Glenoid Bone Loss Is a Risk Factor for Poor Clinical Results After Coracoid Transfer in Rugby Players With Shoulder Dislocations

Abstract

Background: Although surgical shoulder stabilization via coracoid transfer in collision athletes is effective and has a low reinjury rate, the factors affecting poor clinical results and the superiority of the 2 stabilization procedures (Bristow and Latarjet) remain unclear. Purpose: To explore the factor(s) affecting poor clinical results of coracoid transfer in a large cohort of rugby players and to compare postoperative function between the Bristow and Latarjet procedures. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 169 consecutive shoulders of 154 competitive male rugby players who underwent shoulder stabilization surgery (Bankart repair with coracoid transfer) between 2014 and 2018 and had a mean follow-up of 2.7 years (minimum follow-up, 2 years). The Bristow procedure was performed in the first 92 shoulders (84 players), and the Latarjet procedure was performed in the latter 77 shoulders (70 players). A poor clinical result was defined as a postoperative Rowe score of <70 and a postoperative Western Ontario Shoulder Instability Index (WOSI) score of >630. Multiple logistic regression analysis was conducted to identify the factors affecting postoperative functional failure. The postoperative scores and complication rates were also compared between the 2 procedures. Results: In total, 92.3% of the rugby players returned to their preinjury competition level at a mean of 5.9 months postoperatively. The Rowe and WOSI scores showed that shoulder function was improved postoperatively compared with preoperatively. The number of rugby players with a poor clinical result was 18 (10.7%). Multiple logistic regression analysis demonstrated that a poor clinical result was associated with a preoperative glenoid bone defect of >20% of the glenoid width (odds ratio, 9.8), whereas the clinical result was unaffected by the type of coracoid transfer. There were no differences between the 2 procedures in any of the postoperative scores or complication rates. Conclusion: The present study indicated that the most effective predictor of postoperative functional scores was the degree of the glenoid bone defect and not the type of coracoid transfer. This information may be useful for the strategic treatment of shoulder dislocations in collision athletes.

Factors affecting a patient’s experience following the open Latarjet procedure to treat recurrent anterior shoulder instability

“…15,41,42,47 Although previous authors have evaluated the influence of these variables on the clinical outcome following an open Latrerjet procedure, only a few have evaluated their association with patient-reported outcome, with conflicting findings. 3,32 We did not identify an association between radiological injury-related variables and patient-reported outcome. Our findings suggest that while such injury-related factors play a role in the choice of stabilization and risk of clinical failure, they do not significantly influence patient-reported outcome when combined with other patient-related risk factors.…”

“…31 In contrast, few studies have evaluated the influence of such a wide range of patient-and injury-related variables on patient-reported outcome following an open Latarjet procedure in the general population (Table VII). 3,31,32 Di Giacomo et al 3 reported on patient-related risk factors influencing clinical failure (defined as a WOSI score of < 70% of normal), identifying female sex and bilateral shoulder instability as risk factors for failure. Other authors have assessed PROMs following an open Latarjet procedure in selected subgroups only, including those with a previously failed arthroscopic Bankart repair, [9][10][11][12] elite athletes, [32][33][34][35][36] those with epilepsy, 13 and those aged ≥ 40 years.…”

“…3,31,32 Di Giacomo et al 3 reported on patient-related risk factors influencing clinical failure (defined as a WOSI score of < 70% of normal), identifying female sex and bilateral shoulder instability as risk factors for failure. Other authors have assessed PROMs following an open Latarjet procedure in selected subgroups only, including those with a previously failed arthroscopic Bankart repair, [9][10][11][12] elite athletes, [32][33][34][35][36] those with epilepsy, 13 and those aged ≥ 40 years. 14 Although this provides useful information about these subgroups, the results may not be generalizable to all patients undergoing an open Latarjet procedure.…”

Association Between Preoperative Glenoid Bone Loss and Postoperative Outcomes After Coracoid Transfer Combined With Open Bankart Repair: Comparison of the Bristow and Latarjet Techniques

“…Kawasaki et al 15 reported an association between lower postoperative functional scores and the extent of GBL after Bristow procedures combined with a Bankart repair in competitive rugby players. Their colleagues, Shibuya et al, 31 reported on a similar study that included shoulders treated with either the Bristow or the Latarjet procedure and found an association between the simultaneous presence of a low Rowe score and a high WOSI, which they defined as “functional failure,” and the extent of GBL. On the other hand, Tasaki et al 33 compared postoperative outcomes in 2 groups, one with <10% GBL and the other with >10% GBL, and concluded that GBL does not influence postoperative outcomes.…”