Shoulder Elbow iSAWE 17

Question

A 22 year old rugby player has had five anterior shoulder dislocations. The last occurred while asleep.

Shoulder Elbow iSAWE 17, axial CT of the shoulder
Axial CT of the shoulder. Image by RSatUSZ, Wikimedia Commons, CC BY-SA 3.0.
  1. Describe the CT.
  2. How do you quantify bone loss and decide on surgery?
  3. Describe the Latarjet procedure and its complications.

Answer

CT findings

  • Bony Bankart lesion of the anteroinferior glenoid
  • Assess glenoid bone loss on 3D en face reconstruction
  • Look for a Hill-Sachs lesion on the humeral head

Quantifying bone loss

  • Best fit circle on the inferior glenoid, percentage loss of width
  • Over 20 to 25% loss means arthroscopic Bankart repair alone has high recurrence
  • Subcritical loss of 13.5% already worsens outcomes
  • Glenoid track concept (Di Giacomo), Hill-Sachs off track if wider than the track
  • Instability Severity Index Score over 6 favours bony surgery

Latarjet

  • Coracoid transfer to the anteroinferior glenoid through a subscapularis split
  • Bony effect restores glenoid width
  • Sling effect of the conjoint tendon in abduction and external rotation
  • Capsular repair to the coracoacromial ligament stump

Complications

  • Musculocutaneous and axillary nerve injury
  • Graft nonunion, resorption or screw prominence
  • Lateral graft overhang causes arthritis
  • Recurrent instability
  • Loss of external rotation

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.