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Risk factors for recurrence after Latarjet procedure: a systematic review and meta-analysis
Clark H Bulleit1, Eoghan T Hurley1, Aaron D Therien1
1Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA.
Background:
The risk factors associated with recurrent instability following Latarjet procedure remain poorly understood. The purpose of this study was to conduct a systematic review to elucidate risk factors contributing to therapeutic failure after the Latarjet procedure.
Methods:
A comprehensive literature search was performed using the PubMed/MEDLINE and Embase databases based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies that evaluated risk factors for recurrence of instability following the Latarjet procedure that were published after 2000 were included.
Results:
A total of 24 studies, encompassing 3166 patients, were included in the analysis, identifying 13 risk factors. Four studies, comprising 206 patients, evaluated the role of epilepsy as a risk factor for recurrence, with 75% (3) finding a statistically significant increased risk. Meta-analysis demonstrated a recurrence rate of 16.7% (7/42) in epilepsy patients compared with 2.5% (3/119) for those without (P = .003). Previous stabilization surgery was evaluated in 3 studies, with 2 finding increased risk. Meta-analysis revealed a recurrence rate of 17.5% (45/257) for patients with a previous stabilization surgery compared with 5.1% (26/512) for patients undergoing a primary Latarjet procedure. Two studies investigated coracoid width, with 1 finding an increased risk for narrow coracoid measurements. One study found a 4-fold increased risk of recurrence in patients with an engaging Hill-Sachs lesion. However, another study found no difference in the recurrence rate for patients with engaging Hill-Sachs lesions with glenoid bone loss greater than 25%.
Conclusion:
The rate of recurrent instability following the Latarjet procedure is inherently low. However, epilepsy and previous stabilization surgery appear to be significant risk factors for recurrence. Other reported risk factors include fixation technique, glenoid bone loss, off-track Hill-Sachs lesions, and bilateral shoulder instability.
