Outcomes of the Latarjet procedure for the treatment of chronic anterior shoulder instability: patients with prior arthroscopic Bankart repair versus primary cases

Abstract

ObjectivesThe two most common surgical interventions for recurrent anterior shoulder instability include arthroscopic Bankart repair and the Latarjet procedure. However, indications for each procedure remain debated between surgeons with 90% of surgeons (except French surgeons) preferring soft tissue Bankart repair initially. It remains unclear whether the results of a Latarjet procedure performed after a failed arthroscopic Bankart repair differ from those performed for primary cases. The purpose of our study was to compare the postoperative outcomes of patients who had undergone a Latarjet as a primary surgery versus those who had had a Latarjet as revision surgery for a failed arthroscopic Bankart repair MethodsPatients who had undergone open or arthroscopic Latarjet procedure between 2003 and 2015 in 5 fellowshiptrained surgical practices were included. Charts were retrospectively reviewed to identify patients who had undergone a primary Latarjet or those who had had a Bankart repair prior to the Latarjet. Age, ISIS score, BMI, sports activity, hyperlaxity and delay before surgery were retrospectively collected. Outcome measures were prospectively collected, including range of motion, SSV, Walch-Duplay, scores, recurrence of instability, apprehension or new surgery. ResultsA total of 311 patients were included. 28% of the patients were lost to follow-up and the mean follow-up was 3.4 years +/-0.8. There were 21 patients who had had a Bankart repair prior to the Latarjet procedure. Both populations were comparable regarding preoperative data. The postoperative instability rate was 3% in the overall population; 4.8% in the "primary Latarjet" group and 2.3 % in the "Latarjet for failed Bankart" group. This difference was not significant (p=0.50). However, the mean Walch-Duplay score was significantly lower and the pain scores significantly higher in patients who had had a prior Bankart repair: 51.9 +/-25 versus 72.1 +/-25.2 and 2.5/10 versus 1.2/10 respectively. The Simple Shoulder Test was comparable in both groups. ConclusionThe study confirms that the Latarjet is an effective procedure to treat primary chronic anterior instability and also to stabilize a shoulder after a failed Bankart repair. However, the thought that a Bankart repair does not "burn any bridges" appears to be incorrect relative to postoperative pain and functional scores in the setting of future Latarjet procedure.

Clinical Outcomes of Shoulder Stabilization in Females With Glenoid Bone Loss

“…12 Another multicenter study including 308 patients undergoing the Latarjet reported that 91.5% of participants were competitive or recreational athletes. 33 In the current study, only 5 of 17 female patients (29.4%) who underwent the Latarjet procedure were injured during athletic participation. This indicates that sex-related differences may exist in the mechanism of injury and postoperative expectations among male and female patients who undergo the Latarjet procedure.…”

Defining Minimal Clinically Important Difference and Patient Acceptable Symptom State After the Latarjet Procedure

“…The Latarjet procedure is one of the most well-established treatment options for anterior shoulder instability. 10,12,34 This technique involves transferring the coracoid process and the attached conjoint tendon to the anterior glenoid rim. 28 While the Latarjet is generally reserved for high-risk patients with substantial glenoid bone loss 3 or revision cases with failed soft tissue procedures 36 given its relatively high complication rate, 9,37 some surgeons have turned to more aggressively consider this procedure in contact or collision athletes because of the generally good patient-reported outcomes (PROs) and low rates of recurrent instability.…”

Placing the Latarjet in Context

“…The authors’ main conclusion is that patients undergoing a Latarjet procedure after a failed Bankart procedure should not be expected to do as well as those who have the Latarjet as their first operation. Although a 2018 Argentine study of the Latarjet in rugby players reported similar results in both primary and revision procedures, 19 the outcomes reported by Werthel et al 24 are not surprising. The results of orthopaedic revision operations are rarely as good as primary procedures.…”

“…In this month’s second Latarjet article, Werthel and many of the same authors 24 compared the outcomes of 216 patients who underwent the procedure as their initial surgical treatment for chronic shoulder instability with a group of 20 who had the Latarjet performed to salvage a failed Bankart stabilization. In all cases in this study, whether performed arthroscopically or through a mini-open approach, the transplanted coracoid was fixed in place with 2 cannulated cancellous screws.…”