Previous arthroscopic Bankart repair is an independent risk factor for an inferior outcome after Latarjet procedure

Abstract

BackgroundThere is limited evidence that the Latarjet procedure has a worse outcome as a revision operation, after a failed stabilization surgery, compared with when it is the primary procedure for posttraumatic anteroinferior instability of the shoulder joint. PurposeTo compare the results from Latarjet as a primary operation vs. revision surgery after a failed arthroscopic Bankart repair for posttraumatic anteroinferior shoulder instability. In addition, to assess the effect of preoperative bony pathology on outcome. Patients and methodsNinety-nine patients who underwent the Latarjet procedure (47 primary, 52 revision after failed Bankart repair) were analyzed after an average of 3.8 (SD 2.3, range 1–11) years of follow-up. All patients underwent either computed tomography or magnetic resonance imaging preoperatively. Glenoid and humeral bone defects were measured to assess whether the Hill-Sachs lesion was on- or off-track. Clinical outcome measures included the Western Ontario Shoulder Instability Index (WOSI), subjective shoulder value (SSV), and recurrence of instability (dislocation, subluxation, or any perception of instability). ResultsThere were no cases of recurrent dislocation in either group. Four patients in the primary surgery group and 13 in the revision group had at least one subluxation or perception of instability after the Latarjet procedure. Patients with a previous arthroscopic Bankart repair had worse outcomes than those undergoing primary Latarjet when assessed by the WOSI: 76 (SD 22) vs. 85 (SD 15), difference in means −9 (95% CI −17 to −1, p=0.02); SSV: 80 (SD 18) vs. 88 (SD 13), difference in means −8 (95% CI −15 to −2, p=0.01); and the recurrence percentage (25% vs. 9%, p=0.03). A multivariate linear regression model adjusted for the length of follow-up, glenoid bone defect size, Hill-Sachs lesion size, and the frequency of preoperative bipolar bone defects (on/off track Hill-Sachs lesions) further increased the difference in WOSI to −12 (95% CI −21 to −4, p=0.005). DiscussionA previous failed arthroscopic Bankart repair was a significant independent risk factor for inferior outcome. Preoperative bony pathology did not explain the worse outcome from the revision vs. primary Latarjet procedure. Level of evidenceIV, cohort observational study.