title: The open latarjet procedure is more reliable in terms of shoulder stability than arthroscopic bankart repair.
abstract: BACKGROUND
  Arthroscopic Bankart repair and open Latarjet bone block procedure are widely considered mainstays for surgical treatment of recurrent anterior shoulder instability. The choice between these procedures depends mainly on surgeon preference or training rather than published evidence.
  
  
  OBJECTIVE
  We compared patients with recurrent posttraumatic anterior shoulder instability treated with arthroscopic Bankart or open Latarjet procedure in terms of (1) frequency and timing of recurrent instability, (2) risk factors for recurrent instability, and (3) patient-reported outcomes.
  
  
  METHODS
  In this retrospective comparative study, we paired 93 patients undergoing open Latarjet procedures with 93 patients undergoing arthroscopic Bankart repairs over the same period for posttraumatic anterior shoulder instability by one of four surgeons at the same center. Both groups were comparable except that patients in the Latarjet group had more glenoid lesions and more instability episodes preoperatively. Minimum followup was 4 years (mean, 6 years; range, 4-10 years). Patients were assessed with a questionnaire, including stability, Rowe score, and return to sports. Recurrent instability was defined as at least one episode of recurrent dislocation or subluxation. Return to sports was evaluated using a 0% to 100% scale that patients completed after recovery from surgery. Various risk factors for recurrent instability were also analyzed.
  
  
  RESULTS
  At latest followup, 10% (nine of 93) in the Latarjet group and 22% (20 of 93) in the Bankart group demonstrated recurrent instability (p = 0.026; odds ratio, 0.39; 95% CI, 0.17-0.91). Ten recurrences in the Bankart group (50%) occurred after 2 years, compared to only one (11%) in the Latarjet group. Reoperation rate was 6% and 7% in the Bankart and Latarjet groups, respectively. In both groups, patients younger than 20 years had higher recurrence risk (p = 0.019). In the Bankart group, independent factors predictive for recurrence were practice of competitive sports and shoulder hyperlaxity (ie, passive external rotation > 85° in the contralateral uninjured shoulder). Although return to sports was not different between groups, the mean Rowe score was higher in the Latarjet group (78 versus 68, p = 0.018).
  
  
  CONCLUSIONS
  Patients who had the open Latarjet procedure had less recurrent instability and better Rowe scores over a mean 6-year followup. We now perform isolated arthroscopic Bankart repair for carefully selected patients, including patients with an Instability Severity Index Score of 3 or less.
  
  
  METHODS
  Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery & Sports Traumatology, Hôpital de L'Archet, University of Nice-Sophia Antipolis, 151, Route de St Antoine de Ginestière, 06202, Nice, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Bessière
authors.forename: Christophe
authors.initials: C
authors.lastname: Trojani
authors.forename: Michel
authors.initials: M
authors.lastname: Carles
authors.forename: Saurabh S
authors.initials: SS
authors.lastname: Mehta
authors.forename: Pascal
authors.initials: P
authors.lastname: Boileau
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods*; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012783:Shoulder Dislocation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D013177:Sports; D011795:Surveys and Questionnaires; D053441:Suture Anchors; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult