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1. Exposure
This is NOT a standard pectoral approach but more medial one finger breadth inferior and medial to the
coracoid, to the anterior axillary crease. This is a vertical incision. Dissect laterally to the cephalic vein
which is then protected and retracted laterally with the deltoid muscle.
The coracoid process is then exposed with the Pec Minor located medial, the CA ligament located lateral,
and the conjoint tendon presents inferiorly. The anterior lateral border of the CA ligament end of the
conjoint tendon is separated from the deltoid facia. Homan retractor is placed as far superior on the
coracoid as possible.
The arm is positioned in anterior flexion to access easily the upper border of the coracoid.
The Pec Minor is dissected free from the medial border of the conjoint tendon. This will allow the Pec Minor
inferior border to be identified. The surgeon should be aware that the musculocutaneous nerve is just
below, posterior to the pectoralis minor.
This is why the detachment of the Pec Minor must be performed along the medial border of the coracoid.
There are several strategies for manageing the CA ligament. The CA ligament may or may not be used to
attach to the anterior capsule in the open approach at the end of the transfer. Once the surgeon has
determined his preference for managing the CA ligamet and it is released, attention is then directed towards
the prepared the coracoid.
2a
2b
2b. Introduce the Coracoid K wires (#285260) thru
the and holes The lpha distal hole should be 1
cm away from the tip of the coracoid process. The
end of the K -Wire should be seen after its exit.
Instruments
Coracoid drill guide
(Cat # 285365)
Instruments
150mm K wires
(Cat #285260 )
2f
Instruments
Coracoid Step Drill
(Cat# 285240)
CONTINUED
2j
Instrumetnts
Coracoid Step Tap (Cat# 285245)
Instruments
Top Hat Screwdriver (Cat# 285295)
4c. With the curved mayo scissor, initiate the split and use a sponge to develop the plane between the
subscap and capsule.
4d. Place the curved Gelpi retractor into the subscap split.
4e. Make a 1.5 to 2cm VERTICAL capsulotomy at the level of the glenohural joint Not laterally. Introduce
the Fekuda retractor to displace posteriorly the humeral head and expose the anterior border of the glenoid.
This will decrease the ante version of the glenoid which is essential for optimal screw placement/direction
4f. Remove a trapezoidal segment of the labrum at the level of the coracoid transfer site. The trapezoidal
segment should be at least as large as the bony component of the coracoid transfer. Decorticate the bone at
the transfer site. The inferior level of the graft should be at the 5 oclock position.
Instruments
Coracoid 3.5mm Screws (Cat# 285255)
Instruments
Double Cannula (found in Cat#
285180, disposable kit)
Instruments
Glenoid K-Wires (found in Cat#
285180, disposable kit)
7.a
7b. Drill the Glenoid K-Wire and check that they are
parallel
7c. Remove the Coracoid 3.5mm Screw from the lpha
hole.
7.b
7.d
Instruments
Glenoid 3.2mm Drill (Cat# 285300)
CONTINUED
7.e
7e. Thru the alpha hole, load the Latarjet
Cortical Screw over the Glenoid K- Wire and
insert into down thru the cannula.
7.f
Instruments
2.5mm Cannulated Screw Driver (Cat# 285220)
Instruments
2.5mm Solid Screw Driver
(Cat# 285325)
7.i