Low grade of osteoarthritis development after Latarjet procedure with a minimum 5 years of follow-up: a systematic review and pooled analysis

Risk factors associated with glenohumeral arthritis before and after the Latarjet procedure: minimum follow-up of 5 years, using computed tomography imaging

BACKGROUND

Latarjet surgery has emerged as a prevalent option for managing anterior glenohumeral instability. Despite its efficacy, concerns persist regarding the development of postoperative osteoarthritis (OA), a significant complication. Understanding arthritis pathogenesis in patients undergoing this procedure proves challenging, as OA can manifest even in cases without surgical repair. Additionally, studies suggest correlation between inadequate surgical technique and the occurrence of postoperative arthritis. Traditional radiographic imaging may also underestimate the identification of early OA. Therefore, the objective of this study aimed to analyze the risk factors associated with glenohumeral arthritis before and after the Latarjet procedure, with a minimum follow-up of 5 years, using computed tomography imaging (CT).

METHODS

This retrospective study involved patients who underwent the Latarjet procedure between 2012 and 2017. Inclusion criteria were availability of preoperative and at least 5 years postoperative CT and physical examinations. The primary outcome studied was the presence of glenohumeral OA, classified preoperatively and postoperatively using CT scans. Risk factors for progression to pre and postoperative OA were assessed, including etiology, age at the initial injury, number of dislocation episodes before surgery, time interval from the initial injury to surgical stabilization, size of glenoid defect, position and presence of graft resorption, and screw position.

RESULTS

Fifty joints of 45 patients were included in the final analysis. The presence of preoperative OA was found in 21 of 50 cases (42%). The risk of osteoarthritis (OA) was significantly associated with both shoulder dislocation following a seizure disorder and a larger glenoid size defect (P < .05). Of the 29 shoulders without preoperative arthritis, 8 developed arthritis postoperatively (27.5%). Of those 21 cases with preoperative osteoarthritis, progression occurred in 11 cases (52.3%) (P = .25). When considering all cases with OA progression, significant risk factors were the presence of intraarticular screws and when both screws had angulation equal or above 16° (P < .06). When considering those patients with progression of OA above 1 grade, significant risk factors were lateral graft position, screw angulation, and the presence of intra-articular screws.

CONCLUSION

Our study reveals a higher incidence of osteoarthritis than reported in the literature, likely attributed to the imaging method employed. Preoperatively, risk factors for the presence of OA included cases resulting from seizure disorders and larger glenoid bone defects. Postoperatively, the only factors related to the progression of osteoarthritis were those associated with potential surgical technique issues.

Excellent clinical and radiological mid-term outcomes of the arthroscopic "double-inlay" Eden-Hybinette procedure for bone defects exceeding 20%: a 5-year case series

BACKGROUND

Eden-Hybinette procedure can maximize the restoration of the glenoid defect by harvesting a proper size of iliac bone block. We developed an arthroscopic "double-inlay" Eden-Hybinette procedure to achieve better bone union of the graft. The aim of this study was to evaluate the clinical and radiological mid-term outcomes of the arthroscopic "double-inlay" Eden-Hybinette procedure for bone defects exceeding 20%.

METHODS

A retrospective case series was conducted. The inclusion criterion was a bone defect exceeding 20%, especially failed Bristow-Latarjet procedure or recurrent anterior shoulder instability among patients with epilepsy. An arthroscopic "double-inlay" Eden-Hybinette procedure was carried out. Recurrence and apprehension, the American Shoulder and Elbow Surgeons, University of California at Los Angeles, Subjective Shoulder Value, Rowe, and visual analog scale pain scores and rate of return to sports were obtained at final follow-up. Graft position, healing, and resorption were evaluated via 3D computerized tomography scan. Moreover, postoperative complications and the incidence of osteoarthritis were recorded.

