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

BACKGROUND: There 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. PURPOSE: To 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 METHODS: Ninety-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). RESULTS: There 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). DISCUSSION: A 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 EVIDENCE: IV, cohort observational study.

Long-term results of arthroscopic Bankart repair: Minimum 10 years of follow-up.

PURPOSE: This study investigated the long-term results of arthroscopic Bankart repair in terms of rates and timelines of recurrence of instability, with special interest in young adult patients aged ≤20 years. METHODS: Between 2000 and 2005, 186 shoulders [182 patients, 50 women, median age 26 (range 15-58) years] were operated on at a university hospital using arthroscopic Bankart repair because of instability after traumatic anteroinferior shoulder dislocation. Medical records were retrospectively reviewed and patients were assessed using postal questionnaires or telephone interview after a minimum of 10 years of follow-up [median 12.2 (range 10-16) years]. The primary outcome measure was recurrence of instability (assessed from 167 shoulders), other outcome measures included Oxford instability score (OIS), subjective shoulder value (SSV), and Western Ontario instability index (WOSI) (assessed from 157 shoulders). RESULTS: At the end of follow-up, 50/167 shoulders (30%) had recurrence of instability and 30/167 (18%) were subjected to reoperation due to instability symptoms. Twenty-six (52%) failures occurred within ≤2 years, 11 (22%) within 2-5 years, and 13 (26%) >5 years after surgery. Failure rate was 19/35 (54%) for patients aged ≤20 years and 31/132 (24%) for patients aged >20 years; reoperation rates were 11/35 (31%) and 19/132 (14%), respectively. Mean OIS was 20 (SD 9, range 12-50), SSV 83% (SD 21, range 10-100), and WOSI score 80 (SD 22, range 33-100). CONCLUSIONS: Nearly one-third of patients had recurrence of instability after arthroscopic Bankart repair after a minimum of 10-year follow-up. Patients aged ≤20 years did poorly with more than half of the patients having recurrence; alternative stabilization techniques should probably be considered for these patients. LEVEL OF EVIDENCE: IV.