The Open Latarjet Procedure Is More Reliable in Terms of Shoulder Stability Than Arthroscopic Bankart Repair

Abstract

Background Arthroscopic Bankart repair and open Latarjet bone block procedure are widely considered mainstays for surgical treatment of recurrent anterior shoulder instability. The choice between these procedures depends mainly on surgeon preference or training rather than published evidence. Questions/purposes We compared patients with recurrent posttraumatic anterior shoulder instability treated with arthroscopic Bankart or open Latarjet procedure in terms of (1) frequency and timing of recurrent instability, (2) risk factors for recurrent instability, and (3) patient-reported outcomes. Methods In this retrospective comparative study, we paired 93 patients undergoing open Latarjet procedures with 93 patients undergoing arthroscopic Bankart repairs over the same period for posttraumatic anterior shoulder instability by one of four surgeons at the same center. Both groups were comparable except that patients in the Latarjet group had more glenoid lesions and more instability episodes preoperatively. Minimum followup was 4 years (mean, 6 years; range, 4-10 years). Patients were assessed with a questionnaire, including stability, Rowe score, and return to sports. Recurrent instability was defined as at least one episode of recurrent dislocation or subluxation. Return to sports was evaluated using a 0% to 100% scale that patients completed after recovery from surgery. Various risk factors for recurrent instability were also analyzed. Results At latest followup, 10% (nine of 93) in the Latarjet group and 22% (20 of 93) in the Bankart group demonstrated recurrent instability (p = 0.026; odds ratio, 0.39; 95% CI, 0.17-0.91). Ten recurrences in the Bankart group (50%) occurred after 2 years, compared to only one (11%) in the Latarjet group. Reoperation rate was 6% and 7% in the Bankart and Latarjet groups, respectively. In both groups, patients younger than 20 years had higher recurrence risk (p = 0.019). In the Bankart group, independent factors predictive for recurrence were practice of competitive sports and shoulder hyperlaxity (ie, passive external rotation [ 85°in the contralateral uninjured shoulder). Although return to sports was not different between groups, the mean Rowe score was higher in the Latarjet group (78 versus 68, p = 0.018). Conclusions Patients who had the open Latarjet procedure had less recurrent instability and better Rowe scores over a mean 6-year followup. We now perform isolated arthroscopic Bankart repair for carefully selected patients, including patients with an Instability Severity Index Score of 3 or less. Level of Evidence Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Arthroscopic treatment of shoulder instability in professional athletes

“…The arthroscopic procedure seems to be associated with a significant risk of recurrence in athletes 1 . In fact, Bessière et al declared that patients who had the open Latarjet procedure had less recurrent instability and better Rowe scores over a mean 6-year follow-up 2 . At the same time, Blonna et al stated that arthroscopic stabilization using anchors provided better return to sport compared with the open Bristow-Latarjet procedure in the population studied 3 .…”

Management of the unstable shoulder

“…Bone blocks work by providing a physical blockade to excursion of the humeral head and thus dislocation (figure 6). In a retrospective comparative study of 93 participants undergoing a bone block procedure and 93 undergoing a soft tissue repair, the rate of redislocation was lower in the bone block group 20. This stability comes at a cost though.…”

Management of the unstable shoulder

“…In a retrospective comparative study of 93 participants undergoing a bone block procedure and 93 undergoing a soft tissue repair, the rate of redislocation was lower in the bone block group. 20 This stability comes at a cost though. In one of the few long term studies of bone block surgery, arthritis and a restricted range of movement were common long term complications.…”