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Dr. Garcia demonstrates his innovative technique for the Latarjet procedure.
Dr. Garcia specializes in complex knee, shoulder and elbow sports surgeries. He has prepared a number of surgical videos below to help patients better understand their procedures. He is frequently updating his surgical video database so check back soon for further updates.
In this video, orthopedic surgeon Dr. Grant Garcia demonstrates an innovative technique for performing the Latarjet procedure on a cadaver. His approach combines traditional European and U.S. methodologies, specifically utilizing an added compression plate along with a two-screw system to optimize bone graft healing and prevent graft failure complications.
The demonstration covers the following key stages of the procedure:
- Anatomical Landmarks and Incision: Dr. Garcia identifies and marks the essential landmarks, including the acromion, coracoacromial (CA) ligament, and coracoid process. He utilizes an axillary incision along Langer's lines for superior healing and better access to the glenoid.
- Coracoid Exposure and Harvest: He dissects down through the deltopectoral interval to expose the conjoint tendon and coracoid process. After measuring and clearing away the pectoralis minor and soft tissue while carefully avoiding the musculocutaneous nerve, he removes the coracoid graft.
- Graft and Glenoid Preparation: The harvested bone graft is prepared with a saw to create a flat, flush surface and pre-drilled. Dr. Garcia then focuses on the glenoid, performing a split of the subscapularis muscle and a reverse-T capsulotomy to visualize the joint.
- Graft Fixation with Compression Plate: Using a guide system, the coracoid graft is precisely positioned flush with the glenoid surface. The unique aspect of the technique is highlighted as Dr. Garcia applies a specialized plate over the two fixation screws. This plate acts as an extended washer to provide secure, sequential compression across the entire graft interface.
- Capsular and Subscapularis Repair: To conclude the procedure, the capsule is stitched to the CA ligament using high-strength suture tape to make the graft intra-articular. Finally, the split in the subscapularis muscle is closed with interrupted sutures at its lateral margin.
Dr. Garcia notes that this specialized plate and fixation system can also be effectively utilized for alternative shoulder reconstruction procedures, such as distal tibia allografting or iliac crest bone grafting.
