Variation in Technique and Post-operative Management of the Latarjet Procedure Amongst Orthopedic Surgeons.

Abstract Background The Latarjet procedure has become a treatment of choice for glenohumeral instability in the setting of large glenoid osseous defects (> 20%) and for prior failed soft tissue repairs. However, surgical techniques and postoperative rehabilitation protocols vary among expert shoulder surgeons. The purpose of this survey study was to characterize the variation in current practice patterns amongst fellowship-trained orthopedic shoulder surgeons and to identify factors related to variation. Methods A 9-question survey was created (SurveyMonkey, San Mateo, CA, USA) and distributed to orthopedic surgeons who are active members of the American Shoulder and Elbow Surgeons (ASES) or American Orthopedic Society of Sports Medicine (AOSSM). The survey asked questions regarding surgeon experience with the Latarjet, fellowship training, open versus arthroscopic approach, method of coracoid to glenoid fixation, time in sling postoperatively, and time before clearance for return to sport. Subgroup analysis was performed to determine if further variation was evident between surgeons who completed sports medicine versus shoulder and elbow fellowship training. Results In total, 242 surgeons completed the survey. Of them 55% indicated performing a sports fellowship and 39% indicated completing a shoulder and elbow fellowship. Amongst all surgeons, the classic open Latarjet was the strongly preferred technique (79%), followed by open congruent-arc (17%), and all-arthroscopic (3%). With respect to fixation, 98% used screw fixation and only 1% indicated cortical button use. With respect to postoperative course, over 85% of surgeons preferred immobilization for 3-6 weeks after the procedure and 42% of respondents stated they waited at least 6 months prior to clearing their patients to return to sport. Subgroup analysis revealed that surgeons with a shoulder and elbow fellowship, performed the classic open technique 89% of the time compared to 63% of those who completed a sports fellowship (p Conclusion The results of our survey study indicate an overall strong preference for the open classic Latarjet technique as well as an overall strong preference of screw fixation of the coracoid graft to the glenoid amongst all surgeons. Shoulder and elbow fellowship trained surgeons are significantly more likely to perform open surgery with a classic technique compared to sports fellowship trained surgeon. Furthermore, the significant variation between postoperative sling use and return to sport suggests that further research is needed to develop an evidence based postoperative Latarjet rehabilitation protocol.