Majority of Studies Show Similar Rates of Return to Play After Arthroscopic Bankart Repair or Latarjet Procedure: A Systematic Review

Arthroscopic Iliac Crest Autograft Glenoid Augmentation using Tape Cerclage Fixation for Bony Deficiency and Recurrent Anterior Shoulder Instability Improves Functional Outcomes and Achieves High Union Rates with Graft Resorption in Non-Loaded Areas

PURPOSE

This study aimed to evaluate the clinical outcomes, return-to-sport rate, and graft remodeling after arthroscopic iliac crest bone autograft (ICBA) tape cerclage fixation for glenoid bone loss (GBL) in recurrent anterior shoulder instability.

METHODS

Case series of patients with recurrent anterior shoulder instability with GBL≥15% who underwent arthroscopic ICBA metal-free tape cerclage fixation between February 2019 and March 2022 with a minimum follow-up of 2 years. Range of motion, patient-reported outcomes (PROs), return to sport, instability recurrence, and complications were collected preoperatively and at postoperative follow-ups. Graft resorption mapping was assessed by evaluating the distribution of articular surface remodeling on sagittal CT scans. The graft surface was divided in two columns: the inner (loaded) column and the outer (non-loaded) column.

RESULTS

Twenty-eight patients with a mean age of 29.1±7.9 years and a mean follow-up of 37.6±5.8 months were included. The mean GBL was 18.4%±3.4 (range 15-25). External rotation was 4º lower (P<.001) compared to the uninjured side. PROs significantly improved from baseline to 2-year follow-up (P<.001): WOSI: 37.2±18.7 to 94.9±8.8, Rowe: 30.2±16.4 to 96.1±11.5, Constant-Murley: 83±13.6 to 98.7±3.2, SSV: 43.5±21.3 to 96.5±8.3. Twenty-one patients (88%) returned to their previous sport level at a mean of 4.8±1.7 months. No recurrent instability was reported. The glenoid surface area increased from 81.6% preoperatively to 120.1% immediately post-surgery (P<.001), decreased to 101.2% at 1 year (P<.001) and to 98.2% at 2 years postoperative (P=.018). Graft resorption mapping showed higher osteolysis of the graft in the non-loaded area compared to the loaded area at 2 years postoperative (94.2%±12.9 vs 8.7%±15, respectively, P<.001).

CONCLUSION

Arthroscopic glenoid reconstruction using ICBA fixed with tape cerclage is a safe and effective treatment for recurrent anterior shoulder instability with GBL greater than 15% at short-term follow-up. The procedure shows a high union rate, with articular graft surface resorption predominantly affecting non-loaded areas.

LEVEL OF EVIDENCE

Retrospective Case Series.

LEVEL OF EVIDENCE IV

Lower education level is associated with failure to return to sport while bony Bankart lesions predict successful return to pre-injury sport level following open Latarjet procedure

PURPOSE

The aim of this study is to identify prognostic factors of patients that are associated with failure to return to sport (RTS) and return to pre-injury level of sport (RTPS) following open Latarjet procedure.

METHODS

A multicenter retrospective case-control study was conducted across five hospitals in the Netherlands. Consecutive patients who underwent surgical treatment with the open Latarjet procedure between 2014 and 2019, with a minimum follow-up of 24 months, were invited to participate. Participants received a questionnaire after giving informed consent prior to inclusion. Failure to RTS was defined as no return to any type of sport, including non-collision/non-overhead shoulder sport, high-impact/collision sport and overhead shoulder sport. Failure to RTPS was defined as no return to the same or higher level of sport. Risk factors associated with failure to RTS or RTPS were identified using logistic regression analysis. Covariates were selected based on univariate analyses.

RESULTS

One-hundred and forty patients with a mean follow-up of 61 ± 30 months (range: 24-106) and a mean percentage glenoid bone loss of 19 ± 11 (range: 0-47%) were included. Twelve (9%) did not RTS and 48 (34%) did not RTPS. A lower level of education was associated with no RTS (OR: 4.39; 95% CI: 1.13 - 16.97; p=0.03) and bony Bankart with successful RTPS (OR: 0.36; 95% CI: 1.17 - 6.55; p=0.02). Patients who RTS had higher Oxford Shoulder Instability Score (OSIS) (42 ± 7 vs. 35 ± 10, p=0.01) and patients who RTPS had higher OSIS (43 ± 6 vs. 38 ± 8, p<0.001) and satisfaction scores (8 ± 1 vs. 7 ± 2, p<0.001).

CONCLUSION

This study concluded that lower level of education is associated with failure to RTS and that bony Bankart is a prognostic factor of successful RTPS following an open Latarjet procedure.

Open Latarjet Results in Lower Recurrent Instability and Revision Rates Than Arthroscopic Bankart Repair at a 10-Year Follow-Up: A Systematic Review

PURPOSE

To compare arthroscopic Bankart repair versus the open Latarjet procedure at a minimum of a 10-year follow-up evaluating recurrence and arthropathy development rates.

