The Bristow-Latarjet procedure for revision of failed arthroscopic Bankart: a retrospective case series of 59 consecutive patients.

BACKGROUND: Recurrence of anterior instability after arthroscopic Bankart prevents return to sports and remains a surgical challenge. We aim to assess clinical and radiologic outcomes after coracoid bone-block performed either open or under arthroscopy, for the management of failed arthroscopic Bankart PATIENTS AND METHODS: Fifty-nine consecutive patients with anterior instability recurrence after arthroscopic Bankart were revised with a Bristow or Latarjet procedure performed either open (25 cases) or under arthroscopy (34 cases). Patients were reviewed for clinical and radiologic examination at a minimum 2-year follow-up. Glenohumeral bony lesions were evaluated preoperatively with computed tomographic scans. Postoperative bone-block position, union, and postinstability arthritis were also evaluated.

RESULTS: The mean follow-up was 89 months (24-193). The epidemiologic analysis showed that patients with failed arthroscopic Bankart were young (age <23 years), 58 (98%) were practicing sports, with contact/forced overhead sports (53%), often in competition (53%), had hyperlaxity (71%), and for the most part of them glenohumeral bone loss (88%). Their mean preoperative Instability Severity Index Score was 5.4 ± 2.2 points. After revision with Bristow-Latarjet procedure, 53 patients (91%) returned to sports, 37 (70%) to their previous sports activity, and 17 (46%) to their previous level. No patient suffered recurrent dislocation. Four patients (7%) had recurrent subluxations, all after open procedure; 8 patients (14.5%) had persistent anterior apprehension. A large and deep Hill-Sachs lesion was a risk factor for persistent anterior apprehension (P = .002) and lower level when returned to sports (P = .04). Ninety-two percent of bone-blocks were positioned flush with the glenoid anterior rim, with 84% of bone union. At last follow-up, 5% of patients had severe postinstability osteoarthritis (Samilson 4).

CONCLUSION: The Bristow-Latarjet, performed either open or under arthroscopy, is an efficient procedure to restore shoulder stability and allow returning to sports in patients with failed arthroscopic Bankart and glenoid bone loss. Patients with a large and deep Hill-Sachs lesion had more persistent anterior apprehension and a lower sports level.