Outcomes of the Latarjet Procedure Versus Free Bone Block Procedures for Anterior Shoulder Instability: A Systematic Review and Meta-analysis

Abstract

Background: Free bone block (FBB) procedures for anterior shoulder instability have been proposed as an alternative to or bail-out for the Latarjet procedure. However, studies comparing the outcomes of these treatment modalities are limited. Purpose: To systematically review and perform a meta-analysis comparing the clinical outcomes of patients undergoing anterior shoulder stabilization with a Latarjet or FBB procedure. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, Embase, and the Cochrane Library databases were systematically searched from inception to 2019 for human-participants studies published in the English language. The search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement including studies reporting clinical outcomes of patients undergoing Latarjet or FBB procedures for anterior shoulder instability with minimum 2-year follow-up. Case reports and technique articles were excluded. Data were synthesized, and a random effects meta-analysis was performed to determine the proportions of recurrent instability, other complications, progression of osteoarthritis, return to sports, and patient-reported outcome (PRO) improvement. Results: A total of 2007 studies were screened; of these, 70 studies met the inclusion criteria and were included in the meta-analysis. These studies reported outcomes on a total of 4540 shoulders, of which 3917 were treated with a Latarjet procedure and 623 were treated with an FBB stabilization procedure. Weighted mean follow-up was 75.8 months (range, 24-420 months) for the Latarjet group and 92.3 months (range, 24-444 months) for the FBB group. No significant differences were found between the Latarjet and the FBB groups in the overall random pooled summary estimate of the rate of recurrent instability (5% vs 3%, respectively; P = .09), other complications (4% vs 5%, respectively; P = .892), progression of osteoarthritis (12% vs 4%, respectively; P = .077), and return to sports (73% vs 88%; respectively, P = .066). American Shoulder and Elbow Surgeons scores improved after both Latarjet and FBB, with a significantly greater increase after FBB procedures (10.44 for Latarjet vs 32.86 for FBB; P = .006). Other recorded PRO scores improved in all studies, with no significant difference between groups. Conclusion: Current evidence supports the safety and efficacy of both the Latarjet and FBB procedures for anterior shoulder stabilization in the presence of glenoid bone loss. We found no significant differences between the procedures in rates of recurrent instability, other complications, osteoarthritis progression, and return to sports. Significant improvement in PROs was demonstrated for both groups. Significant heterogeneity existed between studies on outcomes of the Latarjet and FBB procedures, warranting future high-quality, comparative studies.

Clinical Outcomes of Shoulder Stabilization in Females With Glenoid Bone Loss

“…Our results demonstrated similar outcomes at nearly 4-year follow-up as compared with historical male controls. 9,13 Notably, in this series, female patients with recurrent anterior instability experienced significant improvements in ASES, SST, and VAS scores. Only 1 patient in our cohort who underwent the Latarjet for glenoid bone augmentation experienced recurrent instability, for an overall recurrence rate of 5.9%, consistent with previously published rates of 1% to 8%.…”

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

“…Since 2014, at least 4 further studies 5-7,24 have compared outcomes between the arthroscopic Bankart and Latarjet procedures, suggesting that the difference between the 2 procedures concerning the quality of outcomes significantly increases with longer follow-up time. This has also been backed by a recent review 8 focusing on the long-term efficacy of Latarjet procedures alone. Considering these novel and important findings, the current article aims to provide an up-to-date review of the evidence, taking all known factors into account including the hitherto not systematically analyzed important aspect of follow-up time.…”

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

“…One systematic review by Gilat et al demonstrated that bone grafting had a rate of recurrent instability (3%), osteoarthritis (12%), other complications (5%) a return to sports (88%) that was not significantly different to patients who underwent the Latarjet procedure; PRO data was also similar with both procedures demonstrating a significant improvement in American Shoulder and Elbow Surgeons score amongst other PROs. 105 Outcome data for bone grafting for posterior shoulder instability is less abundant but a study by Meuffels et al showed that at a median of 18 years, 6 of 11 patients were satisfied with their procedure and would elect to have the intervention again. 106 Seven of 11 had recurrent instability and 4 patients had a recurrent episode of dislocation.…”

“…Complications after anterior or posterior glenoid bone grafting include hardware failure, painful hardware, osteoarthritis, 92 donor site pain (if autograft was harvested), 105 and specifically brachial plexus injury in anterior bone graft placement. 100 Kowalski et al demonstrated in a large Pearldiver database study that both anterior and posterior glenoid bone graft had an overall complication rate (dislocation, closed adhesion release, or reoperation) of approximately 20%, which was significantly greater than Bankart repair.…”

“…However, other literature demonstrates positive outcomes after shorter follow-up 92 with one study by Schwartz et al showing a significant improvement in Rowe score and Walch-Duplay score from 18.4 to 82.1 points and 37.4 to 82.9 points, respectively (P <0.01). 107 Complications after anterior or posterior glenoid bone grafting include hardware failure, painful hardware, osteoarthritis, 92 donor site pain (if autograft was harvested), 105 and specifically brachial plexus injury in anterior bone graft placement. 100 Kowalski et al demonstrated in a large Pearldiver database study that both anterior and posterior glenoid bone graft had an overall complication rate (dislocation, closed adhesion release, or reoperation) of approximately 20%, which was significantly greater than Bankart repair.…”