Konstantinou Efstathios, Stefanou Nikolaos, Mylonas Theodoros, Koskiniotis Alexandros, Komnos Georgios, Varitimidis Socratis, Hantes Michael
Department of Orthopaedic Surgery & Musculoskeletal Trauma, University Hospital of Larissa, School of Health Sciences, University of Thessaly, Larissa, Greece.
Orthop J Sports Med. 2025 Jun 19;13(6):23259671251343807. doi: 10.1177/23259671251343807. eCollection 2025 Jun.
Anterior shoulder dislocation is often complicated by recurrent instability, with reported rates being as high as 70% in young patients. Bony lesions, young age, and contact sports have been correlated with higher rates of recurrent instability. The optimal surgical modality remains debatable, with the majority of surgeons preferring the arthroscopic Bankart procedure as the primary repair for recurrent instability.
To compare the outcomes of the Latarjet procedure performed as a primary procedure versus the Latarjet procedure in the setting of a previously failed Bankart repair.
Cohort study; Level of evidence 3.
A retrospective comparative study was conducted of patients with traumatic anterior shoulder instability who underwent an open Latarjet as primary or revision surgery between 2012 and 2019. Outcomes were assessed using the Rowe score, Oxford Shoulder Instability (OSI) score, visual analog scale (VAS) score, and rate of recurrent instability. All patients had at least 4 years of follow-up. Radiographs were analyzed using the Samilson and Pietro classification.
In total, 43 and 17 patients were included in the primary and revision groups, respectively. Mean follow-up was 7.7 years for the primary group and 7.9 years for the revision group. Postoperatively, Rowe and VAS scores were not significantly different between groups, but OSI scores were significantly worse for the revision group versus the primary group (40.6 ± 1.3 vs 42.1 ± 1.4, respectively). The difference in OSI scores was less than the minimal clinically important difference (8.6), indicating limited clinical relevance. Return to daily activities, including sports activities, was comparable between the 2 groups. One patient from each group had recurrent instability ( = .34). No major complication was recorded in either group during the follow-up. Seven (16%) patients from the primary group and 4 (23%) patients from the revision group showed preoperatively radiographic signs of mild (grade I) osteoarthritis.
The Latarjet procedure effectively prevented chronic anterior shoulder instability and was associated with high patient satisfaction as both a primary and a revision procedure. OSI scores were marginally lower in patients with previous failed Bankart repair compared with primary Latarjet. Similar outcomes were observed for shoulder stability and arthritis development, although these findings are limited to midterm follow-up. These findings support the use of primary arthroscopic Bankart repair with revision Latarjet as a realistic surgical option for previous surgical failure.
肩关节前脱位常并发复发性不稳定，据报道，年轻患者的复发率高达70%。骨损伤、年轻以及从事接触性运动与较高的复发性不稳定率相关。最佳手术方式仍存在争议，大多数外科医生倾向于将关节镜下Bankart手术作为复发性不稳定的主要修复方法。
比较初次行Latarjet手术与在先前Bankart修复失败后行Latarjet手术的疗效。
队列研究；证据等级为3级。
对2012年至2019年间因创伤性肩关节前不稳定而接受开放性Latarjet手术作为初次手术或翻修手术的患者进行回顾性比较研究。使用Rowe评分、牛津肩关节不稳定（OSI）评分、视觉模拟量表（VAS）评分以及复发性不稳定率来评估疗效。所有患者均至少随访4年。使用Samilson和Pietro分类法分析X线片。
初次手术组和翻修手术组分别纳入43例和17例患者。初次手术组的平均随访时间为7.7年，翻修手术组为7.9年。术后，两组间Rowe评分和VAS评分无显著差异，但翻修手术组的OSI评分显著低于初次手术组（分别为40.6±1.3和42.1±1.4）。OSI评分的差异小于最小临床重要差异（8.6），表明临床相关性有限。两组在恢复日常活动（包括体育活动）方面相当。每组各有1例患者出现复发性不稳定（P = 0.34）。随访期间两组均未记录到重大并发症。初次手术组有7例（16%）患者和翻修手术组有4例（23%）患者术前X线片显示有轻度（I级）骨关节炎迹象。
Latarjet手术有效地预防了慢性肩关节前不稳定，作为初次手术和翻修手术均具有较高的患者满意度。与初次行Latarjet手术的患者相比，先前Bankart修复失败的患者OSI评分略低。在肩关节稳定性和关节炎发展方面观察到相似的结果，尽管这些发现仅限于中期随访。这些发现支持将初次关节镜下Bankart修复联合翻修Latarjet手术作为先前手术失败后的一种切实可行的手术选择。
