Bony reconstruction after failed labral repair is associated with higher recurrence rates compared to primary bony reconstruction: a systematic review and meta-analysis of 1319 shoulders in studies with a minimum of 2-year follow-up

Iersel, Theodore P. van; Spanning, Sanne H. van; Verweij, Lukas P.E.; Priester-Vink, Simone; Deurzen, Derek F.P. van; Bekerom, Michel P.J. van den

doi:10.1016/j.jse.2022.02.044

Cited by 4 publications

(5 citation statements)

References 69 publications

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“…Patients with recurrent anterior shoulder instability following primary labral repair experienced no difference in recurrence when revision labral repair was compared with osseous reconstruction in a systematic review and meta-analysis of 4 studies 22 . The recurrence rate after primary osseous reconstruction, 4%, was significantly lower than the rate after revision, 10.7% (p < 0.008), but there were no significant differences in return to sport, additional revision surgical procedures, or complications 23 .…”

Section: Glenohumeral Instabilitymentioning

confidence: 74%

What’s New in Sports Medicine

McKeithan

Lameire

Tagliero

et al. 2023

Journal of Bone and Joint Surgery

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Section: Glenohumeral Instabilitymentioning

confidence: 74%

What’s New in Sports Medicine

McKeithan

Lameire

Tagliero

et al. 2023

Journal of Bone and Joint Surgery

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“…Reports in the literature comparing the clinical outcomes of open Latarjet as primary versus revision surgery are scant. While some studies suggested the worst results after revision surgery, 10,22,30 others reported comparable outcomes between primary and revision surgery. 23,32 Our findings regarding the recurrence after revision surgery are similar to those described in a recent study by Rossi et al, 23 who found equally satisfactory outcomes after the open Latarjet procedure as primary or revision surgery.…”

Section: Discussionmentioning

confidence: 99%

“…However, several recent publications have reported inferior outcomes of the open Latarjet after failed labral repair compared with primary Latarjet surgery, suggesting that the revision Latarjet may be better suited as primary surgery for anterior shoulder instability. 10,22,30,31 Conversely, others have failed to find a significant difference between primary and revision Latarjet repair. 22 The open Latarjet procedure has been widely successful over the decades, but arthroscopic Latarjet repair as a revision surgery has also been on the rise.…”

mentioning

confidence: 99%

Outcomes of Arthroscopic Latarjet as a Revision Surgery After Failed Arthroscopic Bankart Repair

Calvo,

Dzidzishvili,

Valencia

et al. 2024

Am J Sports Med

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Background: The role of arthroscopic Latarjet as a revision surgery after failed arthroscopic Bankart repair has yet to be established. Purpose: To compare clinical outcomes, recurrences, and complication rates of arthroscopic Latarjet as a revision procedure after failed arthroscopic Bankart repair versus arthroscopic Latarjet as a primary procedure. Design: Cohort study; Level of evidence, 3. Methods: This is a retrospective study of prospectively collected data of patients who were diagnosed with anterior shoulder instability and underwent arthroscopic Latarjet stabilization between 2009 and 2018. Patients were separated into 2 groups depending on whether Latarjet was performed after a previous instability surgery (revision) or as a primary surgery (primary). Rowe score, Western Ontario Shoulder Instability Index (WOSI), Constant-Murley Shoulder Outcome (CMSO) score, and Single Assessment Numeric Evaluation (SANE) were assessed pre- and postoperatively with a minimum 24 months of follow-up. In addition, pre- and postoperative levels of sports activity, dislocations, subluxations, and complications were assessed. Results: A total of 97 patients (n = 62 revision; n = 35 primary), with a mean age of 31.0 ± 8.8 and 29.4 ± 7.6 years old in the revision and primary Latajet group, respectively, met the inclusion criteria. The mean follow-up in the revision group was 32 months (24-53) and 35.5 months (27.7-42.2) in the primary Latarjet group. No significant differences between groups were observed in Rowe score (revision = 91.4, primary = 94.1; P = .223), CMSO score (revision = 90.7, primary = 94; P = .105), and SANE (revision = 85.8, primary = 87.3; P = .683) postoperatively. However, the postoperative difference in the WOSI score between the revision and primary Latarjet groups was nearly significant (510 ± 334 vs 403 ± 343, respectively; P = .05). Four (6.4%) postoperative dislocations were reported in the revision and 1 (2.8%) in the primary Latarjet group ( P = .14). Patients in the revision group had a lower return to the previous level of sports participation ( P = .008) and decreased external rotation with the arm by the side compared with the primary Latarjet group ( P = .000). Conclusion: Arthroscopic Latarjet as a revision surgery is a reasonable surgical option in failed Bankart repair cases. The decision to perform arthroscopic Latarjet stabilization as a revision surgery should not be influenced by the potential risk of future complications as it provides comparable clinical outcomes to the primary Latarjet procedure with a low postoperative recurrence rate. However, a decreased level of postoperative sports participation and external rotation with the arm by the side can be expected.

