Long-term Recurrence Rates After Isolated Arthroscopic Bankart Repair in Selected Patients Without Preoperative Bone Loss Versus Open Latarjet Procedure: A Matched-Pair Analysis

Abstract

Background:

Clinical studies have shown that the open Latarjet procedure (OLP) has lower recurrence rates than the isolated arthroscopic Bankart (IAB) procedure for recurrent anterior shoulder instability, but no long-term comparative studies exist for IAB in patients without bone loss.

Purpose/Hypothesis:

This study aimed to compare the outcomes of IAB in selected patients without bone loss versus OLP. The hypothesis was that OLP would be more successful in preventing recurrence, even in carefully selected patients for IAB.

Study Design:

Cohort study; Level of evidence 3.

Methods:

An overall 774 patients who underwent surgical stabilization for recurrent anterior instability between January 2007 and December 2021 were analyzed. A total of 685 shoulders were followed up (89 patients were lost of follow-up: 11,4%), including 582 OLP, 45 IAB, and 58 other techniques (Trillat procedure, Arthroscopic Latarjet procedure, and revision Eden Hybinette procedure). The patients who underwent primary IAB were matched with patients who underwent OLP in a 1:1 ratio using propensity matching, resulting in 45 patients in each group. The main objective was to identify new episodes of instability, with a recurrence rate <5% considered acceptable. Kaplan-Meier analysis was used to evaluate patient survivorship, and logistic regression was performed to consider potential factors affecting recurrence rates. Data were collected on return-to-sport rate, Walch and Duplay score, visual analog scale score, and external rotation.

Results:

The mean follow-up was 9 years and 3 months. A new episode of instability occurred in 2% of the OLP group and 20% of the IAB group (P = .04; odds ratio, 11; 95% CI, 1.91-63.4, Miettinen method). Regarding the rest of our analyses, there was no significant difference. Patients maintained good external rotation with low pain: 68° in the OLP group as compared with 72° in the IAB group (P = .325), with 1.2 out of 10 on the visual analog scale in the OLP group versus 1.5 in the IAB group (P = .433), respectively. Walch and Duplay score reached 79.9 in the OLP group and 78.9 in the IAB group (P = .496), and 89% of the OLP group returned to its previous sport level as compared with 73% of the IAB group (P = .104).

Conclusion:

Patients who underwent an OLP had better long-term survivorship without recurrence when compared with those who underwent an IAB, even without bone loss. The odds of experiencing a new episode of instability recurrence was 11 times higher for patients who underwent IAB, with a mean follow-up of 9 years and 3 months.