COMPARISON OF BANKART, BANKART-REMPLISSAGE, AND LATARJET. RESULTS OF LUXE: A PROSPECTIVE MULTICENTRE CONSECUTIVE COHORT STUDY

Determining which patients are at higher risk of recurrent anterior shoulder instability (RASI) and needing a more invasive surgery, is still debated. To this end, we compared quality of life, function and recurrence in patients undergoing an open Latarjet (L), an arthroscopic Bankart(B) and arthroscopic Bankart-remplissage (BR) procedure. A level 1 prospective multicenter cohort study started in 2009, named the LUXE study, recruited and prospectively followed all surgical cases of RASI. Patients included in this study had a minimum 1 year follow up. Demographic and injury data were collected. ISIS scores were used to stratify patients and determine the surgical procedure. Bone defects of the glenoid and humeral head were measured using 3D CT-scans with the validated Clock method. WOSI and Quick Dash were taken pre-operatively and at follow-ups to assess function. Recurrence rate and complications were noted for subluxation and dislocation. Kaplan-Meyer curves were used to compare survival without recurrence of shoulder dislocation for each surgery. A total of 396 cases were identified and 224 patients were included. The mean age was 29 years with a majority of male patients (73%). Seventy-seven patients (34%) had Bankart arthroscopic repair, 34 patients (15%) had Bankart-remplissage, 61 patients (27%) underwent open Latarjet, and 47 (21%) had other procedures (O) as their primary surgery. The mean follow-up for each subgroup was 3.7 years for B, 3.3 years for L and 5 years for BR (p=0.02). There were more male patients in the Latarjet group (p=0.004). The number of pre-op dislocations was also different: B=8, BR=13, L=24, O=16 (p=0.002). The mean ISIS score was 2 for B, 5 for L and 3 for BR(p < 0 .001). Bone loss was also different between groups as measured by the clock method in degrees (GLENOID: B=40, BR=50, L=83, O=40; p=0.003. HUMERUS: B=54, BR=62, L=70, O=49; p=0.009). Off track Hill-Sachs lesions were more frequent in the BR group with 63% (L=53%, B=34%) (p=0.08). At one year follow up, there was no significant difference in complication rates, return to sport or patient satisfaction. However, the WOSI score was better for B (437) than for BR (740) and L (658). At the last follow up, the recurrence rate for shoulder dislocation or subluxation was 7% for L followed by 18% for B, 26% for BR and 15% for O. (p=0.06). WOSI and function (QDASH) were not significantly different at 3 years. There were significant differences between groups, specially the Latarjet patients who were younger, with higher ISIS scores, larger glenoid bone loss, more prior dislocations and included more males. Regardless, their recurrence rates were much better without significantly more complications. Outcomes were similar for BR and B patients, however, the two groups were not comparable in terms of ISIS scores, bony Bankart and Hill Sachs lesions, follow up, and Off-track Hill-Sachs. This large cohort showed good midterm outcomes in all procedures, favoring Latarjet in terms of lower recurrence of instability and equivalent function. Longer term studies are needed.