It has been reported that there is an unacceptably high recurrence rate for arthroscopic Bankart repair in the presence of an inverted-pear glenoid with or without an engaging Hill-Sachs lesion. An open modified Latarjet procedure has been recommended in such patients.
We have studied the anatomy of the coracoid and the radius of curvature of its inferior surface has been found to be identical to that of the surface of the glenoid. We have used this knowledge to modify the traditional Latarjet procedure by rotating the coracoid by 90 degrees about its axis to lie this inferior surface parallel to the surface of the glenoid. Rotation of the coracoid in this manner has been shown to optimize glenohumeral contact forces when compared with the traditional Latarjet technique.
The results of this procedure have been studied and they confirm the efficacy of this modification of the Latarjet procedure in the extremely challenging category of patients who present with such dramatic bone loss that soft-tissue reconstruction, either open or arthroscopic, is not a reasonable option.