This review addresses how to evaluate and treat the shoulder after a Latarjet procedure has failed. It defines failure as recurrent instability and walks through identifying the cause. It then surveys nonoperative, soft-tissue, autograft, allograft, and salvage options.
The decision tree after a failed Latarjet starts with one question: is there major bone loss? If bone stock is preserved and the problem is a hyperlax capsule or missed multidirectional instability, soft-tissue revision (Bankart or capsular plication) is reasonable and can achieve no recurrence in well-selected patients with defects under 25% and an on-track Hill-Sachs.
If major osseous deficiency exists, you need a bone block: iliac crest autograft fills large defects but risks up to 50% arthritis, while distal tibial allograft restores the articular arc with congruent curvature and strong early stability.
Remember that revision recurs at up to 18% versus 0% to 14% for a primary Latarjet, so meticulous workup with 3D CT to define the defect, check block and screw position, and detect hyperlaxity is essential. Also anticipate altered neuroanatomy: after a Latarjet the axillary nerve sits more medial and the musculocutaneous nerve more inferior and medial, so retractors go in under direct vision.
This review addresses how to evaluate and treat the shoulder after a Latarjet procedure has failed. It defines failure as recurrent instability and walks through identifying the cause. It then surveys nonoperative, soft-tissue, autograft, allograft, and salvage options.
The decision tree after a failed Latarjet starts with one question: is there major bone loss? If bone stock is preserved and the problem is a hyperlax capsule or missed multidirectional instability, soft-tissue revision (Bankart or capsular plication) is reasonable and can achieve no recurrence in well-selected patients with defects under 25% and an on-track Hill-Sachs.
If major osseous deficiency exists, you need a bone block: iliac crest autograft fills large defects but risks up to 50% arthritis, while distal tibial allograft restores the articular arc with congruent curvature and strong early stability.
Remember that revision recurs at up to 18% versus 0% to 14% for a primary Latarjet, so meticulous workup with 3D CT to define the defect, check block and screw position, and detect hyperlaxity is essential. Also anticipate altered neuroanatomy: after a Latarjet the axillary nerve sits more medial and the musculocutaneous nerve more inferior and medial, so retractors go in under direct vision.