Bankart Repair Versus Latarjet Procedure for Recurrent Anterior Shoulder Instability: A Systematic Review and Meta-analysis of 3275 Shoulders

Abstract

Background: Little consensus is available regarding the standard treatment for recurrent anterior instability of the shoulder. Typically, treatment selection has been based on training and tradition rather than the available evidence. Purpose: This study aimed to compare the clinical outcomes between arthroscopic Bankart procedure and the Latarjet procedure in the treatment of recurrent anterior shoulder instability with emphasis on follow-up time. Study Design: Systematic review and meta-analysis. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials, Scopus, Ovid, and Web of Science up to January 2018 and included studies that compared arthroscopic Bankart versus Latarjet for treatment of anterior shoulder instability. Continuous data, such as operative time and patient-reported outcomes, were pooled as mean differences (MDs), whereas dichotomous data, such as recurrence, revision, redislocation, arthropathy, infection, and hematoma, were pooled as risk ratios (RRs), with 95% CIs. Results: Pooling data from 7 cohort studies (3275 patients) showed that arthroscopic Bankart was associated with a higher risk of redislocation (RR, 2.74; 95% CI, 1.48-5.06; P = .03), a higher risk of recurrence (RR, 2.87; 95% CI, 1.91-4.30; P < .0001), and a lower risk of infection (RR, 0.16; 95% CI, 0.06-0.43; P = .0002) compared with Latarjet, while the effect size did not favor arthroscopic Bankart or Latarjet in terms of Rowe score (MD, 0.22; 95% CI, –5.64 to 6.08; P = .94), revision (RR, 0.34; 95% CI, 0.08-1.39; P = .13), and hematoma (RR, 0.20; 95% CI, 0.03-1.19; P = .07). The effect estimate showed a pronounced advantage for Latarjet from 6 to 10 years postoperatively in terms of recurrence and redislocation (RR, 3.00; 95% CI, 1.98-4.56 and RR, 2.85; 95% CI, 1.51-5.38, respectively). Conclusion: Our results showed that Latarjet had less risk of recurrence and redislocation with longer follow-up time. Both procedures were comparable in terms of Rowe score, the need for revision, and postoperative hematoma formation, whereas Bankart repair was associated with a lower risk of infection.

Mid-term outcomes of arthroscopic Latarjet procedure in chronic anterior shoulder instability after failed Bankart surgery or with significant glenoid bone loss

“…The fi xation is performed using two cannulated screws (4). This type of operation provides excellent results with a low incidence of recurrences (5,6).…”

Glenoid bone augmentation: a contemporary and comprehensive systematic review of open procedures

“…119,120 A 2019 computational study using finite element models found an even lower threshold of 16% was the appropriate defect size to determine if bone augmentation was necessary. 121 Treatment choice is often based on training and tradition rather than available evidence, 62 which may leave high-risk patients vulnerable to recurrent instability, poor satisfaction, and additional procedures. The limited use of bone loss as a screening criterion for bone augmentation surgery may be an indication that patients are not adequately assessed for bone block procedures.…”

Open Stabilization Procedures of the Shoulder in the Athlete: Indications, Techniques, and Outcomes

“… 74 A systemic review by Imam et al compared 7 cohort studies and found that there was a higher risk of dislocation occurrence after arthroscopic Bankart repair with a risk ratio of 2.87, however there was no difference in post-op complication rate. 75 Lastly, in a comparative study by Rai et al, authors reported a higher rate of functional satisfaction and a lower operating cost with the open Latarjet procedure compared to arthroscopic Bankart repair. 76 …”