DOI: 10.1177/23259671261470584 ISSN: 2325-9671

Subjective Shoulder Instability Following Anterior Stabilization: Incidence and Time to Resolution After Latarjet Versus Bankart Repair

Vasileios S Akrivos, Antonios Koutalos, Nikolaos Stefanou, Nikolaos Metaxiotis, Sokratis Varitimidis, Michael Hantes
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Background:

Isolated arthroscopic Bankart repair and the Latarjet procedure are widely used to treat recurrent anterior shoulder instability. The incidence and duration of postoperative subjective instability, and whether they differ between these techniques, remain poorly defined.

Purpose:

To compare the postoperative subjective sense of instability between patients undergoing Latarjet versus isolated Bankart repair for anterior shoulder instability, with secondary analysis of functional outcomes, dislocation, subluxation, and reoperation rates.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients treated with either primary open Latarjet or arthroscopic isolated Bankart repair were retrospectively reviewed between 2014 and 2022, with a minimum of 4 years' follow-up. Patients undergoing revision procedures or those who underwent concomitant procedures at the time of either Latarjet or arthroscopic Bankart repair were excluded. Functional outcomes (Constant and Rowe scores), subjective instability, dislocation, and reoperation rates were recorded.

Results:

A total of 104 patients met inclusion criteria, of whom 53 underwent the Latarjet procedure and 51 underwent arthroscopic isolated Bankart repair. The mean follow-up duration was comparable between groups (Latarjet: 69.4 ± 20.6 months; Bankart: 69.9 ± 19.0 months; P = .90). Patients in the Latarjet group were younger (23.3 ± 4.6 vs 25.7 ± 5.3 years; P = .01) and more frequently engaged in manual labor (81.1% vs 33.3%; P < .001). Functional outcomes were favorable in both groups, with significantly higher Rowe scores observed in the Latarjet group (94.0 ± 2.9 vs 86.3 ± 19.2; P = .004), while Constant scores were comparable. Postoperative subjective instability was reported less frequently after Latarjet compared with Bankart repair (39.6% vs 62.7%; P = .02), although mean time to resolution did not differ significantly (19.6 vs 28.0 months; P = .09). Persistent subjective instability at final follow-up was observed at similar rates between groups (13.2% vs 15.7%; P = .71). Redislocation rates were significantly lower in the Latarjet group (3.8% vs 17.6%; P = .02), with a longer mean time to dislocation (56.5 vs 30.0 months; P = .004). Revision surgery rates did not differ significantly between groups. Cox proportional hazards regression demonstrated that surgical technique was a significant predictor of postoperative dislocation, with Latarjet associated with a lower hazard of dislocation (hazard ratio, 0.139; 95% CI, 0.026-0.737; P = .02), whereas time to resolution of subjective instability was not predictive of dislocation.

Conclusion:

The sense of postoperative instability was common and occurred more frequently after isolated arthroscopic Bankart repair than after the Latarjet procedure; however, persistent subjective instability at final follow-up occurred at similar rates between groups. While both procedures achieved excellent functional outcomes, the Latarjet procedure was associated with lower redislocation rates and similar revision and reoperation rates. Its duration was similar between techniques, and its presence was not associated with an increased risk of dislocation.

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