Remplissage vs Latarjet: Fewer Complications?

According to a new study, two-year functional outcomes from primary remplissage are superior to primary Latarjet, with higher return to sport for overhead and contact activities, fewer complications, and comparably low recurrence rates.

This was despite greater bipolar bone loss in the remplissage group.

The study, “Remplissage yields similar 2-year outcomes, fewer complications, and low recurrence compared to Latarjet across a wide range of preoperative glenoid bone loss,” was published online on April 7, 2022 in the journal Arthroscopy.

For this study, the researchers compared functional outcome, return to sport, satisfaction, postoperative recurrence, and complications between the two procedures.

All the surgeries analyzed were performed between 2013 and 2019. All the patients had at least two years of follow-up. The researchers reviewed baseline and two-year range of motion, patient-reported outcomes including Western Ontario Shoulder Instability Index, Single Assessment Numeric Evaluation, and Visual Analog Scale for pain, recurrence, return to sport, satisfaction, and complications.

Overall, 258 patients were included in the study. Seventy of them had remplissage and 188 underwent Latarjet. Baseline demographics, range of motion and patient-reported outcomes were all similar between the groups.

Mean preoperative glenoid bone loss (12.3% +/- 10.9% vs 7.6% +/- 9%; p < 0.001) and off-track lesions (23% vs. 13%; p = 0.046) were higher in the remplissage group while preoperative glenoid bone loss range was similar (0-42% vs 0-47%).

Change in Visual Analog Scale (1.9 vs. 0.9; p = 0.019) and Western Ontario Shoulder Instability Index (1096 vs 805; p < 0.001) were improved in the remplissage cohort.

Percent achieved minimal clinically important difference was improved in Western Ontario Shoulder Instability Index for remplissage. The remplissage group though had worse change in external rotation (-4° vs +19°; p < 0.001).

Return to sport for overhead and contact athletes favored remplissage (91.5% vs 72.7%: p = 0.007); while satisfaction and recurrent dislocation were similar. Surgical complications were observed in 0% of remplissage cases, compared to 5.9% in the Latarjet group.

“Primary remplissage resulted in 2-year functional outcomes that were as good or superior to primary Latarjet, with higher return to sport for overhead and contact activities, fewer complications, and comparably low recurrence rates, even despite greater bipolar bone loss in the remplissage cohort. However, this comes at the expense of decreased external rotation which may be considered in individual patients,” the researchers wrote.

Study authors include Jeffrey L. Horinek, M.D., of Oregon Shoulder Institute, Mariano E. Menendez, M.D., of Midwest Orthopedics at Rush, Pablo Narbona, M.D., of Sanatorio Allende, Cardoba, Argentina, Alexandre Ladermann, M.D., of La Tour Hospital, Meyrin, Switzerland, Johannes Barth, M.D., of Clinique des Cedres, Echirolles, France, and Patrick J. Denard, M.D., of Oregon Shoulder Institute.