Summary

Revision Arthroscopic Latarjet is an efficient and safe procedure with high rate of return to sport and low complication rate..

Abstract

Background

Recurrent anterior instability after arthroscopic Bankart repair (ABR) it's a concern and often related to glenoid bone loss. Results of arthroscopic Latarjet in this setting has never been published.

Purpose

To asses clinical and radiological outcomes after revision arthroscopic Latarjet procedure for recurrence of anterior instability after failed arthroscopic Bankart repair.
Study design: Case series; Level of evidence, 4.

Methods

We included all patients undergoing revision of failed Bankart repair with arthroscopic Latarjet. Recurrence, complications and return to sport were assessed. Forty-eight consecutive patients (38 males; mean age 30 years ±9.4, 17-55) were followed for a mean 73 months (±40, 26-150). All patients had recurrent shoulder dislocation (31 cases) or subluxation (17 cases) and apprehension before revision surgery. ISIS score was 5.2 points (±1.9, 1-9). 32 patients had hyperlaxity and 44 were involved in sport practice. Recurrent instability occurred in average 29 months (±35, 3-166) after ABR, whereas revision surgery was performed 59 months (±62, 8-303) after failed ABR. All patients had a Hill-Sachs lesion and 41% had glenoid bone defect > 20% on preoperative imaging studies or during arthroscopy. Button fixation was performed in 36 patients while 12 patients underwent single screw fixation. An associated capsulolabral repair was performed in all, and an additional Hill-Sachs remplissage only in four patients.

Results

At final follow-up, no recurrence was observed; 10 patients (21%) had persistent anterior apprehension. Two complications (one temporary musculocutaneous nerve palsy and one infection) were addressed and one reoperation was performed. Mean Walch-Duplay and ROWE score were 80 (±16, 45-100) and 82 (±16, 45-100), respectively. Mean subjective shoulder value (SSV) for daily living (SSVdaily) was 91 (±11, 40-100) while for sport (SSVsport) was 86% (±14, 40-100) . Visual analogue scale (VAS) for pain was 1.1 ± 2. No significant difference was observed in terms of range of motion before revision surgery and at last follow-up. Return to sports was achieved in 98% of cases, but only 19 patients practiced high risk sports. 55% returned to competition level (11/20). Return to sport was faster in those patients practicing sports without risk (5.4 ± 1.5 months vs. 6.7 ± 2 months, P = 0.018). Bone block healed in 88% of cases. Flush positioning was observed in 83% of cases and subequatorial in 44 patients. Single screw fixation technique group had higher incidence of bone block nonunion (33% vs 6%, P = .028) and lateralized bone block (33% vs 6%, P < .001). Bone block migrated in 6 patients before 9 months post-operative. Arthritic changes (Samilson 1, 2 and 3) were observed in 15 patients (31%) but no patient developed osteoarthritis with joint line narrowing (Samilson 4). Overall, 47 patients (98%) were satisfied or very satisfied with the procedure. Persistent anterior apprehension was associated to a lower level of SSVsport (p = 0.038) and bone block nonunion/migration (p = 0.012).

Conclusion

Arthroscopic Latarjet is an efficient and safe procedure for failed ABR, with high rate of return to sport and patients’ satisfaction. The arthroscopic nature of the technique offers the possibility to control bone block position and simultaneously address other associated lesions (labrum detachment, engaging hill-sachs lesion, cuff or biceps tendon lesion).