METHODS

A systematic review was performed in concordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they reported on the arthroscopic Bankart repair or open Latarjet procedure with a minimum 10-year follow-up. Recurrent instability, revisions, and instability arthropathy were evaluated.

RESULTS

Overall, 40 studies met our criteria and were included, with 2,019 shoulders undergoing arthroscopic Bankart repair and 1,069 undergoing the open Latarjet procedure. The rate of recurrent instability was 0.0% to 22.6% (redislocations: 0.0%-9.6%) in those undergoing an open Latarjet procedure and 13.3% to 82.2% (redislocations: 9.6%-25.7%) among those undergoing arthroscopic Bankart repair. The rate of total revisions was 0.0% to 17.9% in those undergoing an open Latarjet procedure and 4.8% to 42.9% among those undergoing arthroscopic Bankart repair. The rate of overall arthritis was 10.3% to 71.4% in those undergoing an open Latarjet procedure and 16.7% to 89.3% among those undergoing arthroscopic Bankart repair.

CONCLUSIONS

There was a lower recurrent instability rate and revision rate in the open Latarjet group compared to the arthroscopic Bankart group at long-term follow-up. The rates of moderate to severe arthritis were comparable between the 2 procedures.

LEVEL OF EVIDENCE

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

Over 89% of Patients Return to Work After Undergoing Arthroscopic or Open Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review

PURPOSE

To better define the rate of return to work in patients undergoing Latarjet surgery for anterior shoulder instability.

METHODS

A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane Center Register of Controlled Trials, and Scopus were queried in October 2023 with the following keywords: ((latarjet) OR (anterior shoulder instability)) AND ((work) or (compensation)). Articles were included if they reported return to work in patients (including military members) undergoing Latarjet surgery for traumatic anterior shoulder instability with bone loss and were written in English. This study was registered in Prospero (ID blinded).

RESULTS

Six studies reporting on 419 shoulders were included in the review. Five studies reported on patients in the general population, and 1 reported on military members. Mean age ± standard deviation of patients ranged from 23.1 ± 5.8 to 32.0 ± 12.3 years. Moreover, there were 286 primary Latarjet procedures, 131 revision Latarjet procedures, and 2 unspecified as primary or revision surgery. Mean glenoid bone loss ranged from 14.5% to 22.9%. Return-to-work rates ranged from 89.1% to 100%, with 2 studies reporting all patients were able to return to work. Among military members, 89.1% were able to return to duty. Mean time to return to work ranged from 8.69 to 34.8 weeks after surgery. Four studies also reported return to sport, which ranged from 60.9% to 100%. Mean time for returning to sport varied between 10.0 and 35.2 weeks after the Latarjet procedure.

CONCLUSIONS

Patients with anterior shoulder instability who undergo an arthroscopic or open Latarjet procedure can expect high rates of return to work and sport. All studies reported return-to-work rates over 89%, with 89.1% of military members able to return to duty.

LEVEL OF EVIDENCE

Level IV, systematic review of Level III and Level IV studies.

Clinical outcomes in prospective versus retrospective studies on arthroscopic Bankart repair: a systematic review

BACKGROUND

The majority of the current literature on arthroscopic Bankart repair is retrospective, and discrepancies exist regarding clinical outcomes including recurrent instability and return to play among studies of different levels of evidence.

PURPOSE

The purpose of this study is to perform a systematic review of the literature to compare the outcomes of prospective and retrospective studies on arthroscopic Bankart repair.

METHODS

A search was performed using the PubMed/Medline database for all studies that reported clinical outcomes on Bankart repair for anterior shoulder instability. The search term "Bankart repair" was used, with all results being analyzed via strict inclusion and exclusion criteria. Three independent investigators extracted data and scored each included study based on the 10 criteria of the Modified Coleman Methodology Score out of 100. A χ2 test was performed to assess if recurrent instability, revision, return to play, and complications are independent of prospective and retrospective studies.

RESULTS

A total of 193 studies were included in the analysis, with 53 prospective studies and 140 retrospective in design. These studies encompassed a total of 13,979 patients and 14,019 surgical procedures for Bankart repair for shoulder instability. The rate of redislocation in the prospective studies was 8.0% vs. 5.9% in retrospective studies (P < .001). The rate of recurrent subluxation in the prospective studies was 3.4% vs. 2.4% in retrospective studies (P = .004). The rate of revision was higher in retrospective studies at 4.9% vs. 3.9% in prospective studies (P = .013). There was no significant difference in terms of overall rate to return to play between prospective and retrospective studies (90% and 91%, respectively; P = .548). The overall rate of non-instability complications in the prospective cohort was 0.27% vs. 0.78% in the retrospective studies (P = .002).

