Open versus Arthroscopic Latarjet Procedure for the Treatment of Chronic Anterior Glenohumeral Instability with Glenoid Bone Loss

Abstract Purpose The purpose of this study was to compare the clinical, functional, and radiographic outcomes of open versus arthroscopic Latarjet procedures. Methods Between December 2009 and January 2015, all patients older than 18 years of age who were treated with a Latarjet procedure for chronic osseous anterior instability by a single surgeon were included in this retrospective cohort study. Range of motion, strength, Rowe, Western Ontario Shoulder Instability Index (WOSI) scores and pain level according to the Visual Analog Scale (VAS) were evaluated. In addition, postoperative computed tomography (CT) scans were utilized to evaluate the position of the transferred coracoid, screw orientation, and degree of graft resorption. Results Forty-eight patients with a mean age of 29.5 years (range, 19-59 years) who underwent open (n=15; group OL) and arthroscopic (n=33; group AL) Latarjet procedures were included in the study. The mean follow-up was 30.5 months (range, 24-50 months). At final follow-up there were significant differences in the mean internal rotation (IR) loss (mean of 9° vs 14°, p = 0.044) favoring open surgery and WOSI (p = 0.017) scores favoring arthroscopic. No significant differences were detected in mean forward flexion loss (FF) (p = 0.918), external rotation loss (ER) (p = 0.883), Rowe (p = 0.429) and VAS (p = 0.208) scores. Mean superio-inferior position of the coracoid bone graft was found between 1:55 and 4:49 o’clock (2:05 - 4:55 for group OL; 1:51 - 4:47 for group AL) in en-face views. The grafts were placed laterally in 13% (group OL) and 9% (group AL) of patients. The mean α angles of the screws were 11° and 19.2°, respectively (p = 0.004). The mean graft resorption rates were 21% and 34% (p = 0.087), respectively. Conclusion Good functional results were obtained following both open and arthroscopic Latarjet procedures for the treatment of chronic osseous anterior shoulder instability. Comparative analysis showed small but statistically significant differences in IR loss favoring open and in WOSI favoring arthroscopic techniques. All measured radiographic parameters were similar with the exception of a significant difference in alpha angle with improved screw position in open surgery. Open and arthroscopic Latarjet techniques provide similar clinical and radiographic outcomes