The Role of Arthroscopic Soft Tissue Reconstruction for Failed Bristow-Latarjet Procedure

Purpose

To analyze the functional results after unipolar or bipolar arthroscopic soft tissue stabilization in the treatment of recurrent anterior instability after a coracoid bone block procedure.

Methods

We studied a retrospective series of 41 patients (33 male, 8 female) with recurrent anterior shoulder instability after Bristow (n = 7) or Latarjet (n = 34) coracoid bone block treated with unipolar (isolated Bankart, n = 22) or bipolar (Bankart + Hill-Sachs remplissage, n = 19) arthroscopic stabilization.

Results

The mean follow-up was 72 (25-208) months. Severe glenoid erosion (>25%) was found in 17 patients, and a medium or deep Hill-Sachs lesion (Calandra 2 and 3) was found in 24 patients. A radiographic control was available in 28 patients at final follow-up. Five patients (12%) presented a recurrence of instability (4 subluxations, 1 dislocation). Two patients required revision surgery, 1 in each group. At final follow-up, persistent anterior apprehension was more frequent in patients presenting with severe glenoid bone loss (P = .04) and in patients with medium or deep Hill-Sachs lesions who were treated with unipolar stabilization (P = .04). Return to sports was achieved in 81% of cases. Visual analog scale was 1.3 ± 2, subjective shoulder value was 83% ± 18%, Rowe score was 78 ± 24, and Walch-Duplay score was 76 ± 28. No patients developed severe glenohumeral arthritis (Samilson 4).

Conclusions

Arthroscopic soft tissue stabilization provides good functional results after failed coracoid bone block with an acceptable rate of recurrence and a return to sports in most cases. Patients with significant Hill-Sachs lesions showed better results when treated with combined Bankart repair and Hill-Sachs remplissage. Severe glenoid bone loss was associated with poorer functional results.

Level of Evidence

Level IV, case series.