dri ll has gone across the

the Glenoid, use the scale that is marked on the

Glenoid 3.2mm Dri ll to determine the length o f the

required Screw. 7.d

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7e. Thru th e alpha hole, load the Latar jet

Cor tical Screw over the Glenoid K- Wire and

insert into d own thru the cannu la.

Inst ruments

2.5mm So l id Screw Driver

(Cat# 285325)

7.e

7.f

7.i

CONTINUED 7. CORACOID GLENOID FIXATION

Instruments

Brist ow -Latarjet Cortical Screws (Cat# 285110,

285115, 285120, 285125, 285130,285135,285140))

7g. Remove both Glenoid K. Wires by pu l l ing them

from the po ster ior part of the shou lder .

7h. Remov e the Doub le Cannu la.

7i . Tighten both B one Screws us ing the Sol id

Screwdriver (Cat# 285325, red handle).

Repeat all 6 steps for the hole(from 7.a to 7.f) and c heck from d ifferent

portals good placement of the graft

7f. Thread the screw into the glenoid using the

2.5mm Cannulated Screwdr iver (Cat# 285220).

Do no t over t ighten th e Screw.

Instruments

2.5mm Cann ulated Screw Driver (Cat# 285220)

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