After a failed primary arthroscopic stabilization of the shoulder, the Latarjet procedure is not superior to Bankart Repair for fixing recurrent instability, according to a new study.
“Limited evidence is available regarding the recommended technique of revision surgery for recurrent shoulder instability. Only one previous study has compared the results of soft tissue repair and the Latarjet technique in patients with persistent shoulder instability after primary surgical stabilization,” the researchers wrote.
In the study, “Revision Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Failed Primary Arthroscopic Stabilization With Subcritical Bone Loss,” published online on May 4, 2021 in the Orthopaedic Journal of Sports Medicine, they compare the results of repeated Bankart repair versus arthroscopic Latarjet technique in patients with previous surgical stabilization failure and subcritical glenoid bone defects.
Primary outcomes included objective and subjective functional scores, recurrence rates, and range of movement.
The researchers hypothesized that the Latarjet would be superior. Forty-five patients with subcritical bone loss (<15% of articular surface) had undergone revision anterior shoulder instability repair after failed Bankart repair. Seventeen of the patients underwent arthroscopic Bankart repair, while 28 had arthroscopic Latarjet surgery.
All the patients were evaluated at least two years post-op with the Rowe Score, Western Ontario Shoulder Instability Index, and Subjective Shoulder Value. Any subluxation or dislocation episodes were considered failures.
At revision arthroscopy, 20 shoulders showed a persistent Bankart lesion, while 13 had a medially healed labrum. Six shoulders had a bony Bankart, and another six showed no abnormalities that could explain postoperative instability recurrence.
In the Bankart repair group, seven of the patients had isolated Bankart procedures while the remaining ten had a capsular shift added.
Overall, there were no significant differences in outcome scores, recurrence rate (11.8% vs. 17.9%) or postoperative athletic activity level between the Bankart and Latarjet groups. Both groups had similar mean loss of passive external rotation at 0˚and 90˚of abduction.
“The most relevant finding of this study was that arthroscopic Latarjet did not obtain superior results compared with repeated arthroscopic Bankart repair in patients with recurrent anterior shoulder instability after Bankart repair and subcritical glenoid bone loss. There is no consensus on how severe the bone defect should be to recommend these techniques,” the researchers wrote.
