Latarjet vs Bankart Repair With Hill-Sachs Remplissage for Anterior Shoulder Instability in Case of Minimal Glenoid Bone Loss: A Matched Cohort Analysis From the French Arthroscopic Society

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Abstract

Background: Open Latarjet (Lt) and arthroscopic Bankart associated with Hill-Sachs remplissage (BHSR) have been commonly proposed to treat anterior shoulder instability. Hypothesis: Patients undergoing either Latarjet or arthroscopic Bankart repair with remplissage, when matched according to relevant demographic and injury-specific variables, would have equivalent clinical and radiographic outcomes at a minimum 5-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: In a retrospective multicentric study, including 325 patients treated operatively for primary chronic anterior shoulder instability, 220 patients were reviewed with a minimum follow-up of 5 years. In this database, patients in the Lt and BSHR groups were matched 1 to 1 based on age at surgery, sex, amount of glenoid bone loss, and length and width of the Hill-Sachs lesion. Clinical outcomes were assessed using active range of motion, subjective shoulder value (SSV), Rowe scores, and Walch-Duplay scores. Recurrent instability, postoperative complications, and return to sports (RTS) were compared. Arthritis was evaluated according to the Samilson and Prieto classification. Results: A total of 68 patients (34 patients in the Lt group matched to 34 patients in the BHSR group) were analyzed at a mean follow-up of 90 ± 25 months. Preoperatively, the mean age was 25 ± 6.5 years, the glenoid bone loss was <6% (mean, 5.58% ± 5.52%), and the width and depth of the Hill-Sachs lesion were <27 mm (mean, 15.7 ± 6.91 mm) and 5 mm (mean, 4.8 ± 2.41 mm), respectively, in the 2 groups. Postoperatively, 1 hematoma required a revision in the Lt group. The recurrence rate was 6% (n = 2) in the Lt versus 14% (n = 5) in the BHSR group ( P = .2) at the final follow-up. RTS at 1 year was higher in the Lt group (82% vs 62%; P < .01). There was no difference in active range of motion, Rowe scores, and Walch-Duplay scores at the last follow-up. However, the SSV was higher in the Lt group (92% vs 81%; P = .003). The arthritis rate was 20% (grade 1: n = 6; grade 2: n = 1) in the LT group versus 3% (grade 1: n = 1) in the BHSR group ( P = .054), with no clinical effect on functional scores. Conclusion: At >7 years of follow-up, there was no statistical difference in the recurrence rate between patients in the Lt and BHSR groups. However, RTS was greater at 1 year after the Lt procedure. The possibility of degenerative arthritis developing in the Lt group is worrisome and requires a longer follow-up to assess potential clinical impairment.