Summary

In our study, we found that even when patients with no bone loss were selected for IAB, 20% of them experienced instability recurrence. This rate is much higher than the acceptable rate of 5%. Using the ISIS score is not a valid method for selecting patients for IAB to prevent long-term failures. Our findings suggest that IAB is not effective for treating recurrent anterior shoulder instability

Abstract

Background

Clinical studies have shown that open Latarjet Procedure (OLP) has lower recurrence rates than isolated arthroscopic Bankart (IAB) for recurrent anterior shoulder instability, but no long-term studies exist for IAB without bone loss.
Purpose/Hypothesis: The purpose of this study was to compare the outcomes of IAB in selected patients without bone loss versus OLP at long-term follow-up. The hypothesis was that OLP would be more successful in preventing recurrence, even when patients were selected carefully for IAB.
Study Design: Cohort study; Level of evidence 3.

Methods

A total of 774 patients who had undergone primary IAB or OLP between January 2007 and December 2021 were analyzed. The patients who underwent primary IAB were matched with patients who underwent OLP in a 1:1 ratio using propensity matching. The final analysis included 45 patients in each group. Our main objective was to identify new episodes of instability in patients. We considered a recurrence rate of less than 5% to be acceptable. The patients' survivorship was evaluated using Kaplan-Meier analysis. To account for potential factors affecting recurrence rates, logistic regression was performed. In addition, we collected data on return to sport rate, Walch and Duplay score, VAS, and external rotation.

Results

The mean follow-up was 9 years and 3 months. A new episode of instability occurred in 2% of the OLP group and 20% of the IAB group (p-value 0.04). Regarding the rest of our analyses, there was no significant difference. Patients maintained good external rotation: 68° in the OLP group compared with 72° in the IAB group (p-value 0.325), associated with low pain at 1.2/10 in the OLP group compared with 1.5/10 in the IAB group (p-value 0.433). Walch and Duplay’s score reached 79.9 in the OLP group compared with 78.9 in the IAB group (p-value 0.496) and 89% of the OLP group returned to their previous sport’s level compared to 73% of the IAB group (p-value 0.104).

Conclusion

Patients who underwent an OLP had significantly better long-term survivorship without any recurrence compared to those who underwent an IAB, even if the patients were selected without any bone loss. The risk of undergoing a new episode of instability recurrence was 11 times higher for patients who underwent IAB, with a mean follow-up of 9 years and 3 months.