Open Latarjet-Patte Procedure for Anterior Shoulder Stabilization: Critical Steps and Pearls for the Walch Technique

Background: Latarjet is a term used for different techniques and modifications to expose the glenoid transfer fix coracoid. The procedure intricate technically demanding. Outcomes complications are heterogeneous in literature. A master technique, Walch has been practiced decades, with outstanding long-term results patient satisfaction. Indications: Documented anterior dislocations evidence emergency reduction, or without hyperlaxity confirmation of traumatic capsuloligamentous lesion. Contraindications include voluntary multidirectional instability these criteria. Instability Severity Index Score can guide decision making on whether Bankart surgery sufficient. Large Hill-Sachs lesions may be an indication additional remplissage. Technique Description: Three key maneuvers 6 surgical stages need mastered consistent results. Key include: (1) arm positioning all stages, (2) retractor placement, (3) safe conjoint tendon releases. Six coracoid exposure initial release; osteotomy subsequent bone preparation; (4) subscapularis split arthrotomy; (5) 360° scapula neck exposure; (6) cornerstone drill hole positioning, fixation, simple capsuloplasty. Specific facilitates exposure, releases, split, arthrotomy, insertion, as well capsular repair. crucial inferior (2.5 4.0 partially threaded cancellous screw) 7 mm medial articular surface mandatory direction parallel surface. block dialed exact position, preventing lateral overhang. capsule closed coracoacromial ligament stump 45° external rotation. Results: series >80 cases minimum 1-year follow-up (range: 1-5 years) demonstrated excellent were good (Subjective Shoulder Value >80% 95% cases; Constant score >90% Rowe > 90%) keeping (>1000 cases). complication rate was low: 1 early fracture (1.3%), no dislocation neurological complications, new arthritis progression, position Conclusion: although demanding, provides excellent, consistently reproducible once 3 mastered.