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Long-term results of the Latarjet procedure for
anterior instability of the shoulder
Naoko Mizuno, MD
a,
*, Patrick J. Denard, MD
b
, Patric Raiss, MD
c
, Barbara Melis, MD
d
,
Gilles Walch, MD
e
a
Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Osaka, Japan
b
Southern Oregon Orthopedics, Medford, OR, USA
c
Clinic for Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
d
Policlinico Citt
a di Quartu, Quartu Sant’Elena, Cagliari, Italy
e
Centre Orthop
edique Santy, Lyon, France
Background: The Latarjet procedure is effective in managing anterior glenohumeral instability in the short
term, but there is concern for postoperative arthritis. The purpose of this study was to evaluate the long-
term functional outcome after the Latarjet procedure and to assess the prevalence of and risk factors for
glenohumeral arthritis after this procedure.
Materials and methods: A retrospective review was conducted of 68 Latarjet procedures at a mean of
20 years postoperatively. The mean age at surgery was 29.4 years. Functional outcome was determined
by the Rowe score, subjective shoulder value, and recurrence of instability. Preoperative arthritis and post-
operative radiographs were reviewed to evaluate the development or progression of arthritis.
Results: The mean Rowe score increased from 37.9 preoperatively to 89.6 at final follow-up (P<.001).
The mean subjective shoulder value was 90.9% at final follow-up. The postoperative rate of recurrence was
5.9%. Of the 60 shoulders without arthritis preoperatively, 12 (20%) had developed arthritis at final follow-
up. Among the 8 shoulders with preoperative arthritis (all stage 1), 4 (50%) demonstrated progression of
arthritis at final follow-up. Overall, postoperative arthritis was stage 1 in 14.7%, stage 2 in 5.9%, and stage
3 in 8.8% of cases; no stage 4 arthritis was observed. Risk factors for postoperative arthritis were older age,
high-demand sports activity, and lateral overhang of coracoid bone graft.
Conclusion: The Latarjet procedure provides excellent long-term outcomes in the treatment of recurrent
anterior glenohumeral instability. Twenty years after the Latarjet procedure, arthritis may develop or prog-
ress in 23.5% of cases, but the majority of arthritis is mild.
Level of evidence: Level IV, Case Series, Treatment Study.
Ó2014 Journal of Shoulder and Elbow Surgery Board of Trustees.
Keywords: Latarjet; anterior shoulder instability; long-term; glenohumeral joint; arthritis; risk factor
In 1954, Latarjet described a coracoid process transfer in
which the inferior surface of the coracoid was passed
through the subscapularis tendon and secured to the ante-
roinferior glenoid to treat anterior glenohumeral insta-
bility.
20
Patte proposed that the procedure provides stability
by the ‘‘triple blocking effect’’ (Fig. 1), which includes the
The Institutional Review Board of the ethical committee of the H^
opital
Priv
e Jean Mermoz and the Centre Orthop
edique Santy, Lyon, France,
approved this study (2013-05).
*Reprint requests: Naoko Mizuno, MD, Department of Orthopaedic
Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibaharacho Toyonaka-
shi, Osaka 560-8565, Japan.
E-mail address: nao-miz@hcc5.bai.ne.jp (N. Mizuno).
J Shoulder Elbow Surg (2014) 23, 1691-1699
www.elsevier.com/locate/ymse
1058-2746/$ - see front matter Ó2014 Journal of Shoulder and Elbow Surgery Board of Trustees.
http://dx.doi.org/10.1016/j.jse.2014.02.015
sling effect of the conjoint tendon on the subscapularis, the
bone effect of the graft, and the ligament effect of the
coracoacromial ligament stump.
25
Subsequently, Yama-
moto et al
34
performed a biomechanical study that clarified
the stabilizing mechanism of the Latarjet procedure. They
reported that the primary mechanism is the sling effect at
both the end-range and mid-range positions. Lesser con-
tributions are provided by suturing the coracoacromial
ligament to the capsular flap (capsular effect) at the end-
range position and the glenoid bone reconstruction at the
mid-range position.
