128 LO SCALPELLO (2011) 25:128-132 DOI 10.1007/s11639-011-0110-x Instabilità antero-inferiore: l’intervento di Latarjet modificato G. Di Giacomo 1 , F. Grassi 2 , A. Costantini 1 , P. Fornara 2 1 Concordia Hospital for “Special Surgery”, Roma; 2 S.C. di Ortopedia e Traumatologia, A.O.U. “Maggiore della Carità” - Università degli Studi del Piemonte Orientale “A. Avogadro”, Novara ABSTRACT - ANTEROINFERIOR SHOULDER INSTABILITY: THE MODIFIED LATARJET PROCEDURE Shoulder instability is one of most controversial joint diseases in terms of diagnosis and treatment. Several open surgical treatments for primary anterior glenohumeral instability have been published, including long-term follow-up of these methods, which are reliable and time-tested and can yield excellent clinical results. The use of arthroscopy has improved the recognition of pathologic findings in shoulder instability and allowed a better understanding of the anatomopathology of instability and the correlation between symptoms and lesions. The arthroscopic technique allows reparative and reconstructive surgical procedures aimed at selective treatment of the injured structures, obviating tenotomy or splitting of the subscapularis, thus reducing the risk of iatrogenic damage. In international literature, some studies demonstrate the results of arthroscopic treatment of recurrent traumatic anterior instability comparable with those achieved historically with open procedures. Despite these exciting advances, open surgery remains an acceptable method of treatment, particularly when a surgeon lacks the equipment, experience, or technical skills needed to perform an arthroscopic repair. Moreover, open surgery remains the preferred method of treatment in situations in which arthroscopic techniques cannot adequately address the anatomic lesion, such as anterior instability in the presence of glenoid and/or humeral bony defects or soft tissue deficiencies. The Latarjet procedure, first described in 1958 and used to address anteroinferior shoulder instability, involves using coracoid transfer to stabilize the shoulder by the static action of the transferred bone block and by the dynamic action of the attached conjoined tendon sling (short head of biceps and coracobrachialis) in patients who present anteroinferior shoulder instability. There are different effects by which to achieve shoulder stability with the Latarjet procedure: a) bone effect: bone graft can prevent engagement of a humeral bone lesion because the graft extends the glenoid arch to such a degree that the shoulder cannot externally rotate far enough to engage the Hill-Sachs lesion over the front of the graft; b) muscle effect: transfer of a coracoid graft and conjoined tendon over the top of the lower subscapularis tendon results in increased tension in the inferior fibers of the subscapularis, enhancing anterior stability; c) sling effect: conjoined tendon forms a sling across the anterior–inferior capsule when the shoulder is in 90° abduction and 90° external rotation, providing additional soft tissue restraint anteriorly, all of which act to prevent engagement of the Hill-Sachs lesion even before the anterior capsule is repaired; d) capsular effect: follows capsular restoration. Aggiornamenti