RESULTS

The study cohort included 15 patients, with a mean age of 34.9 ± 13.2 years (range, 19-59 years) and a mean follow-up duration of 5 ± 1.7 years (range, 2.0-8.0 years). No patients experienced recurrent dislocation, and the visual analog scale pain and instability scores during shoulder range of motion decreased from a mean 6.5 ± 2.3 and 9.6 ± 0.9 preoperatively to 1.9 ± 1 and 2 ± 1.7 at the last follow-up (P < .001). The Rowe, American Shoulder and Elbow Surgeons, University of California at Los Angeles, and Subjective Shoulder Value scores of the patients increased from 18.7 ± 10.6, 71.8 ± 5, 22.9 ± 3.5, and 49.3 ± 16.2 preoperatively to 90.3 ± 6.2, 90.1 ± 4.2, 30.1 ± 2.4 (P < .001) and 81.1 ± 15.7 (P = .001) postoperatively. At the final follow-up, the bone graft healing rate was 100%, and there was no severe bone resorption. All patients returned to work, and 73.3% of patients (11 of 15) returned to sports at their preinjury or higher level.

CONCLUSIONS

The arthroscopic "double-inlay" Eden-Hybinette procedure has demonstrated reliability and efficacy, yielding excellent mid-term clinical and radiological outcomes for bone defects exceeding 20%, particularly in cases of failed Bristow-Latarjet procedures or in patients with epilepsy.

Outcomes of arthroscopic cortical-button Latarjet procedure with minimum 5-year follow-up

BACKGROUND

The surgical treatment of anterior shoulder instability with arthroscopic cortical-button Latarjet procedure has been the subject of very few medium and long-term studies. The aim of this study was to analyze the clinical and radiologic results of arthroscopic cortical-button Latarjet procedure with minimum 5 years follow-up.

METHOD

This is a monocentric retrospective study including 40 patients who have undergone shoulder stabilization with primary arthroscopic cortical-button Latarjet procedure and been reviewed with minimum 5 years follow-up. The average age at the time of surgery was 26.6 years (16-59; ±10) and 92.5% were sporty individuals. The average Instability Severity Index score was 6 points (2-9; ±1.6). The clinical evaluation involved active range of motion measurement, apprehension test, Rowe and Walch-Duplay scores, Subjective Shoulder Value and Net Promoter Score. Radiologically, evolution of the bone graft and degenerative arthritis of the shoulder joint were analyzed at the last follow-up.

RESULTS

At an average follow-up of 71 months (60-97; ±12), 3 patients (7.5%) experienced recurrence as a dislocation or subluxation, which was responsible for revision in 1 case. Moreover, apprehension persisted in 6 (16%) patients. There were no significant restrictions in recovery of active ranges of motion, including external rotation. Return to sports was effective in 94.6% of cases. The average Rowe and Walch-Duplay scores were 87 points (15-100; ±20) and 88 points (15-100; ±19) respectively. Subjective Shoulder Value was 91% (10-100; ±16) and NET Promoter Score was 9.3 points (5-10; ±1,3). Radiologically, degenerative arthritis occurred in 18.7% of patients, mainly asymptomatic stage 1 (9.4%). Bone healing was acquired in 72% of cases and partial lysis of the bone block in 41%.

CONCLUSION

At an average follow-up of 6 years, arthroscopic cortical-button Latarjet procedure is effective, enabling return to sport in 95% of cases. Onset of asymptomatic arthritis seems similar to conventional techniques but justifies a longer-term follow-up.

Arthroscopic shoulder instability surgery in patients under 25 years of age: the key role of soft tissue with both anterior and posterior axillary hammock tensioning

BACKGROUND

The arthroscopic treatment of shoulder instability is widely debated in the literature and includes very different surgical techniques. Imaging techniques do not allow an accurate assessment of soft tissue quality. The aim of the study is to demonstrate that correct patient selection and a surgical technique involving anterior and posterior capsular ligament repair with axillary retention may be the most crucial factors for successful arthroscopic treatment.

METHODS

Patients with recurrent shoulder instability who underwent arthroscopic stabilization between 2014 and 2015 and aged between 15 and 25 years, were included. The minimum follow-up was 5 years. Specific exclusion criteria were critical bone loss and patients with genetic connective tissue disorders. Demographics, instability characteristics, surgical procedures, recurrences, both dislocations and subluxations, and surgical revisions were evaluated. The surgical procedure, always performed by the same surgeon, involved the use of a minimum of 3 double-suture fixation devices and repair/tensioning of the axillary hammock. Statistical analysis was based on the non-parametric Kendall statistical model and proportions test, with p < 0.05.