Arthroscopic stabilization for anterior glenohumeral
instability has been performed with increasingly good re-
sults.
1,9,18,19,24,27,28,33
However, there is a substantial failure
rate with an arthroscopic approach in the setting of sig-
nificant glenoid bone loss, large engaging Hill-Sachs le-
sions, or combined glenoid and humeral bone
defects.
1,5,6,18,24,33
In these settings, the Latarjet procedure
effectively reduces the rate of recurrent instability.
5,6,35
A
few studies have reported good results of the Latarjet pro-
cedure at long-term follow-up. However, the prevalence of
glenohumeral arthritis after the Latarjet procedure has
ranged from 49% to 71%.
2,15,16,32
There are several risk factors for arthritis in patients who
have undergone treatment for anterior instability, including
age at initial dislocation and at the time of surgery, number
of preoperative dislocations, excessive anterior tissue
tightening, intra-articular hardware, lateral overhang of the
bone block, and longer follow-up.
4,7,10,12-15,22,23,26,28,29,36,37
However, there are few reports about the long-term risk
factors for arthritis after a Latarjet procedure.
The purpose of this study was to evaluate the long-term
results (minimum of 18 years) of the Latarjet procedure and
to determine the prevalence of and risk factors for long-
term glenohumeral arthritis after this procedure. We hy-
pothesized that the Latarjet procedure would provide a low
rate of recurrent instability with acceptable radiographic
results in the long term. We also hypothesized that risk
factors for postoperative arthritis would include patient
factors, such as age and number of preoperative disloca-
tions, as well as technical factors, such as position of the
coracoid graft.
Materials and methods
Study group
We retrospectively reviewed Latarjet procedures performed by a
single surgeon (G.W.) between 1988 and 1993. The indication for
Latarjet reconstruction was recurrent traumatic anterior instability
with or without hyperlaxity. Contraindications included ‘‘subtle’’
anterior instability without a Bankart lesion (painful shoulder in
the throwing athlete) and voluntary habitual anterior instability.
The inclusion criteria were a minimum follow-up of 18 years and
complete preoperative and postoperative functional outcome and
radiographic data. The exclusion criteria were a previous failed
instability repair and incomplete functional outcome and radio-
graphic data.
Figure 1 Triple blocking effect of Latarjet procedure. (A) A bone block effect occurs by use of the coracoid graft to restore glenoid bone
loss. (B) A sling effect occurs through the conjoined tendon, which limits anterior translation in a position of abduction and external
rotation. (C) A ligament effect occurs through the use of the coracoacromial ligament stump to reattach the medial capsule.
1692 N. Mizuno et al.
Operative technique
All operations were performed by the senior author (G.W.). The
patient was placed in the beach chair position, and a 4- to 5-cm
vertical incision was made beginning at the tip of the coracoid
process extending to the axilla. The deltopectoral interval was
used to expose the coracoid. Laterally, the coracoacromial liga-
ment was incised 1 cm from its insertion on the coracoid tip.
Medially, the pectoralis minor was released from the coracoid. An
osteotomy of the coracoid was performed at the junction between
the horizontal and vertical aspects (Fig. 2,A). The inferior cortex
of the coracoid graft was removed with a saw to create a flat bone
surface for subsequent opposition to the glenoid. A 3.2-mm drill
was used to create 2 holes in the graft, approximately 1 cm apart
(Fig. 2,B). A subscapularis split approach was used to access the
glenohumeral joint by dividing the subscapularis horizontally at
the lower third of the muscle (Fig. 2,C). After the subscapularis
split, the anterior glenohumeral capsule was exposed and a vertical
capsulotomy was performed at the medial origin. A retractor was
placed on the humeral head to expose the anterior glenoid. The
anterior labrum and periosteal sleeve were then excised. The
anteroinferior cortex of the glenoid was freshened with an
osteotome to provide a flat cancellous bed and to promote healing
of the graft. A bicortical hole was drilled in the inferior glenoid to
accommodate the coracoid graft without lateral overhang. The
inferior surface of the coracoid graft was then placed flush with
the articular surface of the glenoid and secured with a 4.5-mm
cancellous screw 35 mm in length. Once the inferior aspect of
the coracoid was secured, superior fixation was achieved by
drilling the superior hole through the coracoid and the glenoid. A
depth gauge was used to determine screw length, and another 4.5-
mm cancellous screw was inserted (Fig. 2,D). The initial screw
was retightened to ensure adequate compression of the graft.
