Primary Latarjet for Anterior Shoulder Instability in Adolescents: An Unstable Conclusion

Abstract

Anterior shoulder instability is a common pathology, particularly among active adolescents. In recent decades, our understanding of anterior shoulder instability and its management has evolved, with more emphasis on osseous abnormalities of the glenoid and humeral head, multidirectional instability, and patient factors that increase the risk of recurrence 1 . Although the arthroscopic Bankart repair is often considered the first-line treatment for anterior shoulder instability, concerns regarding high failure rates exist, specifically in younger patients and/or those with >15% glenoid bone loss 1 . The Latarjet procedure, which functions to improve stability by increasing the glenoid width and by using the sling effect, is often considered an effective treatment option in these cases 2 . As a result of the complexity of many of the factors that contribute to anterior shoulder instability, optimal surgical management remains controversial.We commend Waltenspül et al. for their long-term retrospective analysis of adolescents who underwent an arthroscopic Bankart repair or an open Latarjet procedure for the treatment of recurrent anterior shoulder instability. In their study, with failure defined as redislocation or persistent anterior apprehension, the authors reported failure rates of 57% for arthroscopic Bankart repair and 6% for open Latarjet procedures. This led the authors to conclude that surgeons should consider the open Latarjet procedure for primary treatment of recurrent anterior shoulder instability in adolescents. These results are in contradiction to most other studies on arthroscopic Bankart repair. Although the high failure rate is concerning, it is important to recognize the methodological limitations of the study, as it was not appropriately designed to compare the 2 treatments. Preoperatively there were significant differences in group characteristics, and there was limited discussion of indications for Bankart repair, raising major concerns for selection bias. Additionally, there are concerns about the technical aspects of the arthroscopic repairs and the experience of the surgeons performing them. Included Bankart repairs utilized a mean of 3 anchors, but as few as only 1 anchor. The number of anchors, in conjunction with the utilization of anchors of an outdated design, may indicate inadequate fixation and the use of improper surgical technique 3 . Finally, the study included 81 total cases compiled from 12 surgeons over a 10-year period, raising substantial concerns with regard to surgeon volume and its relationship to the reported outcomes.Although we undoubtedly agree that, in specific circumstances, the Latarjet procedure is a superior option to the arthroscopic Bankart repair, it must be recognized that proceeding with a nonanatomic procedure is a nuanced decision that is not without risk 2 . This choice is complicated further in the adolescent population given their potential need for a future surgical procedure on a nonnative shoulder, the inherently smaller size of the coracoid in a gro...

Latarjet procedure for failed Bankart repair provides better stability and return to sports, but worse postoperative pain and external rotation limitations with more complications, compared to revision Bankart repair: a systematic review and meta-analysis

“…To choose an appropriate treatment method for recurrent instability after primary Bankart repair, the type of bony defect, sports activity, and possible complications are considered. The Latarjet procedure is a reliable option for patients with critical glenoid bone loss (> 20–25% glenoid bone loss) [54], both as a primary and a revision procedure [18, 38, 43]. Revision Bankart repair can be performed when the glenoid bone loss is minimal and the quality of the capsulolabral tissue is still adequate for a sufficient retensioning of the inferior glenohumeral ligament [56].…”

Dynamic Anterior Stabilization with Hill‐Sachs Remplissage Can be Employed in Skeletally Immature Patients—Operative Technique

“…In the adult population, a significant or intermediate glenoid bone loss and engaging Hill‐Sachs lesion are often treated with a Latarjet procedure due to its higher success rate in restoring pre‐injury levels of sports with low recurrence rate. However, the procedure is associated with a higher risk of complications such as early onset arthritis, nerve injury, infection, and implant failure, particularly in cases with extensive dissection and conjoint tendon manipulation 10,18 . In young adolescents, literature is scarce about the use of Latarjet or other bone block procedures for glenoid augmentation, and further research is needed to assess the long‐term outcomes and potential complications in this population 17,19 .…”

“…However, the procedure is associated with a higher risk of complications such as early onset arthritis, nerve injury, infection, and implant failure, particularly in cases with extensive dissection and conjoint tendon manipulation. 10 , 18 In young adolescents, literature is scarce about the use of Latarjet or other bone block procedures for glenoid augmentation, and further research is needed to assess the long‐term outcomes and potential complications in this population. 17 , 19 There are no specific contraindications for the use of glenoid augmentation procedures, including the Latarjet procedure, in the pediatric population.…”