RESULTS

The study population consisted of 44 patients. The first dislocation occurred in 61.4% of cases between the ages of 15 and 19. The number of dislocations prior to surgery was < 3 in 29.5%, between 3 and 9 episodes in 25%, and 10 or more episodes in 45.5%. Defined by patients who had no recurrent dislocations and those whose symptom of instability or subluxation did not require surgical revision, the surgical success rate was 90.9%. During the follow-up period, 4.5% of patients required surgical revision. Patients who required none or one reduction maneuver or had less than three dislocation episodes were statistically correlated with no recurrences after surgery. After the first dislocation, the 88.6% of patients had recurrency. Furthermore, if treated after only one episode, 75% of patients were affected by an isolated capsulolabral injury. Prompt stabilization surgery allows a simpler procedure, due to a reduced bone damage and associated injuries.

CONCLUSIONS

Even in a high-risk age group under 25 years, when the bone defect is subcritical, performing a standardised surgical technique including antero-posterior capsulolabral repair with axillary hammock retensioning demonstrates high success rates. Patients who correlate with the highest chance of success are those who have had less than three dislocation episodes and who have not undergone reduction manoeuvres, confirming the importance of soft tissue quality and thus of early treatment.

TRIAL REGISTRATION

Retrospectively registred.

Female Patients Undergoing Latarjet Surgery Show Similar 2-Year Secondary Surgery Rates but Greater Risk of Emergency Department Visits Compared With a Matched Cohort of Male Patients

PURPOSE

To evaluate sex-based differences in 30-day postoperative emergency department (ED) visits, 90-day complication rates, and 2-year secondary surgery rates after the Latarjet procedure for the treatment of recurrent shoulder instability.

METHODS

A national administrative claims database was used to identify patients with International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes for shoulder subluxation or dislocation on the day of first-time stabilization with the Latarjet technique between 2015 and 2021. Male patients were matched 4:1 to female patients based on age, Elixhauser Comorbidity Index (ECI) score, and body mass index class. Rates of 30-day ED visits and 90-day complications were compared between cohorts, and risk factors for ED visits were identified by multivariate regression. The incidence of secondary surgery within 2 years was compared by Kaplan-Meier analysis.

RESULTS

Prior to matching, 1,059 male and 360 female patients met the inclusion and exclusion criteria. Subsequent 4:1 (male-to-female) matching controlling for age, ECI score, and body mass index yielded 694 male and 185 female patients who underwent the Latarjet procedure. The overall incidence of 30-day ED visits was 9.3%, with an incidence of 8.2% for male patients and 13.5% for female patients. On the basis of multivariate logistic regression, these 30-day ED visits were associated with female sex (odds ratio, 1.79; P = .029) and incrementally higher ECI scores; relative to an ECI score of 0, ECI scores of 1 to 2, 3 to 4, and 5 or greater were associated with odds ratios of 5.31 (P = .006), 8.12 (P < .001), and 12.84 (P < .001), respectively. Ninety-day complications occurred in 1.5% of the total cohort, and the incidence was not statistically different between sexes. Overall, 2-year secondary surgery rates were similar between male and female patients (5.1% and 6.7%, respectively; P = .4).

CONCLUSIONS

Female patients undergoing the Latarjet procedure for recurrent shoulder instability showed similar 90-day complication and 2-year secondary surgery rates to a matched cohort of male patients. Female sex, along with ECI score, however, was associated with a greater rate of 30-day ED visits.

LEVEL OF EVIDENCE

Level III, retrospective comparative case series.

Improvement of coracoid process union rates: a comparative study of conventional open and arthroscopic-assisted Bristow procedures for treating anterior shoulder instability in rugby players

BACKGROUND

The Bristow coracoid transfer procedure is a reliable technique for treating anterior shoulder instability in patients with large glenoid bone loss or those involved in collision sports. However, its success is marred by its inferior bone union rate of the coracoid process as compared to the Latarjet procedure. This study aimed to evaluate whether arthroscopic confirmation of the secured coracoid fixation during the Bristow procedure improves the bone union rate and clinical outcomes as compared to the open procedure.

METHODS

We retrospectively reviewed 104 rugby players (n = 111 shoulders) who underwent an open (n = 66 shoulders) or arthroscopy (AS)-assisted (n = 45 shoulders) Bristow procedure at our center from 2007 to April 2019. In the AS-assisted group, the screw fixation and coracoid stability and contact were confirmed under arthroscopic visualization. Graft union was evaluated through computed tomography at 3 months, 6 months, and 1 year postoperatively. Patient-reported outcome measures were assessed based on the American Shoulder and Elbow Surgeons score, Rowe score, and satisfaction rate. Recurrence, the rate of return to play (RTP), and the frequency of pain after RTP were also assessed.

