Comparative Study Between Functional Outcome of Mini Open Latarjet Versus Arthroscopic Bankart Repair in the Management of Recurrent Anterior Shoulder Instability
Vol 10 | Issue 1 | January-June 2024 | page: 09-12 | Bharadwaj Marrapu, Sasi Bhushana Rao Sasapu, Yeshwanth Thonangi, Jalapati Sairam, Rithika Reddy
https://doi.org/10.13107/jmt.2024.v10.i01.214
Author: Bharadwaj Marrapu [1], Sasi Bhushana Rao Sasapu [1], Yeshwanth Thonangi [1], Jalapati Sairam [1], Rithika Reddy [2]
[1] Department of Orthopaedics, MIMS Hospital, Nellimarla, Andhra Pradesh, India.
[2] Department of Radiology, MIMS Hospital, Nellimarla , Andhra Pradesh, India.
Address of Correspondence
Dr. Bharadwaj Marrapu,
Senior Resident, Department of Orthopaedics, MIMS Hospital, Nellimarla, Andhra Pradesh, India.
E-mail: bharadwajmarrapu@gmail.com
Abstract
Background: Anterior shoulder dislocations are frequent, affecting 2% of people annually. Arthroscopic Bankart repair is used for soft tissue lesions or minor bone loss, while the open Latarjet procedure is preferred for significant bone loss. This study compares functional outcomes of these surgical methods.
Materials and methods: This prospective interventional study, approved by the Institutional Ethical Committee, was conducted at Maharajah Institute of Medical Sciences from January 2023 to June 2024. It included 30 patients with recurrent anterior shoulder instability, managed with either arthroscopic Bankart repair or Latarjet procedure, based on specific criteria.
Results: In an 18-month study comparing mini-open Latarjet and arthroscopic Bankart repair, 30 patients were analyzed. Age distribution was similar between groups. There were no significant differences in functional scores, recurrence rates, or overall satisfaction. The Bankart group had 13.3% recurrence, while the Latarjet group experienced 13.3% superficial infections, which resolved with treatment.
Conclusion: Both techniques were effective, but the arthroscopic Bankart repair had a higher recurrence of shoulder dislocation, while the Latarjet procedure offered better functional outcomes. In developing countries like India, the Latarjet procedure may be preferred due to its potentially better long-term results and the financial burden of repeated treatments with the Bankart repair.
Keywords: Anterior shoulder dislocation, Arthroscopic Bankart repair, Open Latarjet procedure, Recurrent shoulder instability, Functional outcomes, Bone loss, Soft tissue lesions, Financial constraints, Mini-open Latarjet.
Thesis Question
To Compare Functional Outcome of Arthroscopic bankart repair vs Mini open Iatarjet in management of recurrent anterior shoulder instability.
Thesis Answer
The mini-open Latarjet procedure showed better long-term outcomes and lower recurrence rates compared to arthroscopic Bankart repair for recurrent anterior shoulder instability. Despite being more invasive and costly, Latarjet may be more effective in developing countries due to its superior stability and patient satisfaction.
Introduction
Anterior shoulder dislocations are highly prevalent, with an incidence rate of 23.9 per 100,000 people, affecting about 2% of the population [1, 2]. Surgery is often necessary for recurrent dislocations due to a high risk of recurrence with nonoperative methods [3, 4].
Arthroscopic Bankart repair, utilizing suture anchors, is typically used for patients with soft tissue Bankart lesions or up to 25% glenoid bone loss. For significant Hill-Sachs defects (>25% engagement), an additional remplissage procedure is recommended [5, 6, 7]. The open Latarjet procedure is generally preferred for cases with substantial glenoid bone loss. Although there is debate over the benefits of each technique, surgical success is ultimately measured by clinical outcomes and recurrence rates [8–14].
In resource-limited settings like Nepal, cost is a significant factor. Many patients cannot afford the expensive suture anchors needed for arthroscopic repair, and insurance often does not cover these costs [15, 16].
This study aims to compare the functional outcomes of patients undergoing arthroscopic Bankart repair versus those receiving open Latarjet treatment for recurrent anterior shoulder dislocation.
Aim & Objectives
Aim
To compare the functional outcomes of arthroscopic Bankart repair versus mini open Latarjet in the management of recurrent anterior shoulder instability.
Objectives
1. To evaluate and compare the functional outcomes of arthroscopic Bankart repair versus mini open Latarjet for recurrent anterior shoulder instability.
2. To analyze prognostic factors that may predict the outcomes of these surgical interventions.
Materials & Methods
This prospective interventional study was conducted at Maharajah Institute of Medical Sciences, Vizianagaram, over 18 months, from January 2023 to June 2024. The study protocol was approved by the Institutional Ethics Committee (IEC).
Study Design: Prospective interventional study
Study Period: January 2023 to June 2024
Study Setting: Maharajah Institute of Medical Sciences, Vizianagaram, affiliated with Dr. YSR UHS
Ethical Considerations
• Approval was obtained from the Institutional Ethics Committee.
• Participation was voluntary, with informed consent obtained from all participants.
• Participant confidentiality was maintained.
• No participants were subjected to potential harm.
Study Subjects: Patients with recurrent anterior shoulder instability admitted to Maharajah Institute of Medical Sciences and managed with arthroscopic surgery.
