Long-term Results of the Open Latarjet Procedure for Recurrent Anterior Shoulder Instability in Patients Older Than 40 Years

Abstract

Background: Subgroup analyses of the Latarjet procedure have suggested that age over 40 years is a risk factor for dislocation arthropathy. Purpose: To analyze long-term results of the open Latarjet procedure for recurrent anterior shoulder dislocation in patients at least 40 years of age. Study Design: Case series; Level of evidence, 4. Methods: A total of 39 consecutive patients (40 shoulders) with a mean age of 48 years (range, 40-66 years) at surgery were evaluated at a mean follow-up of 11.0 years (range, 8-16 years). Of these, 15 patients (38%) had undergone previous soft tissue stabilization surgery. Long-term results were assessed clinically and radiographically, including computed tomography scanning at final follow-up. Results: No recurrence of dislocation was noted. Subluxation had occurred in 3 patients (8%), and apprehension persisted in 5 patients (13%). The total Walch-Duplay score averaged 89 points at the final follow-up, and the mean Subjective Shoulder Value (60%-91%) had improved significantly ( P < .001). In total, 36 patients rated their result as excellent, 3 as good. Further, 6 patients (15%) underwent joint-preserving reoperation, and 1 patient (3%) had reverse total shoulder arthroplasty for severe dislocation arthropathy. Dislocation arthropathy was severe in 14 patients (37%) and had progressed by at least 2 grades in 17 patients (45%). Patients with severe dislocation arthropathy had already shown degenerative changes preoperatively as opposed to those who ultimately had no or moderate dislocation arthropathy (n = 24) ( P < .001). Progression of dislocation arthropathy was associated with lateral (>1 mm) graft positioning ( P < .001) and older age at surgery ( r = 0.58; P < .001). Conclusion: The open Latarjet procedure for recurrent anterior shoulder instability in patients older than 40 years reliably restores stability and leads to high patient satisfaction. This procedure is, however, associated with a substantial rate of advanced but clinically mild symptomatic dislocation arthropathy, which is associated with the degree of preoperative joint degeneration, older age at surgery, and lateral graft placement.

Primary Open Latarjet Procedure Results in Functional Differences but No Structural Changes in Subscapularis Muscle Quality vs the Healthy Contralateral Shoulder at Long-term Follow-up

“…The Latarjet procedure is associated with loss of active ROM, loss of active ER 14 up to 19°, and minimal loss of active IR. 26 In the current study, we included patients without any previous or revision surgery, with clear recurrent anterior instability before the Latarjet procedure, and without any contralateral shoulder pathology or multidirectional instability.…”

“…The Latarjet procedure for recurrent anterior shoulder instability is very reliable, with reported long-term recurrence rates usually <10%. 1 , 9 , 12 , 14 , 18 The stabilizing mechanisms of this procedure rely on the bone-block effect (ie, increasing glenoid surface area) as well as the sling effect (ie, dynamic tensioning of the lower part of subscapularis in abduction). 36 A split in the subscapularis muscle is required to transfer the coracoid bone block through the muscle and fix it to the anteroinferior glenoid neck.…”

“…With the technical advancement in shoulder stabilization procedures from a subscapularis takedown to a tendon-sparing and muscle-splitting approach, subscapularis function after the Latarjet procedure became more predictable with better range of motion (ROM), increased muscle power, and less fatty infiltration. 24 Yet, the Latarjet procedure using a muscle-splitting approach is associated with loss of external rotation (ER) 14 up to 19° and minimal loss of internal rotation (IR). 26 Furthermore, short-term results focusing on subscapularis function after the Latarjet procedure revealed internal and external strength deficits and reduced endurance but no atrophy or fatty infiltration of the subscapularis muscle.…”

Both Open and Arthroscopic Latarjet Result in Excellent Outcomes and Low Recurrence Rates for Anterior Shoulder Instability

“…The Latarjet procedure has seen a resurgence in popularity in recent years, because of its high success rates, with studies reporting excellent long-term shoulder stability and low recurrence rates. 3 , 10 , 11 , 12 Therefore, it has been advocated for in patients with high risk factors for recurrence after an arthroscopic Bankart repair, with several scoring systems available to stratify risk, primarily focusing on glenoid bone loss, Hill-Sachs lesions, and involvement in collision sports. 13 , 14 , 15 , 16 Because of Latarjet’s nonanatomical nature and invasive approach, there have been concerns over the associated risk of complications, 17 , 18 such as bone block nonunion or resorption, fracture of the coracoid, or injury of the musculocutaneous nerve, either during the approach or during retraction.…”

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

“…Similarly, a study by Ernstbrunner et al showed that the open Latarjet reliably restored anterior shoulder stability, however patients had a significant amount of dislocation arthropathy with 37% of cases showing severe arthritis progression. 73 …”