RESULTS

The mean follow-up period was 73.5 (range: 45-160) months for the open group and 32.3 (range: 24-56) months for the AS-assisted group. In the former, the rates of bone union were 50%, 72.7%, and 88.9% at 3 months, 6 months, and 1 year, respectively. In contrast, the AS-assisted group had significantly greater bone union rates-88.9%, 93.3%, and 95.6% at 3 months, 6 months, and 1 year, respectively. Both groups showed significant improvement in the American Shoulder and Elbow Surgeons and Rowe scores compared to preoperative values as well as high satisfaction rates (open: 92%; AS-assisted: 95.7%). There were no statistically significant differences in the recurrence and RTP rates as well as the frequency of pain after RTP between the 2 groups.

CONCLUSION

The AS-assisted procedure allows early and high bone healing without compromising the clinical outcomes.

The Arthroscopically Guided Bristow-Latarjet Procedure With Cortical Button Fixation: A Minimum 10-Year Follow-up

BACKGROUND

Despite improved visualization, the use of arthroscopic surgery to perform the Latarjet procedure has not decreased the rates of complications and glenohumeral osteoarthritis (OA) in the long term. Many of the reported complications are related to the use of screws for bone block fixation with freehand drilling.

PURPOSE

To evaluate the long-term (at a minimum 10-year follow-up) clinical and radiological outcomes of the arthroscopic Bristow-Latarjet procedure using a posterior guided drilling technique and suture button for coracoid bone graft fixation.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Consecutive patients who underwent the arthroscopic Bristow-Latarjet procedure with suture button fixation between 2011 and 2013 were reviewed by 2 independent evaluators. Complications and revision surgery were recorded, and we evaluated patient-reported outcomes including subjective scores, recurrence of shoulder instability (dislocation or subluxation), range of motion limitations, and return to sports. Patients had radiographs taken at least 10 years after surgery to assess glenohumeral OA according to the Samilson-Prieto classification system and computed tomography scans to assess bone block positioning and healing.

RESULTS

A total of 65 consecutive patients (68 shoulders) with a mean follow-up of 135 months (range, 120-156 months) were included. The mean age at the time of surgery was 25 ± 8 years; 7 patients had previous failed Bankart repair. At follow-up, 94% (64/68) of the shoulders had no recurrence of instability. The 4 cases of instability recurrence were traumatic and occurred at 3 weeks (a fall), 4 months, 2 years, and 7 years after surgery. No hardware failures, coracoid fractures, or neurological complications were observed. Overall, 61 patients (94%) were still participating in sports, with 44 (68%) at the same or higher level. Range of motion showed nonsignificant restrictions in external rotation with the arm at the side (7° ± 9°) and with the arm at 90° of abduction (9° ± 10°) compared with the contralateral side. Additionally, 11 shoulders (16%) had some residual anterior apprehension on clinical examination. At last follow-up, 77% (47/61) of the shoulders had no OA development or progression. Previous failed Bankart repair was a risk factor for the development of OA. Patients with OA had significantly lower Subjective Shoulder Value scores (79% vs 91%, respectively; P = .01) and decreased external rotation with the arm at the side (40° vs 65°, respectively; P = .001) compared with patients with no or little OA.

CONCLUSION

The arthroscopically guided Bristow-Latarjet procedure with suture button fixation is a safe and durable surgical treatment method for recurrent anterior shoulder instability, allowing a high rate of return to sports without significant motion restrictions and no or little OA in the long term.

Current Trends and Outcomes for Open vs. Arthroscopic Latarjet

PURPOSE OF REVIEW

This paper aims to analyze and compare the existing research on open and arthroscopic Latarjet procedures for treating anterior shoulder instability. The review will assess different factors such as graft positioning, functional outcomes, complications, and return-to-play rates for both approaches. The study's primary goal is to establish which technique yields superior outcomes.

