Abstract
Objectives:
Recent evidence has suggested that subcritical bone loss can result in a higher rate of recurrent instability as well as inferior outcomes following an arthroscopic soft tissue Bankart procedure. Several options to manage subcritical bone loss exist including the addition of a Infraspinatus Remplissage or a bone transfer procedure. The purpose of this study is to compare the outcomes between the arthroscopic Bankart repair plus Remplissage to an open Latarjet for the treatment of anterior shoulder instability in patients with glenoid bone loss from 13.5-20% in an active-duty military population. We hypothesize that there will be no difference in recurrence rate or patient reported outcomes between the two procedures.
Methods:
A retrospective matched cohort comparison of patients who underwent anterior glenohumeral instability procedures with subcritical bone loss was performed. Inclusion criteria included symptomatic anterior shoulder instability, subcritical glenoid bone loss (13.5-20%), recurrent instability with at least two instability episodes, surgical treatment with arthroscopic Bankart repair plus Remplissage or open Latarjet, and minimum follow-up of 2 years. Outcomes assessed included recurrent instability (defined as postoperative dislocation or subjective subluxation), military physical restrictions, WOSI, and SANE scores.
Results:
Fifty patients were included, 25 of whom underwent an arthroscopic Bankart repair plus Remplissage and 25 patients treated with an open Latarjet. The average bone loss was 18.2% and 19.4%, respectively. Overall, five patients experienced recurrent instability, 3 in the arthroscopic Bankart group and 2 in the open Latarjet group. The average post-operative SANE score for arthroscopic Bankart/Remplissage group was 86.1% and open Latarjet group was 84.2% (p<0.1). The average post-operative WOSI score for the arthroscopic Bankart plus Remplissage group was 66.2% and open Latarjet group was 67.5% (p=0.1). There was no difference in the number patients placed on permanent physical restrictions in the arthroscopic Bankart plus Remplissage group (5) compared with open Latarjet (3) (p<0.1). There were 4 complications other than recurrent instability in the Latarjet cohort compared to 0 in the arthroscopic Bankart plus Remplissage cohort (p=0.05).
Conclusions:
In patients with subcritical glenoid bone loss (defined as 13.5% to 24%), there was no difference in recurrent instability between an arthroscopic Bankart plus Remplissage compared to an open Latarjet. Additionally, there was no difference in post-operative SANE or WOSI scores, complications, or the number of patients placed on permanent military restriction.