Summary

The open Latarjet procedure provides good outcomes with acceptable complication rates in the long-term, for symptomatic HAGL lesions.

Abstract

Introduction

Limited long-term evidence is available for the management of recurrent anterior glenohumeral instability caused by humeral avulsion of glenohumeral ligament (HAGL). We present a retrospective review with long-term follow-up of patients treated with an open Latarjet procedure for recurrent anterior shoulder instability due to a HAGL.

Methods

19 patients were operated on with by a single surgeon at a single centre, undergoing standardised assessment, rehabilitation and follow-up. 16 patients with complete clinical and radiological data and minimum 2 year follow-up were available for review. Outcomes assessed included range of motion (ROM), joint stability, Visual Analogue Score (VAS) for pain, Walch-Duplay score (WDS), Rowe score (RS), Constant-Murley score (CMS), Subjective Shoulder Value (SSV), satisfaction rating, return to sport and documentation of clinical and radiological complications.

Results

Patients were all male with no hyperlaxity, had a median age at surgery of 28 years (18-42) and median follow-up of 10 years (2.8-15). After surgery, the median range of motion showed recovered elevation of 175°, external rotation of 62° and internal rotation to T12 level. Post-operative VAS was 0.5, WDS 86, RS 95, CMS 77 and SSV 88%. 87% returned to sport, 68% got back to the same pre-injury level and 93% were satisfied. There were no recurrent dislocations or subluxations but 2 patients had subjective apprehension, associated with a significant Hill-Sachs and medial-seated graft, although SSV was 80%. Other complications included a superficial infection (successfully treated), a delayed bone-graft union (healed at 1yr), a patient with mild long-term pain and another with persistent stiffness. 56% had mild post-operative arthritis but 13% already had pre-operative degenerative changes. None required further surgery.

Conclusions

The open Latarjet procedure provides good outcomes with acceptable complication rates in the long-term, for symptomatic HAGL lesions. It is an effective treatment option and a safe alternative to arthroscopic or open HAGL repair.