The Latarjet procedure for the treatment of recurrence of anterior instability of the shoulder after operative repair: a retrospective case series of forty-nine consecutive patients.

BACKGROUND: Recurrence of anterior shoulder instability after operative repair is an uncommon but disabling condition for which treatment options have been insufficiently studied. Coracoid transfer as described by Latarjet is a highly successful primary operation for recurrent anterior shoulder instability. The purpose of this study was to verify the hypothesis that this procedure is also effective for treating recurrent glenohumeral instability after previous operative repair.

METHODS: Forty-nine consecutive patients with either one (n = 32), two (n = 12), or at least three (n = 5) previous stabilizations other than a Latarjet procedure and recurrence of anterior glenohumeral instability associated with a lesion of the anterior aspect of the glenoid rim had revision with a coracoid transfer as described by Latarjet. Clinical outcomes at a mean of thirty-eight months postoperatively included the subjective shoulder value, the Constant-Murley score, and glenohumeral stability. Standardized anteroposterior and axial radiographs before and after the Latarjet revision were used to grade the degree of glenohumeral osteoarthritis.

RESULTS: The results in all forty-nine patients were reviewed. No shoulder redislocated, subluxations recurred in two patients, and five patients reported slight, unspecified shoulder symptoms. No revision surgery was needed. Forty-three shoulders (88%) were subjectively graded as excellent or good; three, fair; and three, poor. Dissatisfaction was associated with persistent pain, and patients with preoperative pain had a twentyfold higher probability of having postoperative pain. The mean subjective shoulder value increased from 53% preoperatively to 79% at the time of follow-up (p < 0.001), and the Constant-Murley score remained high (80% preoperatively and 85% at the time of follow-up; p = 0.061). Optimal graft placement was obtained in thirty cases and was related to better clinical outcome and less progression of osteoarthritis than was suboptimal graft placement.

CONCLUSIONS: Coracoid transfer as described by Latarjet can effectively restore anterior glenohumeral shoulder stability if previous operation(s) have failed to do so. If recurrence is associated with chronic pain, the pain is likely to persist and compromise the subjective outcome.