Coracoid graft position was confirmed, with care taken to ensure
that it lay flush to the glenoid surface without lateral overhang.
Finally, with the arm in external rotation, the anterior capsule was
closed by suturing it to the coracoacromial ligament stump
remaining on the medial aspect of the coracoid graft.
Postoperative rehabilitation
Postoperatively, patients were placed in a sling for 2 weeks. Three
days after surgery, active-assisted forward flexion and external
rotation were allowed as tolerated. The sling was removed 2
weeks after surgery and self-mobilization was continued. Four
weeks after surgery, patients were allowed to resume athletic
conditioning of the lower extremities. Eight weeks after surgery,
strengthening of the shoulder was initiated. Return to sporting
activities, including contact sports, was allowed once clinical and
radiographic evaluation confirmed satisfactory healing of the
coracoid graft, usually at 3 months after surgery.
Clinical and radiographic evaluation
Preoperatively, all patients underwent a physical examination, and
functional outcome was assessed with the Rowe score.
30
In this
Figure 2 Surgical technique. (A) The coracoid process was osteotomized at the junction between horizontal and vertical parts. (B)Two
holes were drilled to flat cancellous surface of the coracoid. (C) The subscapularis muscle was divided at the junction of the superior two
thirds. (D) The coracoid graft was fixed with 2 malleolar screws lying flush with the glenoid articular surface.
Latarjet long-term follow-up 1693
system, outcomes are graded excellent when the score is 90 to 100
points, good when it is 75 to 89 points, fair when it is 51 to 74
points, and poor when it is 50 points. Basic demographic data,
activity, and number of preoperative dislocations were also
recorded. Postoperatively, patients were examined at 6 weeks,
3 months, and 6 months after surgery. At a minimum of 18 years
after surgery (mean, 20 years), we attempted to recontact the
patients. For those patients in the local area or those willing to
travel to our institution, a detailed physical and radiographic ex-
amination was performed in person. Eight of the 60 patients
returned for this examination. For those patients who lived far
from our institution, a detailed questionnaire was sent and an order
was provided to obtain radiographs. The questionnaire included
self-assessed range of motion,
8
strength, stability, activity, satis-
faction, and subjective shoulder value (SSV). This questionnaire
was used to calculate the postoperative Rowe score and recurrence
of instability.
In all patients, the same radiologic protocol was used preop-
eratively and postoperatively (Fig. 3). Radiographs were obtained
before surgery, immediately after surgery, at 3 months post-
operatively, and at the time of final follow-up (18-22 years;
average, 20 years). True anterior-posterior views of the gleno-
humeral joint were taken under fluoroscopic control in neutral and
internal and external rotation to determine the degree of gleno-
humeral arthritis (Fig. 4). Arthritis was graded into 4 stages ac-
cording to the Samilson and Prieto classification
31
as modified by
Buscayret et al.
7
In this modified classification, stage 1 consists of
humeral or glenoid osteophytes <3 mm, stage 2 consists of
osteophytes 3 to 7 mm with slight irregularity of the glenohumeral
joint, stage 3 consists of osteophytes >7 mm with glenohumeral
joint space narrowing and sclerosis, and stage 4 consists of
complete glenohumeral joint space loss. On the basis of this
staging, we recorded preoperative arthritis, progression of arthritis
in patients with arthritis before surgery, and postoperative devel-
opment of arthritis in patients without arthritis before surgery.