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“…10,11 In addition, various authors have reported suboptimal results in patients undergoing revision surgery after a previous failed procedure. 10,11,28…”

Section: Discussionmentioning

confidence: 99%

“…10,11 In addition, various authors have reported suboptimal results in patients undergoing revision surgery after a previous failed procedure. 10,11,28 An alternative that could be considered in the face of unfavorable long-term results with Bankart repair is bone reconstruction with the Latarjet procedure. A recent systematic review conducted by Hurley et al 12 evaluating long-term outcomes of the Latarjet procedure for anterior shoulder instability reported an 8.5% recurrent instability rate at a mean follow-up of 17 years.…”

Section: Discussionmentioning

confidence: 99%

A 2-Year Follow-up May Not be Enough to Accurately Evaluate Recurrences After Arthroscopic Bankart Repair: A Long-term Assessment of 272 Patients With a Mean Follow-up of 10.5 Years

et al. 2023

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Background: There is a great discrepancy between the rates of recurrent instability reported after arthroscopic Bankart repair in relation to the follow-up time. Purpose: To analyze the rate of recurrences after arthroscopic Bankart repair in the long term, emphasizing whether a minimum follow-up of 2 years is adequate to assess this outcome. Study Design: Case series; Level of evidence, 4. Methods: Between January 2008 and April 2013, a total of 356 athletes underwent arthroscopic Bankart repair for anterior glenohumeral instability at our institution. Return to sports, the Rowe score, the Subjective Shoulder Value (SSV), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. We analyzed the proportion of recurrences before and after 4 years of follow-up. Additionally, we performed a Kaplan-Meier analysis to evaluate recurrence-free time in patients with a recurrence. Results: The mean follow-up was 10.5 ± 1.6 years, and the mean age was 20.8 ± 3.9 years. In total, 90% of patients were able to return to sports; of these, 91% returned to their preinjury level of play. The Rowe, SSV, and ASOSS scores showed a statistical improvement after surgery ( P < .01). The proportion of patients with a recurrence during the follow-up period was 25% (95% CI, 20%-31%; n = 70), and the mean time until a recurrence was 3.8 ± 2.6 years. Only 39% of the recurrences (95% CI, 30%-48%) occurred in the first 2 years after surgery, while 61% (95% CI, 50%-73%) occurred in the first 4 years after surgery. Conclusion: In our study, the effectiveness of Bankart repair to stabilize the shoulder decreased significantly over time. Indeed, less than half of the recurrences occurred after 2 years of follow-up. Therefore, we propose that the recommended minimum follow-up should be 4 years; otherwise, it is very likely that the actual rate of recurrences will be significantly underestimated.

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Bony reconstruction after failed labral repair is associated with higher recurrence rates compared to primary bony reconstruction: a systematic review and meta-analysis of 1319 shoulders in studies with a minimum of 2-year follow-up

Cited by 4 publications

References 69 publications

What’s New in Sports Medicine

What’s New in Sports Medicine

Outcomes of Arthroscopic Latarjet as a Revision Surgery After Failed Arthroscopic Bankart Repair

A 2-Year Follow-up May Not be Enough to Accurately Evaluate Recurrences After Arthroscopic Bankart Repair: A Long-term Assessment of 272 Patients With a Mean Follow-up of 10.5 Years

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