Low rate of recurrent instability following the open Latarjet procedure as a revision procedure for failed prior stabilization surgery

Abstract

Purpose The purpose of this study is to systematically review the literature to ascertain functional outcomes, recurrence rates and subsequent revision rates following the open Latarjet procedure when performed as a revision procedure. Methods Two independent reviewers performed the literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Studies where the Latarjet procedure was performed as a revision procedure were included. Clinical outcomes analyzed were: (1) functional outcomes, (2) recurrent instability, (3) revisions, and (4) complications. ResultsThe review found 16 studies with 713 shoulders that met the inclusion criteria. 605 of the patients were male (84.9%), with an average age of 28.2 years (15-62) and follow-up of 47.7 months. The most commonly reported functional outcome measure was the Rowe score, with a weighted mean of 92.7. 86/95 patients had good-excellent outcomes (90.4%). 136/143 patients reported return to play (95.1%). 141/161 patients returned to the same level of competition (87.6%). 50 patients experienced recurrence (8.4%). Five patients experienced redislocation (0.9%) and 37 patients experienced subluxation (6.7%). There were 29 revisions (5.1%), with 12 revisions due to recurrence (2.1%). There were 68 total complications, not including recurrence (11%). The most common complications were 13 cases of nerve damage and infection respectively (2.1%). There was 17 cases of new instability arthropathy (6.5%), and 31 cases of residual pain (6.7%). Conclusion This review shows that the revision Latarjet provides excellent functional outcomes, low rates of recurrence and complications, and a high rate of return to sport among athletes. This results from study can be used to explain the expected outcomes associated with the Latarjet procedure performed as a revision. Level of evidence IV.

Factors affecting a patient’s experience following the open Latarjet procedure to treat recurrent anterior shoulder instability

“…3,31,32 Di Giacomo et al 3 reported on patient-related risk factors influencing clinical failure (defined as a WOSI score of < 70% of normal), identifying female sex and bilateral shoulder instability as risk factors for failure. Other authors have assessed PROMs following an open Latarjet procedure in selected subgroups only, including those with a previously failed arthroscopic Bankart repair, [9][10][11][12] elite athletes, [32][33][34][35][36] those with epilepsy, 13 and those aged ≥ 40 years. 14 Although this provides useful information about these subgroups, the results may not be generalizable to all patients undergoing an open Latarjet procedure.…”

“…3-5 Previous authors have highlighted the importance of premorbid psychosocial factors in determining outcomes following several orthopaedic procedures. 6-8 Some have also assessed variables influencing the risk of failure following an open Latarjet procedure, 3 and individual variables which may influence patient-derived outcome, such as the influence of a failed arthroscopic Bankart repair, 9-12 epilepsy, 13 and in specific age groups. 14 However, none have evaluated the relative influence of a wide range of both patient-related and injury-related variables on patient-reported outcomes.…”

Return to Professional Australian Rules Football After Surgery for Traumatic Anterior Shoulder Instability

“…For first-time dislocators with no bone loss, the preferred primary surgery was a capsulolabral reconstruction. A Latarjet procedure was indicated in the case of a failed capsulolabral repair 1 or multiple dislocations with any bone loss. A Latarjet was also indicated in the case of significant glenoid bone loss and/or significant bipolar lesions (bony lesions of both glenoid and humeral head).…”

Editorial Commentary: Lower Return to Play After Failed Prior Instability Surgery: Should the Open Latarjet Be the Gold Standard for Anterior Shoulder Instability?

“…Studies have shown that the open Latarjet can result in excellent clinical outcomes and low recurrence rates. [5][6][7][8] On the other hand, some argue that because of the complexity of the surgery and higher complication rates, an open Latarjet should only be undertaken in the setting of significant bone loss or in the revision situation.…”