Arthroscopic Bankart repair vs. Latarjet procedure for recurrent shoulder instability: a meta-analysis of clinical outcomes and complication rates in general and athletic populations.

ABSTRACT

BACKGROUND: The Bankart repair and Latarjet procedure are both effective surgical methods for treating repeated recurrent anterior dislocation of the shoulder. However, there is still little consensus regarding the standard treatment for recurrent anterior instability of the shoulder. Typically, the choice of treatment has been influenced more by training and tradition rather than the existing evidence. This systematic review and meta-analysis aimed to compare patient-reported outcomes, recurrence, and complications between the 2 procedures, among both athletic and nonathletic cohorts. METHODS: Relevant clinical trials were identified through a systematic search of databases in April 2023 including PubMed, Scopus, Web of Science, and Cochrane. Randomized controlled trials and cohort studies were included if they compared patient-reported outcomes or complication rates of open Latarjet procedure vs. arthroscopic Bankart repair. Continuous data, such as patient-reported outcomes were pooled as the weighted mean difference. For dichotomous data such as recurrence and revision rates, the pooled risk ratio (RR) with 95% confidence intervals (CIs) was calculated using random effects meta-analysis. RESULTS: Twenty-one clinical studies (3 randomized controlled trials) were included in the meta-analysis involving a total of 13,176 operated shoulders. Arthroscopic Bankart showed a 3.08 times higher risk of recurrence and revision due to postoperative instability (RR = 3.08, 95% CI 2.03-4.68) compared with those who had the Latarjet approach. The Rowe score was higher in the Latarjet group by an average of 4.55 points (95% CI 2.41-6.68). This difference was more pronounced in athletes, with an increase of 5.47 points (95% CI 0.16-10.78), compared with the nonathletic population 4.03 (95% CI 2.04-6.02). Return to sport time was shorter by 0.40 months (95% CI -0.75 to -0.05) in the Latarjet group. The total complication rate was approximately 47% lower in the Bankart group (RR = 0.53, 95% CI 0.31-0.90). Additionally, the risk of hematoma was 75% lower in patients undergoing the arthroscopic Bankart compared with the Latarjet procedure. External rotation, assessed both in abduction and adduction of the arm, as well as forward elevation, show no significant differences between the 2 groups. CONCLUSION: Our results demonstrate that the Latarjet procedure has a lower recurrence rate, excels in patient-reported outcomes, and requires less time for return to sports. Thus, it may be a superior alternative to arthroscopic Bankart repair. However, it is still associated with a higher incidence of complications.