Arthroscopic Flipped Coracoid Transfer (Laterjet Procedure) With Endobutton Fixation for Anterior Shoulder Instability

Abstract Glenoid bone loss is one of the most important risk factors for recurrent anterior shoulder instability. Transfer of the coracoid process is a well‐established procedure for this. In the classic Latarjet procedure, the subscapularis tendon is split and the graft is fixed with screws. The subscapularis split may weaken the tendon, and screws may contact the humeral head after partial graft osteolysis, leading to cartilage damage. To avoid splitting the subscapularis, the “flipped” coracoid transfer technique has been described, in which the coracoid process is passed above the subscapularis and the superior instead of the inferior surface of the graft is fixed to the anterior glenoid. The origin of the conjoint tendon is located superiorly. The “flipped” technique uses a U‐tape cerclage with 2 glenoid tunnels drilled posteriorly, thereby reducing the risk of axillary nerve injury anteroinferiorly. The tape obtains the risk of suture cutout with insufficient primary stability. Therefore, the present “flipped” technique uses 2 double Endobuttons with a sliding, self‐locking Nice knot posteriorly. This fixation has been shown to provide sufficient stability. The technique is performed fully arthroscopically except for coracoid osteotomy which is performed through a 4‐cm miniopen incision.