Return to Sport After Coracoid Bone Block Transfer for Shoulder Instability: A Systematic Review

Abstract

Background: Shoulder dislocations can be devastating for an athlete. Coracoid bone block transfer is often used for the treatment of recurrent shoulder instability. Questions/ Purposes: The primary purpose of this study was to determine the rate and mean time of return to sport in athletes after a coracoid bone block transfer at the pre-operative level of competition, a lower level, or a different level. We also sought to determine how return to sport rates after a coracoid bone block procedure compared with rates after several comparator interventions. Finally, we looked to determine the post-operative clinical outcomes and complications reported after a coracoid bone block procedure. Methods: We systematically searched three databases (PubMed, Embase, and MEDLINE) for studies reporting return to sport after a coracoid bone block procedure. Results: A total of 52 studies (with levels of evidence ranging from II to IV) evaluating 2953 shoulders in 2888 patients were included in this systematic review. The mean rate of return to sport at any level was 88.4% (2291 of 2592 patients). However, the rate of return to the pre-operative level was 70.3% (1387 of 1974 patients). The mean time to return to sport was 5.38 months (range 21 days to 36 months). The rate of return to sport was higher after the Latarjet procedure, as compared with Bankart repair (87.0% and 75.8%, respectively). All studies showed improvements in clinical outcome measures after coracoid bone block intervention. The cumulative complication rate was found to be 6.46% (158 of 2446 patients). Conclusion: Coracoid bone block transfer allows for a high rate of return to sport, although the rate of return to sport at athletes' preoperative level is lower. The rate of return to sport after Latarjet procedure is higher in comparison with Bankart repair. Additionally, coracoid bone block transfer is associated with improvements in a number of clinical outcome measures. Common post-operative complications include non-union between bone block and glenoid, hematoma, and infection.

Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores

“…Rossi et al [33] reported that time for RTP after the Latarjet procedure was 3.7 months for patients who performed non-contact/non-overhead sports, compared to 5.1 months for those that performed high-impact/contact [14] found that at 6 months followup, 55% of patients failed to meet criteria for RTP, defined as < 20° loss of ROM as compared with baseline values in any plane, and/or lower strength grade than the baseline value. Several systematic reviews report return to play (RTP) within 5.8 months following the Latarjet procedure [21,28], but the type of sport and preoperative patient characteristics that influence RTP remain unknown.…”

Unicortical fixation does not compromise bony union in the Latarjet procedure

“…The benefits of the Latarjet procedure have been well documented, with its important role in providing GHJ stability in patients with significant bone loss, failed primary procedures, and in athletes mandating return to elite contact sport. 3,7,10,27,29 In this study, there was no significant difference in the rate of bony union between participants undergoing a Latarjet with unicortical vs. those with bicortical screw fixation. However, the absolute numbers of patients with nonunion were small, and the study was underpowered to demonstrate a statistically significant difference.…”

Outcomes After Open Latarjet in Patients With or Without SLAP Lesions

“…20 Indeed, the rate of return to sport is >80%, at 5 months on average, and up to 73% of patients recover before 8 months. 1,21,26 Regarding its effectiveness, some surgeons advocate for Latarjet as the reference technique for all cases of anterior instability, especially in high-risk athletes, even without any bony lesions. 5,11,29 Latarjet is mainly performed as an open surgery.…”