The Latarjet Procedure in Patients With Subcritical Glenoid Bone Loss: Long-Term Results and Its Association With Graft Resorption

Abstract

Background: There are concerns that the Latarjet procedure for subcritical glenoid bone loss results in significant graft resorption and increased complications. Purpose: To (1) analyze the long-term results of the primary open Latarjet procedure in patients with subcritical preoperative glenoid bone loss and (2) find whether graft resorption influences these results. Study Design: Case series, Level of evidence, 4. Methods: A total of 50 shoulders (n = 48 patients) underwent the primary open Latarjet procedure at a mean age of 27 years (range, 19-37 years) for recurrent anterior shoulder instability with subcritical glenoid bone loss (<15%). After a mean of 8.5 years (range, 6-13 years), signs of recurrent instability, shoulder function, and patient-reported outcome measures—including the West Ontario Shoulder Instability Index (WOSI); the American Shoulder and Elbow Surgeon (ASES) score; the subjective shoulder value (SSV)—were assessed. Computed tomography-morphometric analysis of graft resorption was conducted to define the pattern and volume of resorption, and its influence on clinical outcomes. Results: At the final follow-up, a significant increase in the SSV (65% to 84%; P < .001), with a relative WOSI score of 19% ± 17% and an ASES score of 91 ± 9, was observed. One shoulder (2%) sustained a recurrent traumatic shoulder dislocation after 6.75 years but did not require revision surgery. Five shoulders (10%) experienced a subluxation, and 6 shoulders (12%) had positive anterior apprehension. Significant (P < .001) graft resorption (mean, 24% of the total graft volume) was observed at the long-term follow-up, although no patient underwent revision surgery. Resorption was concentrated in the superior segment of the graft (75%; P < .001). Overall, graft resorption had no significant influence on any clinical outcome measure—including complications, pain, or signs of postoperative instability (P > .05). Conclusion: The primary open Latarjet procedure for subcritical glenoid bone loss (<15%) results in an excellent clinical outcome. Although significant graft resorption (ie, concentrated around the superior screw) can be expected at the long-term follow-up, it does not result in adverse clinical outcomes, with complication and recurrence rates comparable to results of the Latarjet procedure for larger glenoid bone loss.