Summary

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

Abstract

Aim

The purpose of the study was to analyze long-term clinical outcomes of patients with anterior glenohumeral instability managed with an arthroscopic Bankart or an arthroscopic Latarjet procedure.
We hypothesized that the arthroscopic Latarjet would yield better long-term results in terms of recurrence rate, clinical and functional status.

Methods

Retrospective of prospective collected data study of patients with anterior glenohumeral instability managed with an arthroscopic bankart repair or an arthroscopic Latarjet procedure and a minimum 10-years follow-up. Patients treated with an arthroscopic Latarjet were matched-paired in a 1:1 ratio with patients who underwent an arthroscopic bankart procedure according to preoperative features except for bone loss. Inclusion criteria for this study were (1) disposal of pre-operative magnetic resonance imaging (MRI) or computed tomography (CT) and (2) a minimum 10-year follow-up. Revision surgery and concomitant procedures not addressed in this study, but potentially related to instability (i.e., SLAP repair, biceps tenodesis, remplissage or rotator cuff repair) were considered as exclusion criteria. Patients suffering from posterior, multidirectional glenohumeral instability, and voluntary instability were also excluded. Recurrence at the time of follow-up, set as subluxation or dislocation, intraoperative and postoperative complications were recorded and compared between two groups. Postoperative status was assessed at the final follow-up using the Rowe score, WOSI Index, subjective shoulder value (SSV) and return-to-sport rate.

Results

80 patients, 40 in each group, mean age 26.5 ± 15.4 years, with a mean follow-up of 13.2 years (range 10 to 17 years) were included. Recurrence rate was significantly higher in the Bankart group compared with the Latarjet group (35% vs 10%, p=0.009). The mean estimate for the cumulative proportion of stable shoulders at 15 years follow-up was 64.4% in the Bankart group and 89.6% in the Latarjet group (p=0.008). Revision surgery was necessary in 5 (12.5%) patients in the Bankart group and 2 (5%) in the Latarjet group (p=0.407). There was no statically significant difference between groups in rates of complications (15% in the Bankart group vs 17.5% in the Latarjet group, p=0.483). Regarding postoperative outcomes, WOSI score was significantly better in patients treated with a Latarjet procedure compared with those who underwent a Bankart repair (p=0.004). No statistically differences were found in postoperative degree of instability, ROWE and SSV score between the two groups (p=0.114, p=0.155, p=0.261). Most patients were able to completely return to their previous sport (52.5%); no statistically differences between groups were found. However, patients in the Latarjet group achieved higher activities level when compared to those in the Bankart group (p=0.018).

Conclusion

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