The Latarjet procedure can be effective without remplissage to restore stability in athletes with glenoid bone defects greater than 25% and off-track Hill-Sachs lesions, according to a new study.
Latarjet Procedure Put to the Test in New Study
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Secondary#remplissage#laterjetprocedure#glenoidbonedefects
The researchers of “The Latarjet Procedure Without Remplissage Is Effective to Restore Stability in Athletes With Glenoid Bone Defects Greater Than 25% and Off-Ttrack Hill-Sachs Lesions” published in the August 2021 issue of the journal Arthroscopy, had a two-fold purpose for their study.
First, they wanted to report on the clinical outcomes of the Latarjet procedure without remplissage in athletes with glenoid bone defects greater than 25% and off-track Hill-Sachs lesions. Second, they wanted to know if the isolated Latarjet procedure converted off-track Hill-Sachs lesions to on-track Hill-Sachs lesions.
The study enrolled 29 athletes who had anterior glenohumeral instability with glenoid bone defects greater than 25% and off-track Hill-Sachs lesions, who were treated with Latarjet surgery, and who had a minimum follow-up period of 24 months. The mean age was 30 years.
The researchers analyzed the glenoid track before the procedure and 3 months afterward using 3D CT. Functional outcomes were evaluated using return to sport, range of motion, Rowe score, Visual Analog Scale score for pain during sports activity and Athletic Shoulder Outcome Scoring System score. They also assessed recurrence rates.
Overall, 27 (93%) of the athletes were able to return to sports and 25 (86%) were able to return to the same level as before their injury. There was no significant difference in shoulder range of motion between preoperative and postoperative results.
The Rowe, Visual Analog Scale, and Athletic Shoulder Outcome Scoring System scores all significantly improved after surgery (p < .001). The mean width of the glenoid pathway changed from 21.5 mm (SD [standard deviation], 2.54 mm) in the preoperative period to 35.1 mm (SD, 5.46 mm) at 3 months’ follow-up.
“All the Hill-Sachs lesions remained on track, and no patient had recurrence of instability at the end of follow-up. No complications occurred in this series,” the researchers wrote.
“The Latarjet procedure was effective to restore stability in athletes with recurrent glenohumeral instability with glenoid bone defects greater than 25% and off-track Hill-Sachs lesions, avoiding recurrence in all patients after an average follow-up period of 35 months. Moreover, the Latarjet procedure converted all off-track Hill-Sachs lesions to on-track Hill-Sachs lesions as measured on CT.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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