What is the most common complication of the Latarjet procedure?

Most Common Complication of the Latarjet Procedure

The most common complication of the Latarjet procedure is neurologic injury, occurring in approximately 3.1-10% of cases. This includes injuries to the axillary, musculocutaneous, and suprascapular nerves 1.

Overview of Latarjet Procedure Complications

The Latarjet procedure is an effective surgical intervention for anterior glenohumeral instability, particularly in cases with significant glenoid bone loss. However, it carries a substantial complication rate of 15-30% overall 2.

Neurologic Complications

Neurologic injuries represent the most frequent complication type:

• Nerve distribution affected:

  • Axillary nerve (most common)
  • Musculocutaneous nerve
  • Suprascapular nerve
  • Radial nerve (less common)
  • Brachial plexopathy (rare)

• Recovery patterns:

  • Most neurologic injuries (approximately 85%) resolve completely within 2-6 months 3, 1
  • Some patients experience persistent sensory disturbances or residual weakness

• Risk factors for nerve injury:

  • Longer superior screws (particularly associated with suprascapular nerve injury)
  • Increased screw divergence angle 4

Other Major Complications

While neurologic injuries are most common, other significant complications include:

1. Graft/Hardware Failure (4.7%)

   • Loosened or broken screws
   • Often requires reoperation
   • Risk factors:
     • Fixation with only one screw
     • Increased screw divergence angle 4

2. Infection (1.4-6%)

   • Superficial infections (typically resolve with oral antibiotics)
   • Deep infections (require irrigation, debridement, and IV antibiotics) 1

3. Recurrent Instability (0.3-8%)

   • Can occur early (within 8 months) or late (years after surgery) 4, 3

4. Long-term Complications

   • Graft osteolysis
   • Shoulder arthritis 2

Risk Factors for Complications

Several factors increase the risk of complications:

• Advanced age - Associated with higher overall complication rates 1
• Technical factors:
  • Screw divergence angle >30°
  • Single screw fixation
  • Longer screws (>40mm for superior screw)
  • Improper graft positioning 4

Clinical Implications

When performing the Latarjet procedure:

• Careful attention to neuroanatomy is essential to minimize nerve injury risk
• Proper screw placement with appropriate length and minimal divergence reduces both neurologic and hardware complications
• Older patients should be counseled about their increased risk of complications
• Patients should be informed about the relatively high complication rate, while reassured that most complications (particularly neurologic) resolve completely

The arthroscopic Latarjet technique has been developed as an alternative to the open procedure, with similar complication rates but potentially less initial postoperative pain 5.