Bilateral anterior shoulder instability: epidemiology and results after bilateral open Latarjet procedure

Abstract

There are no reports in the current literature involving a larger series of patients with bilateral shoulder instability. Descriptive analysis of a cohort of 75 patients (67M/8F) with surgically treated bilateral anterior shoulder instability. Clinical and radiological outcome was assessed in a subgroup of 16 patients at a minimum follow-up of 2 years following bilateral Latarjet procedures. The mean age at onset of instability was 20 years and 25 years at the time of surgery. Seventy-two patients played contact or over-head sports. In 67 patients, instability was traumatic in etiology. Hyperlaxity was present in 21 cases. Bankart lesions were identified in all shoulders, glenoid bone loss in 67 and humeral bone loss in 60. Surgery was performed in “one-stage” (5–21 days between procedures) in 27 patients and in “two-stages” in 48 (mean 36.7 months between procedures). At 1-year and at final follow-up (mean 153 months) postoperatively, the mean Walch–Duplay score in those who underwent one-stage treatment was 76 and 82, respectively, compared to 78 and 69 in those treated in two stages. The mean subjective shoulder value in the one-stage group was 87 % at one year and 93 % at final follow-up compared with 92 % and 93 % for the two-stage group. All but one patient in each group was either satisfied or very satisfied with the outcome following surgery. Return to sport at the preoperative level was possible in 56 % of patients. Recurrence of instability was observed in one patient following one-stage treatment compared to three cases in those treated in two-stages. In this cohort of patients, bilateral anterior shoulder instability was primarily traumatic in origin and was more frequently observed in young males involved in contact and overhead sporting activities. There was no clear advantage to adopting a one-stage strategy rather than performing surgical intervention in two separate stages.