Revision Latarjet may yield similar outcomes vs. primary Latarjet for shoulder instability
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Key takeaways:
- Revision Latarjet surgery yielded comparable outcomes vs. primary Latarjet surgery for patients with shoulder instability.
- Both surgeries yielded comparable rates of recurrent dislocations and complications.
For patients with anterior shoulder instability, revision open Latarjet surgery after failed arthroscopic Bankart repair may yield comparable outcomes vs. primary open Latarjet surgery, according to published results.
Rashad Madi, MD, postdoctoral research fellow at the University of Pennsylvania Perelman School of Medicine, and colleagues performed a retrospective analysis of data from 29 patients who underwent surgery for anterior shoulder instability between 2014 and 2023.
Madi and colleagues compared outcomes between 12 patients (mean age, 22.3 years) who underwent primary open Latarjet surgery with a mean follow-up of 4.7 years and 17 patients (mean age, 25.7 years) who underwent revision open Latarjet surgery after failed arthroscopic Bankart repair with a mean follow-up of 4.6 years. According to the study, outcome measures included glenoid bone loss, Hill-Sachs lesion size, recurrent dislocations, reoperations and overall complications.
Madi and colleagues found patients who underwent primary Latarjet had significantly higher mean glenoid bone loss (18.4%) compared with patients who underwent revision Latarjet (10.5%). They found no significant differences in the width of Hill-Sachs lesions between patients who underwent primary Latarjet (14.2 mm) compared with patients who underwent revision Latarjet (10.4 mm).
In addition, Madi and colleagues found patients who underwent primary Latarjet had a recurrent dislocation rate of 8.3% and a reoperation rate of 25%, while patients who underwent revision Latarjet had a recurrent dislocation rate of 11.8% and a reoperation rate of 23.5%. They noted these differences were not statistically significant.
“Prior arthroscopic Bankart repair does not necessarily compromise the effectiveness of a subsequent Latarjet procedure,” Madi and colleagues wrote in the study. “Ultimately, patient-focused discussions encompassing potential risks and benefits are essential in deciding the appropriate surgical intervention.”
Perspective
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Rashad Madi, MD, and colleagues detail the outcomes of 29 patients treated with open Latarjet coracoid transfer treated during a decade at a referral center by three surgeons without significant differences in recurrence or revision whether performed as a primary stabilizing procedure or following an arthroscopic Bankart repair.
This work stands in contrast to two larger studies showing higher recurrence and worse outcomes in Latarjet procedures that are revision surgeries. The first by Jean-David Werthel, MD, and colleagues reported on more than 300 Latarjets performed by five surgeons at five centers in France during 2 years with significantly worse patient-reported outcome measures in the Latarjet as secondary procedure. Daniel L. Rodkey, MD, and colleagues reported on 234 Latarjets in the U.S. military health system during 8 years by numerous surgeons finding more recurrences in the secondary Latarjet (21% vs. 9%).
The authors are applauded for following their patients and reporting their outcomes. Unfortunately, they do not provide a complete understanding of who these patients are within the full spectrum of their instability practice. It can be assumed from 29 patients during 9 years for three surgeons that the Latarjet procedure is not as commonly performed at this center compared with the Werthel group, for example. This suggests that some selection bias exists in who gets a Latarjet as a primary procedure – also manifested by the greater bone loss in this group. This study does add to the body of literature on Latarjet outcomes and can support the performance of arthroscopic Bankart repair in most instability patients, because a failure treated with a Latarjet can be as successful as a primary Latarjet.
While stronger data discussed above contradicts this conclusion, most U.S. surgeons are reserving Latarjet for revision patients or primary patients only with significant bone loss.
References:
Werthel JD, et al. Am J Sports Med. 2020;doi:10.1177/0363546519888909.
Rodkey DL, et al. Arthroscopy. 2021;doi:10.1016/j.arthro.2021.04.059.
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