Free bone graft transfer may yield similar outcomes as Latarjet for shoulder instability
Key takeaways:
- Free bone graft transfer and Latarjet surgery yielded clinically similar outcomes for anterior shoulder instability at 5-year follow-up.
- Neither technique prevented the progression of instability arthropathy.
According to published results, free bone graft transfer and the Latarjet procedure demonstrated clinically similar outcomes for patients with anterior shoulder instability and glenoid bone loss at 5 years.
Results showed the techniques had similar rates of successful stabilization. However, neither technique prevented the progression of instability arthropathy.
“At this 5-year midterm follow-up, the results revealed that both the Latarjet procedure and the free bone graft transfer (FGBT) yielded similar results in the main outcome measurement of the Western Ontario Shoulder Instability (WOSI) index, Rowe score and Subjective Shoulder Value (SSV),” Eva Schulz, MD, orthopedic surgeon at the Kardinal Schwarzenberg Clinic in Austria, and colleagues wrote in the study. “The range of motion (ROM) was also similar in both groups except for a persistently lower level of internal rotation motion in the Latarjet group.”
Schulz and colleagues performed a prospective, randomized controlled trial of 60 patients who underwent surgery at one of two centers for anterior shoulder instability with more than 15% glenoid bone loss between 2012 and 2015. Patients were randomly assigned 1:1 to receive either open FBGT with the “J-bone” graft technique or open Latarjet surgery.
“The J-bone graft technique refers to an implant-free method of FBGT, in which a J-shaped iliac bone graft is press-fit into an osteotomy at the anterior glenoid rim,” Schulz and colleagues wrote.
At 5 years, 63.3% of the FBGT group and 66.6% of the Latarjet group were available for follow-up. Outcomes included WOSI index, Rowe score, SSV, VAS pain scores, patient satisfaction, return to sport, return to work, ROM, strength and progression of instability arthropathy.
Schulz and colleagues found no significant differences in WOSI scores between the FBGT group (221) and the Latarjet group (201) at all follow-up timepoints. They also found no significant differences in Rowe scores, SSV, VAS scores, patient satisfaction, return to sport or return to work between the groups at all follow-up timepoints.
Although ROM and strength were similar between the groups, Schulz and colleagues noted the FBGT group had significantly better internal rotation at all follow-up timepoints.
CT scans and X-rays showed both groups had comparable increases in progression of instability arthropathy at 5 years.
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