Does previous arthroscopic bankart repair influence coracoid graft osteolysis in latarjet procedure? A case-control study with computed tomography scan data.

Abstract

Latarjet procedure is commonly performed in treatment of recurrent shoulder instability and also indicated as a salvage procedure for recurrence after failed arthroscopic Bankart repair. While this procedure has shown success, there is an increased awareness of complications in recent studies, especially for graft osteolysis. Most relevant research have focused on pathophysiology, incidence, location or risk factors of graft osteolysis; however, the data is limited to primary Latarjet procedures. This study aims to investigate the effect of previous arthroscopic Bankart repair surgery on corocaid bone graft osteolysis in Latarjet procedure.This retrospective case-control study analyzed data from patients who underwent primary Latarjet procedure or revision Latarjet procedure following failed arthroscopic Bankart repair. Clinical outcome measures included range of motion (ROM), subjective shoulder value (SSV) and Rowe score. Volumetric analysis of each transferred coracoid graft were performed using early postoperative and late postoperative computed tomography (CT) scan data and amount of graft osteolysis was then calculated as percentage of volume reduction of each graft.32 patients who met the inclusion criteria, with 24 patients in the primary Latarjet group (group I) and 8 patients in revision Latarjet group (group II), were included to study. Mean age of patients was 32.5±7.7 years and mean follow-up duration was 52.1±8.9 months. Both study groups showed significant improvement in SSV compared to baseline (p<0.05). Comparison of postoperative clinical outcome measures showed no significant difference between two study groups in any outcome parameter (p>0.05). No recurrence was observed during follow-up period. There were 6 patients (25%) with positive apprehension sign in group I and 4 patients (50%) in group II (p>0.05). Analysis of radiological data revealed that all patients underwent some degree of graft osteolysis with varying osteolysis ratios between 12% to 98%. Mean osteolysis ratio of the coracoid graft was 67.3±22.6% in group I and 69.4±25.6% in group II, without significant difference between two groups (p>0.05).Findings of this study suggest that both primary and revision Latarjet procedures following failed arthroscopic Bankart repair underwent considerable amount of coracoid graft osteolysis. Previous arthroscopic Bankart repair did not seem to have significant influence on the amount of graft osteolysis and both primary and revision Latarjet procedures showed satisfactory clinical outcomes.