RECENT FINDINGS

Recent studies have suggested that arthroscopic Latarjet surgery can produce outcomes similar to open surgery regarding functional scores and patient satisfaction. Some research indicates that arthroscopy may even provide slightly better results. Both techniques have similar complication rates, but arthroscopy requires a longer learning curve and operating time. It is crucial to ensure the proper placement of the graft, and some studies suggest that arthroscopy may be better at achieving accurate positioning. Both open and arthroscopic Latarjet procedures are equally effective in treating shoulder instability. While arthroscopy offers a faster recovery time and causes less soft tissue damage, it requires surgeons to undergo a steeper learning curve. The optimal graft position for both techniques is still debated. More long-term data is needed to establish superiority. Future research should compare approaches in larger cohorts and identify outcome-affecting factors to improve the treatment of shoulder instability. Both techniques are promising, but arthroscopy may be a better option as the procedure evolves into a less invasive reconstruction.

Long-term Effectiveness and Outcome-Determining Factors of Arthroscopic Bankart Repair for Recreational Sports Population: An Assessment of 100 Patients With a Mean Follow-up of 12.7 Years

BACKGROUND

A limited number of studies have reported the long-term effectiveness of and associated factors for recurrence of anterior shoulder instability after arthroscopic Bankart repair (ABR).

PURPOSE

To report the long-term clinical outcomes after ABR in a recreational sports population and identify the associated factors that influence the final instability status.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

A retrospective study was performed in patients treated with ABR between 2007 and 2013 by a single surgeon. Patient data, magnetic resonance imaging measurements of bone loss and glenoid track, and intra- and perioperative factors were analyzed. After a minimum follow-up of 10 years, patient-reported outcomes including the Western Ontario Shoulder Instability Index score, the Rowe score, the visual analog scale for pain and function, the American Shoulder and Elbow Surgeons score, and sports activity were assessed. The current instability status was classified into 3 groups: stable, apprehensive, and redislocated. These groups were statistically compared with respect to outcomes and associated factors.

RESULTS

A total of 100 patients with a mean age of 22.4 ± 5.5 years and a mean follow-up of 12.7 ± 2.1 years were included. At the final follow-up, 38 patients (38%) showed recurrent symptoms: 19 patients (19%) with subjective apprehension and 19 patients (19%) with redislocation, including 10 patients (10%) with revision surgery. At the final follow-up, the redislocated group showed the lowest patient-reported outcomes and return to sports (both P < .001). The apprehensive group also showed a lower Western Ontario Shoulder Instability Index score (P = .011), Rowe score (P = .003), American Shoulder and Elbow Surgeons score (P = .027), and return to sports (P = .005) than the stable group. Participation in contact sports (P = .026), glenoid bone loss (P = .005), size of Hill-Sachs lesion (P = .009), and off-track lesions (P = .016) were all associated with recurrent symptoms, whereas age <20 years (P = .012), participation in contact sports (P = .003), and off-track lesions (P = .042) were associated with redislocation.

CONCLUSION

After long-term follow-up in a recreational sports population, ABR demonstrated a 19% rate of subjective apprehension and 19% rate of redislocation, with a gradual decline in clinical outcomes and sports activity over time. Therefore, candidates for ABR should be selected based on consideration of risk factors such as off-track lesions, age <20 years, and participation in contact sports.

Isolated Primary Latarjet Procedures for Anterior Shoulder Instability Results in High Rates of Graft Resorption and Glenohumeral Degenerative Changes With Low Rates of Failure at a Minimum 2-Year Follow-Up: A Systematic Review

PURPOSE

To evaluate the incidence of postoperative complications after an isolated primary Latarjet procedure for anterior shoulder instability at a minimum 2-year follow-up.

METHODS

A systematic review was performed in accordance with 2020 PRISMA guidelines. EMBASE, Scopus, and PubMed databases were queried from database inception through September 2022. The literature search was limited to human clinical studies reporting on postoperative complications and adverse events after a primary Latarjet procedure with a minimum 2-year follow-up. Risk of bias was measured using the Newcastle-Ottawa Scale.

