Arthroscopic Bankart versus the open Latarjet procedure for anterior–inferior shoulder instability in young males: a randomised controlled trial with minimum 5-year follow-up

Objective To compare arthroscopic Bankart repair with the open Latarjet procedure in the treatment of anterior–inferior shoulder instability in young male patients. Methods A multicentre randomised controlled trial was conducted in orthopaedic departments at eight public hospitals in Finland. A total of 122 male patients (mean age 21 years, range 16–25) with anterior–inferior shoulder instability were randomised to undergo either arthroscopic Bankart repair or the open Latarjet procedure. The coprimary outcomes were recurrence of instability and Western Ontario Shoulder Instability Index (WOSI) at 5 years. The secondary outcomes included incidence of revision surgery, return to sports and progression of osteoarthritis on plain radiographs. Results At 5-year follow-up, 87 of 122 patients (71%) were available for analyses. Redislocations occurred in 16 of 62 patients (26%) in the Bankart group and 3 of 60 patients (5%) in the Latarjet group (p=0.004). Revision surgery was performed in 9 of 62 patients in the Bankart group and in 0 of 60 patients in the Latarjet group. Model-estimated mean WOSI at follow-up was 85.3 and 86.3 in the Bankart and the Latarjet groups, respectively (p=0.77). Among patients participating in competitive sports preoperatively with available follow-up data, return to previous level was achieved by 2 of 10 patients (20%) in the Bankart group and 5 of 7 patients (71%) in the Latarjet group (p=0.0195). Follow-up plain radiographs were available for 70 patients (40 in the Bankart and 30 in the Latarjet group). No statistically significant between-group differences were observed in the progression of osteoarthritis on plain radiographs. Conclusion The open Latarjet procedure was associated with significantly lower rates of redislocation and revision surgery compared with arthroscopic Bankart repair, while patient-reported outcomes did not differ between groups at 5 years.