Long-term outcomes of anterior shoulder instability treated with open latarjet procedure - a systematic review of outcomes at a minimum 15-year follow-up

Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Anterior Shoulder Instability: A Matched-Pair Long-Term Follow-up Study

Background

The Bankart and the Latarjet procedures are 2 of the most commonly utilized surgical techniques to treat anterior shoulder instability. However, the long-term outcomes after these procedures remain unclear, and there is not enough information regarding arthroscopic Latarjet.

Purpose

To analyze long-term outcomes of patients with anterior glenohumeral instability managed with an arthroscopic Bankart or Latarjet procedure.

Study Design

Cohort study; Level of evidence, 3.

Methods

Patients who underwent an arthroscopic Latarjet were matched-paired in a 1:1 ratio with patients who underwent an arthroscopic Bankart procedure at a single institution between 2007 and 2012. Recurrence at the time of follow-up as well as intraoperative and postoperative complications were recorded and compared between the 2 groups. Postoperative status was assessed at the final follow-up using the Rowe score, the Western Ontario Shoulder Instability Index (WOSI), the Subjective Shoulder Value, and the return-to-sport rate.

Results

A total of 80 patients, 40 patients in each group, were included (overall mean age, 26.5 ± 15.4 years). The mean follow-up was 13.2 years (range, 10-17 years). The recurrence rate was significantly higher in the Bankart group compared with the Latarjet group (35% vs 10%, respectively; P = .009). The mean estimate for the cumulative proportion of stable shoulders at 15-year follow-up was 64.4% in the Bankart group and 89.6% in the Latarjet group (P = .008). Revision surgery because of instability was necessary in 8 (20%) patients in the Bankart group and 2 (5%) in the Latarjet group (P = .41). There was no significant group difference in complication rate (15% in the Bankart group vs 17.5% in the Latarjet group; P = .48). The WOSI score was significantly better in patients treated with arthroscopic Latarjet (P = .004). More than half of the patients were able to completely return to their previous sport (52.5%), with no significant difference between groups.

Conclusion

Arthroscopic Latarjet was associated with a significantly lower recurrence rate and better postoperative WOSI score and sports activity level at long-term follow-up compared with arthroscopic Bankart, without any greater risk of complications.

The impact of glenohumeral bone loss on range of motion in patients with anterior shoulder instability

BACKGROUND

Loss of shoulder range of motion (ROM) is common after surgical management of anterior shoulder instability; however, it remains unclear to what degree this is related to their injury.

AIM

The purpose of this study was to compare passive shoulder ROM in patients with ASI to a normal contralateral shoulder.

METHODS

A total of 121 patients undergoing stabilization surgery were prospectively enrolled. Preoperative advanced imaging was used to assess for glenoid bone loss and the presence of off-track Hill-Sachs lesions. Passive ROM was measured in both shoulders while under anaesthesia prior to surgery.

RESULTS

In all directions, there was a significant loss of ROM in shoulders with instability. Regression analysis showed that neither a glenoid bone defect nor greater glenoid bone loss were associated with a loss of ROM in any plane. The presence of a Hill-Sachs lesion was significantly associated with a loss of external rotation, while off-track lesions were associated with a loss of ROM in all planes (p < 0.05).

CONCLUSION

Patients with anterior shoulder instability lost motion in all directions, with a profound loss of external rotation. The presence of a glenoid bone defect nor greater bone loss did not reliably predict a loss of range of motion. A Hill-Sachs lesion was predictive of a loss of external rotation, while an off-track lesion was predictive of a loss of range in all directions.

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.

The clinical utility of immediate post-operative PACU plain film radiographs following uncomplicated open Latarjet procedure - An institutional series of consecutive patients

Background

Immediate post-operative plain film radiograph x-rays in PACU following open Latarjet procedure are often ordered as routine. However, such radiographs utilize institutional cost and time, whilst potentially exposing patients to often-unnecessary additional radiation. This study sought to evaluate whether routine immediate post-operative radiographs following uncomplicated open Latarjet procedures impacted clinical decision-making in our institution.

Methods

From 2017 to 2020, patients who underwent open Latarjet procedure by one of four fellowship-trained upper limb surgeons at a single institution were included in this study. Post-operative radiographs taken immediately in PACU were reviewed to determine if any reported radiographic findings impacted on clinical decision-making in the immediate post-operative setting. SPSS was used for descriptive statistics.

Results

A total of 337 patients underwent an X-ray in PACU immediate after uncomplicated open Latarjet procedure. Overall, 98.5% were male (n = 332), the mean patient age of included patients was 22.9 ± 4.2 years. No patient had an abnormal finding on their post-operative x-ray. Two patients returned to the operating room in the immediate post-operative period, both requiring washout and debridement due to haemtoma or superficial wound infection.

Conclusion

The findings of this study suggest that the use of post-operative plain films in PACU following open Latarjet procedure remains a costly use of resources, with little ultimate impact on clinical decision making in the short-term post-operatively.

Level of Evidence

IV - Institutional Case Series of Consecutive Patients.