Complications Related to Latarjet Shoulder Stabilization: A Systematic Review

Abstract

Background: In cases of recurrent anterior shoulder instability with a glenoid defect, Latarjet procedures are widely used for stabilization. Although complications with this procedure have been reported, few studies have comprehensively analyzed issues related to the Latarjet procedure. Purpose: To identify the overall complication rate of the Latarjet procedure used for anterior shoulder instability and to compare the rate of complications between arthroscopic and open approaches. Study Design: Systematic review; Level of evidence, 4. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed by using the PubMed, EMBASE, Scopus, and Cochrane Library databases. Data on complications were extracted and classified as intraoperative, postoperative, or instability-related for further analysis. Quality assessments were performed with criteria from the Methodological Index for Nonrandomized Studies (MINORS). A quantitative synthesis of data was conducted to compare the complication rates between arthroscopic and open approaches. Results: A total of 35 articles were included in this analysis. The MINORS score was 11.89. A total 2560 Latarjet procedures (2532 patients) were included. The overall complication rate was 16.1% (n = 412). The intraoperative complication rate was 3.4% (n = 87) and included a 1.9% (n = 48) incidence of nerve injuries and a 1.0% (n = 25) incidence of iatrogenic fractures. Screw problems, vascular injuries, and conversion arthroscopic to open surgery each occurred at a rate of <1%. The postoperative complication rate was 6.5% (n = 166), and the most common complication was nonunion (1.3%; n = 33). The instability-related complication rate was 6.2% (n = 159) and included a 1.5% (n = 38) rate of redislocation, a 2.9% (n = 75) rate of positive apprehension test, and a 1.0% (n = 26) rate of instability. Overall, 2.6% (n = 66) of patients required an unplanned secondary operation after the initial surgery. The arthroscopic approach was associated with a higher rate of intraoperative complications compared with the open approach (5.0% vs 2.9%; P =.020) and a lower rate of instability-related complications (3.1% vs 7.2%; P < .001). Conclusion: The Latarjet procedure for anterior shoulder instability results in an overall complication rate of 16.1% and a reoperation rate of 2.6%. However, serious complications at short-term follow-up appear rare. When the arthroscopic approach was used, the rate of intraoperative complications was higher, although instability-related complications were lower when compared with the open approach.

Clinical and Radiological Outcomes in Patients With Anterior Shoulder Instability and Glenoid Bone Loss after Arthroscopic Free Bone Block Combined With Dynamic Anterior Stabilization

“…38 However, we detected slight external rotation limitations, with a mean of 8.1° in adduction and 7.5° in abduction postoperatively, consistent with external rotation restrictions reported in previous studies using bone augmentation procedures for ASI. 6,19,49,56 Remarkably, a >10° external rotation limitation only occurred in those patients with preoperative hyperlaxity. Most of them successfully returned to sports, and only 1 patient with restricted ROM in all directions failed to return sports.…”

“…27,34,71 In the current study, all patients reported no recurrent dislocations or subluxations after FBB-DAS, except 2 patients (3.1%) with positive apprehension test findings, which is slightly lower than the 6.2% postoperative instability rate after the Latarjet procedure. 17,19 Moreover, recurrent instability after the Latarjet procedure is a tricky issue in certain high-risk patient populations. Privitera et al 52 reported an 8% redislocation rate and a 14% instability rate in contact and collision athletes treated with the Latarjet procedure.…”

“…In the present study, only 2 patients (3.1%) experienced a postoperative complication, and one of them underwent a secondary operative procedure (1.5%) of arthroscopic release for stiffness, while the Latarjet procedure has been reported to have an overall clinical complication rate of 15.1% and a reoperation rate of 2.6% to 5.6%. 17,19 The transferred coracoid is fixed by bicortical screws for the traditional Latarjet procedure, which can cause some potential neurological and hardware-related complications. 10,17,19 Nonrigid fixation of bone blocks and adjustable loops with cortical buttons for LHBT transfer would avoid complications associated with screws, such as graft fractures, screw impingement, and the need for hardware removal.…”

“…11,23,26 The Latarjet procedure, with both bone block and tendon sling effects, 27,34,71 has been considered the standard choice to improve functional outcomes and lower the recurrence rate in patients with ASI with critical glenoid bone loss. 25,43 However, several concerns have been raised regarding the long learning curve, 42 high rates of hardware-related complications, 17,19 and potential biomechanical adverse effects after coracoacromial ligament resection. 18,22…”

Arthroscopic Autologous Scapular Spine Bone Graft for Recurrent Anterior Shoulder Dislocation With Subcritical (10%-15%) Glenoid Bone Loss

“… 8 , 9 On the other hand, despite the fact that the Latarjet procedure can significantly reduce the rate of redislocation, growing evidence in the literature indicates that it has plenty of postoperative complications, such as bone graft osteolysis and nerve injury. 10 , 11 , 12 ICBG procedure has similar drawbacks, and it requires an additional surgical site, making donor site morbidity also a concern. The reported complication rate of ICBG procedure is approximately 25%-30%, with infection hematoma, meralgia paresthetica, and lilac wing fracture being the main reasons of failure.…”