[Anterior shoulder instability with non critical bone loss: Bankart-Remplissage or Latarjet?].

INTRODUCTION

Significant Hill-Sachs lesions are associated with recurrent shoulder instability. Bankart-Remplissage (B+R) and Latarjet (L) are valid treatments for these injuries. Few studies compare both techniques.

OBJECTIVE

To compare functional outcome, complications and recurrent instability rate between B+R and L in patients operated for anterior shoulder instability (ASI) with significant Hill-Sachs (HS) lesions and non critical glenoid bone loss (NC-GBL).

MATERIAL AND METHODS

Retrospective cohort study with patients operated between 2010 and 2018 for ASI. 107 met inclusion criteria. Demographic data, complications, recurrence rate and subsequent procedures were obtained from their medical records. CT scan imaging was used to assess humeral and glenoid bone loss. Online questionnaires were sent for assesing functional outcomes with SSV, WOSI, VAS and qDASH. 48 patients completed the online assessment (26 B+R, 22 L). The mean follow-up was 3.8 years.

RESULTS

Comparing both groups, there were no differences in WOSI, SSV, EVA and qDASH. There was no difference in complication rate (B+R: 13 [18.8%], L: 5 [13.2%], p = 0.16), revisions (B+R: 4 [5.7%], L: 1 [2.6%], p = 0.41) and recurrent instability (B+R: 4 [5.7%], L: 1 [2.6%], p = 0.41). L in subgroup who practiced collision sports had better SSV (92.5 vs 72.5 p = 0.048) and WOSI (98.3 vs 67.3 p = 0.043). B+R in dominant extremity had worst complication rate (50 vs 9.1% p = 0.038). Association was not found between complications and recurrent instabillity according to glenoid bone defect or previous dislocation episodes.

CONCLUSION

Significant Hill-Sachs lesions with NC-GBL, both Bankart-Remplissage and Latarjet achieve satisfactory results, with similar recurrent instability and functional outcomes. Latarjet has better subjetive funtional results in collision sports and less complication in dominant extremity compared to Bankart-Remplissage.