The Latarjet Procedure for Anterior Shoulder Instability in Pediatric and Adolescent Athletes

Abstract

Objectives: To investigate surgical outcomes of the Latarjet procedure in the pediatric and adolescent athletic population compared to alternative techniques used to treat anterior shoulder instability with glenoid bone loss. Method(s): This retrospective comparative cohort study involved a review of 40 patient records with a mean age of 16.7 years (range: 14.3 to 19.2) with anterior shoulder instability and glenoid bone loss (mean: 19%). Demographic and clinical features were recorded pre- and post-operatively, with mean follow up of 26.3 months (sd, 22.8). Advanced imaging and arthroscopic assessment were used to quantify concomitant pathology. Percent glenoid bone loss was calculated using the "glenoid rim distances" method. Glenoid track width and Hill-Sachs interval (HSI) were measured to determine if shoulders were on-track or off-track. Patients were contacted to obtain validated functional outcome questionnaires, including Quick-DASH, ASES, and Marx shoulder activity scale. Result(s): Of the 40 patients, 18 underwent the Latarjet procedure and 22 underwent alternative stabilization procedures. At presentation, both groups were statistically similar with regard to presence of HS (overall 92%), and mechanism of initial dislocation. However, patients who underwent the Latarjet procedure were slightly older at surgery (p=0.045), had longer symptom duration (p=0.015), and had failed more arthroscopic Bankart repair procedures (p=0.002). Additionally, more patients had "off-track" glenohumeral bone loss in the Latarjet group (38%) compared to the control group (9%), (p=0.049). Post-operatively, the Latarjet and control groups had comparable minimal loss of external rotation (47% vs .45%, p=0.768) and high rates of return to sports (94% vs 100%) at a similar time (5.3 vs. 5.4 months, p=1.0). There was a 17% recurrent instability rate in the Latarjet cohort similar to 23% in the control cohort (p=0.709). There were no cases of post-operative nerve palsy or coracoid non-union in those who underwent the Latarjet, compared to one non-union following bony Bankart ORIF in the control group. Functional outcome scores were similarly high across both groups (Table 1). Conclusion(s): Despite being a technically challenging, salvage-type, open reconstructive shoulder procedure, the Latarjet procedure yielded low complication rates and comparably good outcomes in an adolescent cohort with more risk factors for recurrence than a control group of adolescents undergoing other procedures. For young, athletic patients with multiple instability recurrences, previous surgeries, long symptom duration, and glenohumeral bone loss-including severe, 'off track' variations-the Latarjet procedure provides a high rate of return to sports, good/excellent functional outcome scores, and low rates of recurrent instability and complications.