Latarjet and Distal Tibia Allograft Provide Higher Functional Outcomes Than Soft Tissue Stabilization After Failed Arthroscopic Bankart Repair in Competitive Athletes
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Published on: January 24, 2018
Phob Ganokroj1,2, Toufic R Jildeh1,3, Annalise M Peebles1
1The Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Purpose:
To evaluate the outcomes following revision surgery for failed primary arthroscopic Bankart repair and describe the influence of preoperative injury characteristics on postoperative revision outcomes in a competitive athlete population.
Methods:
Patients who underwent revision surgery after a previously failed arthroscopic Bankart repair between 2000 and 2014 were retrospectively reviewed. The type of revision surgeries included revision arthroscopic Bankart repair (n = 12, 15%), open Bankart repair (n = 9, 11.3%), Latarjet procedure (n = 30, 37.5%), and distal tibia allograft (n = 27, 33.8%). Patients were evaluated with the American Shoulder and Elbow Surgeon score, Western Ontario shoulder instability index, and Single Assessment Numerical Evaluation score at a minimum of 2 years follow-up. Demographic and intraoperative findings as a percentage of glenoid bone loss, Hill-Sachs lesions, labral and capsule pathologies, and complications were also reported.
Results:
A total of 78 patients (97.4% male) met inclusion criteria with a median age of 25.9 years (18.2-49.3), mean follow-up period of 2.6 years (range 1.8-6.2 years), and mean 18.0% ± 8.1% glenoid bone loss at final follow-up. The revision arthroscopic Bankart and open Bankart groups had statistically lower postoperative American Shoulder and Elbow Surgeon score, Single Assessment Numerical Evaluation score, and Western Ontario Shoulder Index scores than the Latarjet and distal tibia allograft groups (P < .001). In addition, there was a significant difference in American Shoulder and Elbow Surgeon score between patients who presented with failure of arthroscopic stabilization and glenoid bone loss <25% (91) and >25% (94) (P = .035). There was no significant difference in the post-revision functional outcomes between differences in the size of Hill-Sachs lesion, labral and capsule pathologies.
Conclusions:
In the setting of a failed primary arthroscopic Bankart procedure, patients presented with high amounts of glenoid bone loss, frequently exceeding 15% at revision. Patients who underwent either Latarjet procedure or distal tibia allograft showed higher functional outcomes than soft tissue stabilization procedures after failed arthroscopic Bankart repair in a competitive athlete population.
Level Of Evidence:
Level III, retrospective cohort study.