Inclusion Criteria:
• History of recurrent shoulder dislocations
• Age between 20-40 years
• Willingness to participate
• Soft tissue glenoid lesions and bone loss less than 10% for arthroscopic Bankart repair
• Glenoid bone loss of 10-25% or less than 10% with a Hill-Sachs lesion for Latarjet surgery
Exclusion Criteria:
• First-time dislocation
• Age ≥65 years
• Bony Bankart lesions >25% of glenoid
• Voluntary dislocators
• Psychiatric disorders
• Neuropathic joint
• Refusal to provide written/informed consent
Sample Size: 30 patients
Sampling Technique: Simple random sampling
Results
This study at Maharajah Institute of Medical Sciences evaluated the effectiveness of mini open Latarjet versus arthroscopic Bankart repair for recurrent anterior shoulder instability. The participants, mostly young males with a predominance of right-sided injuries and frequent prior dislocations, were equally divided between the two surgical methods.
Both techniques showed comparable functional outcomes in terms of ASES, Rowe, Quick DASH scores, and external rotation. Patient satisfaction was high for both groups, with the Latarjet group reporting slightly better satisfaction. Notably, the Bankart group experienced two cases of re-dislocation, whereas the Latarjet group had two cases of superficial wound infection. Overall, while both procedures were effective, Latarjet showed a slight advantage in patient satisfaction and fewer recurrent dislocations.
In the Bankart group, two patients had re-dislocation; one underwent an open Latarjet revision. In the Latarjet group, two patients had superficial wound infections, which resolved with treatment. No additional complications were reported in either group.
Figures and X-Rays
• Age Groups: Distribution by age range.
• Gender Distribution: Predominantly male.
• Side of Involvement: Predominantly right-sided.
• Mode of Injury: Most common was road traffic accidents.
• Bankart Lesion Types: Various types and locations.
• Hill-Sachs Lesions: Mostly medium and small sizes.
• Track Status: Majority off track.
Discussion
his study, conducted over 18 months at Maharajah Institute of Medical Sciences, compared the functional outcomes of mini open Latarjet versus arthroscopic Bankart repair for recurrent anterior shoulder instability. The Latarjet procedure is well-regarded for its triple-stabilizing effect—capsular repair, anterior glenoid augmentation, and sling effect—which can enhance stability and reduce recurrence rates compared to the Bankart repair [10 , 12 , 28].
Findings from this study support the Latarjet technique's superior performance, with lower recurrence rates and higher functional satisfaction. Specifically, the Bankart group experienced a 13.3% recurrence rate, while the Latarjet group reported no recurrences [10]. This is consistent with previous research demonstrating the Latarjet's effectiveness in improving stability and patient outcomes [11, 12]. The Bankart repair, though less invasive and cosmetically preferred, was associated with a higher recurrence rate and slightly lower patient satisfaction [ 25, 27].
Complications were noted in both procedures. Graft-related issues, including fractures and nonunion, were common, with arthroscopic methods possibly having a higher risk due to technical complexities [19]. Despite these challenges, no significant differences in complication rates were observed between the techniques in this study [30]. The open Latarjet method has been associated with concerns about wound infections and neurological injuries, but these complications were managed effectively in this cohort [16].
Both techniques resulted in minor increases in cartilage wear at the 3-month follow-up, indicating the need for longer-term monitoring [16]. This study's findings align with the broader literature, which often highlights the Latarjet procedure's superior long-term outcomes compared to Bankart repair [14]. However, the technical demands of both procedures suggest that patient-specific factors and surgeon expertise are crucial in achieving optimal outcomes.
Conclusion
• Both arthroscopic Bankart repair and the Latarjet procedure showed positive clinical outcomes for managing recurrent anterior shoulder instability. Despite the advantages of arthroscopic Bankart repair, such as being minimally invasive and having aesthetic benefits, it was associated with a higher tendency for recurrent shoulder dislocations compared to the Latarjet procedure. In contrast, the Latarjet procedure offered superior functional satisfaction and a lower recurrence rate.
• Given these findings, the Latarjet procedure may be more suitable in developing countries like India. This recommendation is based on the procedure’s potentially better long-term outcomes and its ability to minimize the financial burden associated with recurrent treatments. While arthroscopic Bankart repair is less invasive, its higher recurrence rate and the financial implications of repeated surgeries make Latarjet a more viable option in resource-constrained settings.
Clinical message
In this study comparing Mini Open Latarjet to Arthroscopic Bankart Repair for recurrent anterior shoulder instability, both techniques demonstrated positive clinical outcomes. However, the Arthroscopic Bankart Repair was associated with a higher rate of recurrence, while the Latarjet procedure provided superior functional satisfaction and lower recurrence rates. These findings suggest that, despite its invasiveness, the Mini Open Latarjet may offer better long-term stability and patient outcomes, particularly in resource-constrained settings where repeated treatments could be financially burdensome. Future studies with longer follow-ups are needed to confirm these results and guide optimal treatment choices.
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How to Cite this Article: Marrapu B, Sasapu ABR, Thonangi Y, Sairam J, Reddy R. Comparative Study Between Functional Outcome of Mini Open Latarjet Versus Arthroscopic Bankart Repair in the Management of Recurrent Anterior Shoulder Instability. Journal Medical Thesis 2024 January-June ; 10(1):09-12. |
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