Modified Latarjet with or without remplissage for recurrent anterior shoulder instability: a prospective randomized...

Recurrent anterior shoulder instability with glenoid bone loss remains a surgical challenge. The Latarjet procedure has shown reliable results, yet controversy persists regarding the role of adding remplissage. While some studies suggest it may improve stability in cases with concomitant Hill-Sachs lesions, others report no clear functional advantage and potential restriction of external rotation.

A prospective randomized, single-blinded trial was conducted from 2016 to 2019, enrolling 60 patients with recurrent anterior shoulder instability, glenoid bone loss >25%, and off-track Hill-Sachs lesions. Patients were randomized to modified Latarjet alone (n = 30) or Latarjet plus remplissage (n = 30). Outcome assessors were blinded, and follow-up was 24 months. Evaluations included range of motion, Rowe, Oxford, Constant scores, visual analog scale pain, satisfaction, return to activity, and complications.

After ≥2 years, all clinical outcomes had improved significantly in both groups (P < .01), with no significant differences between the groups. Mean Rowe: 85.67 ± 21.16 vs. 85.17 ± 17.83 (P = .92); visual analog scale: 2.93 ± 1.86 vs. 2.73 ± 1.33 (P = .63); Constant: 84.36 ± 12.69 vs. 86.56 ± 11.41 (P = .48); Oxford: 38.70 ± 9.02 vs. 40.36 ± 9.03 (P = .47). Return to preinjury activity: 25/30 vs. 26/30 (P = .72). External rotation loss was greater in Group 2 (12.47 ± 1.67° vs. 25.67 ± 6.0°, P < .01). Operative time was longer in Group 2 (60.71 ± 12.8 vs. 86.5 ± 12.7 minutes, P < .001).

Both techniques provided significant and comparable clinical improvement. The addition of remplissage was associated with more post-operative limitation of external rotation and longer operative times.