CONCLUSIONS

The overall rates of recurrent dislocations-subluxations are higher in prospective studies than retrospective studies. However, rates of revision were reportedly higher in retrospective studies. Complications after arthroscopic Bankart repair are rare in both prospective and retrospective studies, and there was no difference in rates of return to play.

Shoulder dislocations in professional male football (soccer): A retrospective epidemiological analysis of the German Bundesliga from season 2012/2013 until 2022/2023

PURPOSE

Injuries exert a detrimental impact on the team performance in professional football. Shoulder dislocations are known for their severity and often cause substantial lay-off times. However, there is a notable gap in the general understanding regarding the frequency and convalescence of these events in professional football. Thus, the aims of this study were (1) to determine the incidence, (2) to evaluate return to competition (RTC) and redislocation events (RDEs) and (3) to identify relevant player-, match- and injury-related parameters.

METHODS

All shoulder dislocations within the highest three German football leagues (1.-3. Bundesliga) during the seasons 2012/2013 until 2022/2023 were identified. Player-, injury- and match-related data were obtained by performing a media analysis. Data were analysed using descriptive statistics. p Value was set at 0.05.

RESULTS

A total of 90 first-time shoulder dislocations in 89 players with a median age of 25 years (interquartile range [IQR]: 23-28) were available for analysis. The incidence was 9.1 per 1000 Bundesliga matches played and increased over time. Forty-four (49%) shoulder dislocations were treated conservatively and 46 (51%) operatively. Median RTC was 24 days (IQR: 12-43) following conservative and 103 days (IQR: 85-135) following surgical treatment (p < 0.001). Twenty-two (24%) players suffered a redislocation, of whom 13 (59%) underwent initial conservative and nine (41%) initial surgical treatment (not significant [n.s.]). RDE following conservative treatment was after a median of 4 months (IQR: 2-22) and 7 months (IQR: 3-23) following surgical treatment (n.s.).

CONCLUSION

The incidence of shoulder dislocation within professional football is increasing and currently amounts to 9.1 per 1000 matches played. A conservative treatment leads to a quicker RTC, while frequency and time to RDE were similar regardless of treatment. The increasing incidence of shoulder dislocations in professional football necessitates an analysis of relevant injury mechanisms and the implementation of specific preventive measures.

LEVEL OF EVIDENCE

Level III.

Return to sports following arthroscopic Bankart repair in collision athletes: A systematic review

Background

The purpose of this study was to systematically review the rate and time frame to return to sports in collision athletes following arthroscopic Bankart repair.

Methods

A systematic literature search based on Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases was performed. Manuscripts were included if they studied collision or contact athletes, reported on return to play rates or percentages, underwent arthroscopic Bankart repair, published in a peer-reviewed journal, and published in English. The study characteristics and clinical outcomes were extracted.

Results

A total of 19 studies with 1077 patients were included. Among collision athletes undergoing arthroscopic Bankart repair, the overall rate of return to sports was 89.8% (range 72%-100%). The mean time to return to sports was 5 months (range 3-6). The overall rate of returning to the same level of play was 80.8% (range 71.1%-100%). There were high return to sports rates among all collision sports. Specific return-to-play criteria were reported in most of the studies (95%), with time to return to sport being the most reported item (89.4%).

Conclusion

Although overall return to sport among collision athletes following arthroscopic Bankart repair remains high, the proportion of athletes returning to their preoperative level of play was substantially lower.

Criteria-based return to sport testing after open Latarjet reveals residual deficits and can be utilized for sports clearance with excellent outcomes at mean 3.6 year follow-up: A small case series of competitive athletes

OBJECTIVE

The purpose of this study was to assess the use of a criteria-based return to sport (CBRTS) test to evaluate readiness for return to play (RTP) in competitive athletes that underwent open Latarjet.

DESIGN

Retrospective case series.

METHODS

Ten competitive athletes (mean age 19.9 years) treated with open Latarjet for recurrent glenohumeral instability underwent CBRTS testing at a mean of 5.3 months postoperatively. Testing consisted of four components: 1. isometric strength, 2. isokinetic strength, 3. endurance, and 4. function. Patients failing 0 or 1 component of the test were cleared to RTP. Patients failing multiple components underwent additional deficit-based rehabilitation.

RESULTS

Of the 10 patients that tested, 4 passed their overall CBRTS test and were cleared to RTP. The remaining 6 patients failed the overall CBRTS test. Seven patients (70%) failed at least one section of the strength testing, two patients (20%) failed endurance testing, and two patients (20%) failed functional testing. At final follow-up (mean 3.6 years), 1 patient had recurrent instability (10%) and 9 patients returned to play (90%).

CONCLUSIONS

CBRTS testing may be clinically useful for return to play clearance decisions after open Latarjet procedure, as it can reveal deficits that may not be identified with time-based clearance alone.