Postoperative Recovery Comparisons of Arthroscopic Bankart to Open Latarjet for the Treatment of Anterior Glenohumeral Instability

摘要

Objectives: Recurrent anterior glenohumeral instability is a disabling pathology that can be successfully treated by arthroscopic Bankart repair or an open Latarjet procedure. Long-term outcomes have shown lower rates of apprehension, recurrent dislocation and operative revision following Latarjet when compared to Bankart repair. However, there is a paucity of studies comparing the short-term post-operative recovery of arthroscopic Bankart versus open Latarjet. The purpose of this study is to evaluate the post-operative recovery following Bankart and the open Latarjet procedure. Methods: The surgical outcomes system (SOS) database (Arthrex Inc., Naples, FL) was used to compare the post-operative recovery outcomes after either a primary or revision arthroscopic Bankart and an open Latarjet procedure. Patients were included who had a minimum of 1 year follow-up. Preoperative and postoperative (2 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 year) time points were evaluated. Outcomes measures included Visual Analog Pain Scale (VAS), American Shoulder and Elbow Surgeons (ASES) Shoulder Function Score, ASES Shoulder Index Score, and SANE Score. Overall, 787 patients underwent primary Bankart (518 male, 240 female, 4 not recorded), 36 underwent revision Bankart (24 male, 10 female, 2 not recorded) and 75 underwent an open Latarjet procedure (59 male, 12 female, 4 not recorded). The mean age for primary Bankart, revision Bankart, and open Latarjet was 40.8, 38.6 and 32.8 respectively. Additionally, the average BMI for primary Bankart, revision Bankart, and open Latarjet was 27.2, 28.13, and 25.6, respectively. Results: The postoperative recovery curves are displayed in Figure 1. When compared to primary Bankart, open Latarjet demonstrated significantly lower VAS scores at six weeks (p=0.0272) and at three months (p=0.0094). Medium term outcomes for ASES Shoulder Index Score, ASES Shoulder Function Score, and SANE Score, at 1- and 2-years showed no difference between primary Bankart and Latarjet. For the revision Bankart and open Latarjet procedures, the open Latarjet cohort demonstrated significantly higher ASES Shoulder Index Scores at the 3-months (p= 0.0017), 1-year (p= 0.0021), and 2-years (p= 0.0006) timepoints. Open Latarjet patients also had significantly higher ASES Shoulder Function Scores than revision Bankart at 3-months (p= 0.0162), 1-year (p= 0.0083), and 2-years (p= 0.0013). Revision Bankart repair resulted in significantly higher VAS scores than open Latarjet at 2-weeks (p= 0.0025), 6-weeks (p=0.0114), 3-months (p= 0.0024), 1-year (p= 0.0039), and 2-years (p= 0.0007). Conclusion: When compared to Bankart repair, open Latarjet provides improved pain and functional outcomes during the early recovery phase, 2-weeks, 6-weeks, 3-months, and 6-months, with equivalent medium-term outcomes at 1-2-years. Furthermore, when compared to revision Bankart reconstruction, open Latarjet provides improved ASES Shoulder Index Scores, ASES Shoulder Function Scores and VAS Scores at nearly all timepoints. In the treatment of recurrent anterior glenohumeral instability, open Latarjet is reasonable option in the primary setting and should be favored over Bankart repair for revision cases with improved pain relief and functional scores.