University Côte d'Azur.
Arthroscopy. 2017 Dec;33(12):2139-2143. doi: 10.1016/j.arthro.2017.08.269.
The Latarjet procedure is a complex and difficult operation when performed both with an open approach and arthroscopically. The difficulties come from the fact that it is a combined intra- and extra-articular procedure, and that working close to the brachial plexus may be frightening for surgeons. Because of the high complication and reoperation rates reported in the literature, this procedure is, at the moment, rejected by a large part of the orthopaedic community, specifically in North America. The Chinese experience shows, after the European one, that arthroscopic Latarjet is an efficient and irreplaceable option for the treatment of recurrent anterior shoulder instability in the context of capsular and/or glenoid deficiency. A recent study shows that the arthroscopic procedure provides accurate bone block positioning and high rates of healing, excellent clinical results (no recurrence of instability at 2-year follow-up), and low rates of complications (no neurovascular injury). Although the arthroscopic Latarjet should be approached with caution, the learning curve should not be thought of as prohibitive. To learn how to perform an arthroscopic Latarjet, surgeons should visit an experienced surgeon and take a course to practice on cadavers first. Although it will take time and effort to learn and perform this operation correctly, we should command our Chinese colleagues to encourage us to follow their path. There is no reason that in the near future the orthopaedic community does not adopt the arthroscopic Latarjet procedure, as we adopted the arthroscopic rotator cuff repair and other complex surgical procedures. Among the strongest reasons to perform the Latarjet procedure arthroscopically are the accuracy of graft placement, the safety for neurovascular structures provided by direct visualization and magnification, and the excellent clinical results allowing young people to go back to sport, including high-risk (contact, overhead) sports.
Latarjet 手术无论是开放入路还是关节镜下操作，都是一项复杂且困难的手术。困难来自于它是一种关节内和关节外联合的手术，并且靠近臂丛神经操作可能会让外科医生感到恐惧。由于文献中报告的高并发症和再手术率，目前该手术被大部分骨科医生，特别是北美地区的医生所拒绝。中国的经验与欧洲的经验相似，表明关节镜下 Latarjet 是治疗伴有肩盂和（或）关节盂唇缺损的复发性肩关节前不稳定的有效且不可替代的选择。最近的一项研究表明，关节镜下手术可实现准确的骨块定位和高愈合率，获得良好的临床结果（2 年随访无不稳定复发），并发症发生率低（无神经血管损伤）。尽管关节镜下 Latarjet 手术应谨慎进行，但不应将学习曲线视为不可逾越的障碍。要学习如何进行关节镜下 Latarjet 手术，外科医生应首先拜访有经验的外科医生，并参加课程在尸体上进行练习。尽管学习和正确执行此操作需要时间和精力，但我们应该鼓励中国的同行们鼓励我们追随他们的脚步。在不久的将来，骨科医生没有理由不采用关节镜下 Latarjet 手术，就像我们采用关节镜下肩袖修复和其他复杂的手术程序一样。选择关节镜下进行 Latarjet 手术的最强理由包括：移植物放置的准确性、直接可视化和放大提供的神经血管结构安全性，以及出色的临床结果，使年轻人能够重返运动，包括高风险（接触、头顶）运动。
