Summary

The majority of athletes with recurrent glenohumeral instability who underwent Latarjet surgery were able to return to sport at the same level as before the injury with a complete recovery of shoulder function and a similar percentage of complications regardless of the severity of the preoperative glenoid bone loss

Abstract

Introduction

Latarjet surgery has proven effective for the management of recurrent anterior instability with glenoid bone deficit in athletes. In recent years, its indications have been extended to the management of patients considered “high risk”, despite not presenting a significant bone deficit. Among these patients are contact athletes, patients with previous failed surgeries, patients with Hill-Sachs off track lesions and patients with subcritical glenoid bone deficit (deficit of 10% to 20%).
The aim of the following study was to compare functional outcomes, return to sport and complications in a consecutive series of patients with recurrent glenohumeral instability by dividing patients for analysis into three groups according to the severity of the preoperative glenoid bone loss (GBL) (Group 1: GBL ≤ 10%; Group 2: GBL between 11 - 20%; Group 3: GBL >20%.

Materials And Methods

Prospective comparative cohort study of a consecutive series of competitive sports patients with anterior glenohumeral instability operated on at the our Institution in the period between January 2014 and January 2019. For functional evaluation of the shoulder we measured range of motion, Rowe score, ASES score, visual analog scale and ASOSS score. The sports outcomes evaluated were the percentage of return to sport, the sports level achieved and the time elapsed between surgery and return to competition. Graft consolidation was assessed by 3D computed tomography in all patients. All intraoperative and postoperative complications were documented. All results were compared between the three groups of patients.

Results

310 patients were prospectively evaluated, (Group 1: GBL ≤ 10% (n=120) ; Group 2: GBL between 11 - 20% (n=105); Group 3: GBL >20% (n=85). Mean follow-up was 8.3 years (range 6.3-9.9 years). Mobility, Rowe score, ASES score, visual analog scale (VAS) and ASOSS score showed significant improvement after surgery (P<0.001). We found no statistically significant differences in range of motion or functional scores in relation to the severity of the preoperative GBL. In total, 286 patients (92%) returned to sport and of these, 259 patients (83%) were able to return to competition at their pre-injury level. The overall mean interval between surgery and return to sport was 5.4 months (range 3 to 7 months). In total there were 48 complications (15%) and 11 reoperations (3.5%) with no significant differences between groups. The control 3D tomography was performed on average at 3.4 months. The graft consolidated in 94.5% of patients. At the end of follow-up, 11% of patients had a mild stage of osteoarthritis and 6% had a mild stage of osteoarthritis.

Conclusion

The majority of athletes with recurrent glenohumeral instability who underwent Latarjet surgery were able to return to sport at the same level as before the injury with a complete recovery of shoulder function and a similar percentage of complications regardless of the severity of the preoperative GBL.