From the Guidelines
The Latarjet procedure is currently the most recommended surgical option for treating shoulder instability, especially in patients with significant bone loss or those who have failed previous Bankart repairs, due to its ability to provide both bone augmentation and a sling effect from the conjoint tendon. When considering the treatment options for shoulder instability, including AAGR (arthroscopic anterior glenoid reconstruction), Latarjet, and Bankart procedures, it's essential to assess the degree of bone loss and the patient's history of dislocations.
- The Bankart repair is typically recommended for first-time dislocations with minimal bone loss, as it is the least invasive option, involving arthroscopic reattachment of the torn labrum to the glenoid rim.
- The Latarjet procedure is often preferred for patients with significant bone loss (>20-25% of the glenoid) or those who have failed previous Bankart repairs, as it provides both bone augmentation and a sling effect from the conjoint tendon, as noted in the context of shoulder dislocation or instability 53, 54, 55.
- The AAGR is a newer technique that may be considered for patients with significant bone loss who are not candidates for Latarjet, using arthroscopic placement of bone graft to reconstruct the glenoid without the need for coracoid transfer. The recovery time and return to full activities vary among these procedures, with Bankart typically requiring 4-6 months, and Latarjet and AAGR requiring 5-6 months, emphasizing the importance of patient-specific factors, including degree of bone loss, number of previous dislocations, activity level, and surgeon experience, in deciding the most appropriate surgical approach, as highlighted by the need to assess both osseous and labroligamentous pathology in patients with shoulder dislocation or instability 1.
From the Research
Comparison of AAGR, Latarjet, and Bankart Procedures
- The AAGR (Arthroscopic Bankart Repair with Remplissage) procedure is compared to the Latarjet procedure in terms of clinical outcomes and complications in patients with engaging Hill-Sachs lesions and subcritical glenoid bone loss 2.
- The Latarjet procedure is compared to the Bankart repair in terms of recurrence rates, patient-reported outcomes, and complications in patients with recurrent traumatic anterior shoulder instability 3, 4.
- The Bankart repair is compared to the Latarjet procedure in terms of return to sport, range of motion, and subjective perception of the shoulder in patients with posttraumatic recurrent anterior shoulder instability 3.
Outcomes of Latarjet and Bankart Procedures
- The Latarjet procedure is associated with fewer recurrences and better patient-reported outcomes compared to the Bankart repair 4.
- The Bankart repair is associated with better return to sport and subjective perception of the shoulder compared to the Latarjet procedure 3.
- There is no significant difference in the rate of recurrent instability between the Bankart repair and Latarjet procedure in patients with subcritical glenoid bone loss 5.
Complications and Risks
- The Latarjet procedure is associated with a higher risk of complications, including nerve injury and hardware failure, compared to the Bankart repair 2.
- The Bankart repair is associated with a higher risk of recurrence compared to the Latarjet procedure 4.
- The AAGR procedure is associated with fewer complications compared to the Latarjet procedure in patients with engaging Hill-Sachs lesions and subcritical glenoid bone loss 2.
Surgical Decision-Making
- The choice of surgical procedure depends on the individual patient's condition, including the size and location of the glenoid bone loss, the presence of soft tissue injury, and the patient's activity level and expectations 6.
- The glenoid track concept and measurement of the glenoid track can help guide surgical decision-making 6.
- Three-dimensional technologies and patient-specific guides can also aid in surgical planning and execution 6.