RESULTS

Twenty-two studies, consisting of 1,797 patients (n = 1,816 shoulders), with a mean age of 24 years were identified. The overall postoperative complication rate ranged from 0% to 25.7%, with the most common complication being persistent shoulder pain (range: 0%-25.7%). Radiological changes included graft resorption (range: 7.5%-100%) and glenohumeral degenerative changes (range: 0%-52.5%). Recurrent instability following surgery was documented in 0% to 35% of shoulders, while the incidence of bone block fractures ranged from 0% to 6% of cases. Postoperative nonunion, infection, and hematomas had a reported incidence rate ranging from 0% to 16.7%, 0% to 2.6%, and 0% to 4.4%, respectively. Overall, 0% to 7.5% of surgeries were reported failures, and 0% to 11.1% of shoulders required reoperation, with a revision rate ranging from 0% to 7.7%.

CONCLUSIONS

The incidence of complications following the primary Latarjet procedure for shoulder instability was variable, ranging from 0% to 25.7%. High rates of graft resorption, degenerative changes, and nonunion were present while failure and revision rates remained low at a minimum 2-year follow-up.

LEVEL OF EVIDENCE

Level III, systematic review of Level I-III studies.

Current Evidence Regarding Shoulder Instability in the Paediatric and Adolescent Population

Paediatric and adolescent shoulder instability is caused by a unique combination of traumatic factors, ligamentous laxity, and pattern of muscle contractility. The multifactorial nature of its aetiology makes interpretation of the literature difficult as nomenclature is also highly variable. The purpose of this review is to summarize the existing literature and shed light on the nuances of paediatric and adolescent shoulder instability. The epidemiology, clinical features, imaging, and management of all forms of paediatric shoulder instability are presented. The main findings of this review are that structural abnormalities following a dislocation are uncommon in pre-pubertal paediatric patients. Young post-pubertal adolescents are at the highest risk of failure of non-operative management in the setting of traumatic instability with structural abnormality, and early stabilisation should be considered for these patients. Remplissage and the Latarjet procedure are safe treatment options for adolescents at high risk of recurrence, but the side-effect profile should be carefully considered. Patients who suffer from instability due to generalized ligamentous laxity benefit from a structured, long-term physiotherapy regimen, with surgery in the form of arthroscopic plication as a viable last resort. Those who suffer from a predominantly muscle patterning pathology do not benefit from surgery and require focus on regaining neuromuscular control.

Editorial Commentary: Both Bristow and Latarjet Procedures Result in Low Rates of Recurrent Shoulder Instability Despite Potential for Bone Resorption and Lack of Graft Healing

Anterior shoulder instability surgery has evolved over the decades, including both anatomic and nonanatomic repairs and reconstructions. Surgeons are continually advancing their skills and performing more of these procedures using arthroscopic as opposed to open techniques in patients with and without glenoid bone loss. However, there is a steep learning curve and increased technical demands when performing these procedures arthroscopically. Despite high success rates, bone graft resorption or lack of healing after Latarjet and Bristow procedures is well documented, and it is possible that patients develop enough scarring that their shoulders remain stable. Osteoarthritis after these nonanatomic procedures can occur making shoulder arthroplasty and reconstruction technically more challenging because of scarring and the altered anatomy. It remains to be seen whether these arthroscopic techniques as opposed to open surgery lessen the scarring and thus the technical demands of shoulder reconstruction in the small subset of patients who unfortunately develop symptomatic shoulder osteoarthritis. Therefore, in my practice, these techniques are carefully chosen for select patients. My indications for use of the Bristow procedure as a primary procedure for anterior shoulder instability are in patients who perform mixed martial arts fighting and high-level wrestlers without significant glenoid or humeral bone loss. My indications for the Latarjet procedure are in patients with chronic anterior instability and associated anterior glenoid bone loss 15% to 30%, off-track Hill-Sachs lesions, and revision surgery, particularly in high-demand contact and collision athletes. These 2 arthroscopic procedures, despite being nonanatomic, provide surgeons with excellent treatment options for those difficult patients with anterior shoulder instability. Despite high success rates with these arthroscopic procedures, patients should be counseled on the risks of graft resorption, graft nonunion, and possible shoulder osteoarthritis. The appropriate indications for these arthroscopic procedures can enhance the successful outcomes for high-risk patients with shoulder instability while also considering the possible long-term impacts of altering shoulder anatomy and scarring in the rare patient who develops shoulder osteoarthritis.

The arthroscopic treatment of anterior shoulder instability with glenoid bone loss shows similar clinical results after Latarjet procedure and iliac crest autograft transfer

PURPOSE

Recurrent anterior shoulder instability caused by critical bone loss of the glenoid is a challenging condition for shoulder surgeons. The purpose of this prospective multicenter trial was to compare the arthroscopic transfer of the coracoid process (Latarjet procedure) with the arthroscopic reconstruction of the glenoid using iliac crest autografts.

