Arthroscopic Latarjet Procedure With Anterior Capsular Reconstruction Provides Low Rates of Recurrence and...

To evaluate the clinical outcomes and radiographic findings associated with the modified arthroscopic Latarjet procedure after a minimum 5-year follow-up.

Patients with recurrent anterior shoulder instability who underwent a modified arthroscopic Latarjet procedure with anterior capsule reconstruction between March 2015 and December 2017 were systematically followed from January 2023 to June 2024. The minimum follow-up duration was 5 years. Clinical evaluations included the American Shoulder and Elbow Surgeons (ASES), Constant-Murley (CM), and Rowe scores, as well as assessment of range-of-motion (ROM) and rate of return to sports (RTS). X-ray and computed tomography (CT) imaging were used to evaluate graft union, progression of osteoarthritis (OA), and fatty infiltration (FI) of the subscapularis muscle. Statistical analyses included comparisons of pre- and postoperation measures, correlation analyses (Pearson's/Spearman's), and binary logistic regression for OA progression.

Of the 64 consecutive patients who underwent modified arthroscopic Latarjet procedure, 44 (mean age at operation, 32.2 ± 8.7 years; range, 19-54 years) were included in the final analysis, with a mean follow-up of 7.1 ± 1.4 years (range, 60-105 months). At final follow-up, no patient experienced recurrent shoulder dislocation or subluxation. Functional scores improved significantly compared with preoperative values (ASES: 90.0 (85.0-94.6) to 99.0 (95.0-100.0), P = .0002; CM:84.1 ± 8.5 to 94.0 (91.0-97.0), P < .0001; ROWE: 40.0 (35.0-45.0) to 91.6 ± 10.6, P < .0001). Twenty-six patients (59.1%) achieved the minimal clinically important difference for the ASES (6.4), 29 patients (65.9%) for the CM (4.6), and all patients (100%) for the Rowe score (4.4). No significant restriction in range of motion was observed (forward elevation: 170° (160.0°-180.0°) to 160.2°± 11.8°, P = .109; external rotation: 60° (60.0°-60.0°) to 54.3°± 13.2°, P = .140; internal rotation: T9 to T8, P = .533). All patients returned to sports, with 61.4% resuming play at or above their preinjury level or higher. One patient required removal of the proximal screw. Coracoid bone union was achieved in 43 cases (97.7%). FI of the subscapularis muscle was observed in 34 cases (77.3%), including grade I in 27 cases (61.4%) and grade II in 7 cases (15.9%). Radiographic evaluation showed OA progressed in 9 cases (20.5%), including progression from grade 0 to I in 7 cases (15.9%) and from grade 0 to grade III in 2 cases (4.5%). Grade I OA did not affect shoulder function. Binary logistic regression analysis revealed that high-grade (grade II) FI of the subscapularis muscle at the final follow-up significantly associated with OA progression (P = .017, OR = 45.014).

The arthroscopic Latarjet procedure with anterior capsular reconstruction showed favorable clinical and radiological outcomes after a minimum 5-year follow-up. Patients showed significant improvements in patient-reported measures, high rates of RTS, and no recurrent dislocation or subluxation. Satisfactory positioning of the coracoid graft and high rates of bone union were achieved. A low rate of severe OA progression was observed. Analysis of the limited number of cases with OA progression in this series suggested that the degree of postoperative FI of the subscapularis muscle may be associated with the extent of OA progression.

Level IV, retrospective case series.