Geographic Variability in the Management of Anterior Glenohumeral Instability: A Binational Analysis

The Bankart and Latarjet procedures are the 2 most commonly performed procedures for stabilization of anterior glenohumeral instability around the world. The aim of this study was to describe actual trends in surgery for anterior instability in the United States and in France.

Glenohumeral stabilization surgery overall is becoming more frequent in France and in the United States, with an increasing number of Latarjet procedures having been performed in each country in recent years.

Cross-sectional study; Level of evidence, 3.

A retrospective review was performed using French and American databases from 2009 to 2018. Procedure codes MEMA005 and MEMC004 were pulled from the French National Health Insurance System and Current Procedural Terminology codes 23455, 29806, and 23462 were pulled from IBM MarketScan. During this period, 73,914 patients underwent anterior shoulder stabilization surgery in France and 391,521 in the United States. For each year and the global period, the estimated number of Bankart procedures in the United States was compared with the number of French procedures. The same comparison was done for Latarjet procedures. The sex ratio was compared using chi-square testing. The mean age was compared using a Student t test.

The Bankart procedure represents 98% of the shoulder stabilization procedures in the United States, but the Latarjet procedure is becoming more common in the United States, having increased by 154% during the 10-year study period. In France, the Latarjet procedure represents 75% of the surgeries, having increased by 40% during the 10-year study period. However, use of the Bankart procedure in France increased from 11.2/100,000 in 2009 to 13.4/100,000 in 2018.

This study demonstrated that, overall, use of the Latarjet procedure has been increasing over the last decade in both the United States and France. However, there remains a divergence in the treatment of anterior shoulder instability between the 2 countries. The Latarjet procedure remains the preferred treatment option in France for anterior shoulder instability (75% Latarjet vs 25% Bankart), whereas the Bankart procedure is dominant within the United States (98% Bankart vs 2% Latarjet). When breaking data down by age groups, more Bankart procedures are being performed on younger patients, and in both countries the incidences of women requiring these surgeries are increasing. The authors hope this study will serve as a foundation for future prospective studies establishing evidence-based algorithms to guide the treatment of anterior instability and provide a root cause analysis on why different surgeons choose a specific procedure to treat this problem.