METHODS

A prospective multi-center trial was performed in nine orthopaedic centres in Austria, Germany and Switzerland between July 2015 and August 2021. Patients were prospectively enrolled and received either an arthroscopic Latarjet procedure or an arthroscopic iliac crest graft transfer. Standardized follow-up after 6 months and mimimum 24 months included range of motion, Western Ontario stability index (WOSI), Rowe score and subjective shoulder value (SSV). All complications were recorded.

RESULTS

177 patients (group Latarjet procedure: n = 110, group iliac crest graft: n = 67) were included in the study. WOSI (n.s.), SSV (n.s.) and Rowe score (n.s.) showed no difference at final follow-up. 10 complications were seen in group Latarjet procedure and 5 in group iliac crest graft; the frequency of complications did not differ between the two groups (n.s.).

CONCLUSION

The arthrosopic Latarjet procedure and arthroscopic iliac crest graft transfer lead to comparable results regarding clinical scores, frequency of recurrent dislocations and complication rates.

LEVEL OF EVIDENCE

Level II.

Outcomes at Long-term Follow-up After Open Latarjet Versus Open Bankart Repair in Rugby Players

Background

Because rugby is a collision sport, it exposes players to a high risk of recurrence after anterior shoulder stabilization. Therefore, the choice of surgical procedure warrants close attention in order to optimize the time to return to sport and the stability of the shoulder throughout the player's career.

Hypothesis

The open Latarjet procedure would allow for a faster return to play and provide a lower rate of recurrence than the open Bankart repair at long-term follow-up.

Study Design

Cohort study; Level of evidence, 3.

Methods

The study retrospectively enrolled 62 competitive rugby players who had undergone an anterior shoulder instability procedure and had at least 5 years of follow-up data. A total of 32 players treated with an open Bankart repair (BK group) were compared with 30 players (31 shoulders) treated with an open Latarjet procedure (LT group). Outcomes between groups were compared with the Rowe score, Walch-Duplay score, recurrence rate, and osteoarthritis evaluation on plain radiograph (Samilson classification).

Results

The recurrence rate was significantly higher at 18.8% for the BK group (mean follow-up, 6.9 ± 1.7 years) compared with 3.3% for the LT group (mean follow-up, 6.2 ± 1.4 years) (P = .04). No postoperative complications occurred in the BK group, whereas 1 infection and 1 hematoma required a second surgery in the LT group (P = .14). In the BK and LT groups, 97% and 90% of players, respectively, were able to return to rugby at the same level or higher (P = .27), at a mean time of 8 and 6.3 months, respectively (P = .03). The mean Rowe and Walch-Duplay scores were not significantly different between the groups; however, the osteoarthritis rate was significantly higher in the BK versus the LT group (68% vs 38%, respectively; P = .03); 23% of patients, all in the BK group, had Samilson grade 2 osteoarthritis.

Conclusion

The open Latarjet procedure outperformed the open Bankart procedure in terms of stability, time to return to play, and radiological outcomes at long-term follow-up in competitive rugby players.

Arthroscopic Latarjet Procedure Using FiberTape Cerclage With a Simplified Technique for Suture Passage and Coracoid Fixation

Arthroscopic Latarjet has evolved as a reproducible procedure to address significant anterior glenoid bone loss in recurrent anterior instability of the shoulder joint. While arthroscopic Bankart procedure for anterior shoulder instability has changed from metal anchors to absorbable or soft all-suture anchors to avoid metal-ware and subsequent abrasion in cases of osteolysis or backout, Latarjet procedure, until recently couple of titanium screws were used to fix the coracoid bone to the anterior glenoid. Arthroscopic techniques for Latarjet procedure of coracoid bone transfer have shown results similar to the open technique in many recent studies. We use an all-arthroscopic technique that is different and easier from the currently described technique using FiberTape cerclage loops, with 2 ultrabraid tapes fixing the coracoid bone to the prepared anteroinferior glenoid surface. The repair is completed using all-suture anchors to fix the anterior capsule over the attached coracoid, thus exteriorizing the transferred bone and preventing contact with the moving humeral head.