Outcomes of the Latarjet Procedure for the Treatment of Chronic Anterior Shoulder Instability: Patients With Prior Arthroscopic Bankart Repair Versus Primary Cases

Abstract

Background: It remains unclear whether results differ between a Latarjet procedure performed after a failed arthroscopic Bankart repair and one performed as the primary operation. Purpose: To compare the postoperative outcomes of the Latarjet procedure when performed as primary surgery and as revision for a failed arthroscopic Bankart repair. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective comparative case-cohort analysis was performed for all patients undergoing a Latarjet procedure for recurrent anterior shoulder instability. Patients were separated into 2 groups depending on if the Latarjet procedure was performed after a failed arthroscopic Bankart repair (group 1) or as the first operation (group 2). Outcome measures included recurrent instability, reoperation rates, complications, pain, Walch-Duplay scores, and Simple Shoulder Test. Results: A total of 308 patients were eligible for participation in the study; 72 (23.4%) did not answer and were considered lost to follow-up, leaving 236 patients available for analysis. Mean follow-up was 3.4 ± 0.8 years. There were 20 patients in group 1 and 216 in group 2. Despite similar rates of recurrent instability (5.0% in group 1 vs 2.3% in group 2; P = .5) and revision surgery (0% in group 1 vs 6.5% in group 2; P = .3), group 1 demonstrated significantly worse pain scores (2.56 ± 2.7 vs 1.2 ± 1.7; P = .01) and patient-reported outcomes (Walch-Duplay: 52 ± 25.1 vs 72.2 ± 25.0; P = .0007; Simple Shoulder Test: 9.3 ± 2.4 vs 10.7 ± 1.9; P = .001) when compared with those patients undergoing primary Latarjet procedures. Conclusion: Functional outcome scores and postoperative pain are significantly worse in patients undergoing a Latarjet procedure after a failed arthroscopic Bankart repair when compared with patients undergoing primary Latarjet. The assumption that a failed a Bankart repair can be revised by a Latarjet with a similar result to a primary Latarjet appears to be incorrect. Surgeons should consider these findings when deciding on the optimal surgical procedure for recurrent shoulder instability.

Clinical Outcomes of Shoulder Stabilization in Females With Glenoid Bone Loss

“… 12 Another multicenter study including 308 patients undergoing the Latarjet reported that 91.5% of participants were competitive or recreational athletes. 33 In the current study, only 5 of 17 female patients (29.4%) who underwent the Latarjet procedure were injured during athletic participation. This indicates that sex-related differences may exist in the mechanism of injury and postoperative expectations among male and female patients who undergo the Latarjet procedure.…”

No Difference in Outcomes After Arthroscopic Bankart Repair With Remplissage or Arthroscopic Latarjet Procedure for Anterior Shoulder Instability

“…The Latarjet procedure has been shown to be a viable procedure for patients with a failed prior stabilization, with previous studies showing similar results to those in patients with primary instability. 24 , 25 Although it is unclear how a prior failed ABR affects the outcomes of ABRR, further soft-tissue damage may predispose these patients to a higher risk of failure. 26 Both procedures appear to result in similar outcomes with their appropriate indications, but surgeons should be cautioned about choosing ABRR in patients with severe glenoid bone loss until this is better defined.…”

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

“…87 Forty-four studies reported the number of prior dislocations, which ranged from 2.2 51 to 40 93 dislocations. Three studies compared primary and revision surgery 86,100,101 ; 30 studies or study arms included only patients having primary surgery; and seven only included those having revision surgery (Supplementary Table 2). 30,58,64,75,78,102,103 RADIOGRAPHIC FINDINGS Roughly a third of included studies (29/92, 32.5%) measured postoperative arthritis, and an additional eight studies measured postoperative arthropathy.…”

“…Nine studies reported the rate of recurrent instability without specifically defining instability as redislocation. 40,46,50,64,69,76,90,100,106,111 Among the 69 studies that used the coracoid bone and specifically reported redislocations, the majority (47/ 69,75.3%) reported patients experiencing either a single redislocation or no redislocation. Noticeably higher rates of postoperative instability were reported in studies of at-risk patient populations; 42.9% (6/14) of patients with epilepsy, 33 33.3% (3/9) of patients with seizure disorders, 34 and 48.0% (12/25) of patients with chronic locked anterior shoulder dislocations experienced postoperative instability.…”