Finally, comparative glenoid profile views
3,11
were taken to assess
anterior bone loss and fracture of the glenoid preoperatively and to
assess bone union and the position of the coracoid process post-
operatively. The position of the coracoid graft was assessed on the
immediate postoperative films. A flush position was defined as
having the lateral aspect of the graft within 1 mm of the glenoid
surface. Medial or lateral overhang was consequently defined as
the lateral aspect of the graft positioned >1 mm medial or lateral
to the glenoid surface, respectively. The radiographs were assessed
by a single observer who was blinded to the patient’s history.
Statistical analysis
Preoperative and postoperative Rowe scores were compared with
the Mann-Whitney Utest. The association of the patient’s char-
acteristics and glenohumeral arthritis were evaluated with the
Wilcoxon rank sum test and Pearson c
2
tests. To identify the risk
factors for osteoarthritis, a multivariate statistical analysis was
also conducted. The level of significance was set at P.05.
Results
During the study period, 334 Latarjet procedures were
performed; 266 shoulders did not have complete follow-up,
leaving a total of 68 shoulders in 60 patients available for
this study. The average age at the time of surgery was
29.4 years (16-58 years). There were 49 men (54 shoulders)
and 11 women (14 shoulders). Thirty-nine of the pro-
cedures were on the dominant extremity. Sixty-three pa-
tients had recurrent dislocations, 5 had recurrent
subluxations, and 30 had both subluxations and dislocations
before surgery. Sixty-one patients (89.7%) participated in
sports (26 patients [38.2%] competitively and 35 patients
[51.4%] recreationally), and 13 patients (19.1%) were
classified as participating in contact collision sports.
Preoperatively, a fracture of glenoid was present in 24
shoulders (35.3%), a bone defect of glenoid was present in
15 shoulders (22.1%), and a Hill-Sachs lesion was present in
56 shoulders (82.4%). Eight patients (11.8%) demonstrated
glenohumeral arthritis before surgery that was stage 1 in all
cases.
Functional outcome
The mean follow-up was 20 years (18-22 years). The mean
Rowe score increased from 37.9 preoperatively to 89.6
Figure 3 Postoperative radiographic findings. (A) Anterior-posterior view shows a coracoid graft secured with 2 screws. (B) Glenoid
profile view (Bernageau view) demonstrates that the graft is positioned flush with the glenoid. Inset shows the position for obtaining this
radiograph. (C) Scapular Y view shows that the graft is positioned appropriately in the superior to inferior position.
1694 N. Mizuno et al.
postoperatively (P<.001). The mean SSV at final follow-
up was 90.9% (40%-100%). Forty-one patients (60.3%) had
no pain, 18 (26.5%) had pain during athletic activities, and
9 (13.2%) had pain during activities of daily living. Fifty-
five patients (80.9%) were very satisfied, 10 patients
(14.7%) were satisfied, and 3 patients (4.4%) were disap-
pointed with the result. The disappointed group included
patients who had shoulder pain during sports or were
apprehensive during activities of daily living. Fifty-seven
patients (93.4%) returned to sports at the same level, and
5 patients (8.2%) switched to another type of sport or
participated at a lower level because of their shoulder.
Recurrence of instability
Postoperative recurrence developed in 4 of 68 shoulders
(5.9%), with dislocation in 2 shoulders (2.9%) after a new
traumatic episode and subluxation in 2 shoulders (2.9%)
(Table I). The coracoid graft was positioned medially in the
2 shoulders with redislocation. One of the patients with
recurrent subluxation had a well-positioned coracoid
graft but experienced subluxation with overhead tennis
activity. The other patient with recurrent subluxation rein-
jured himself skiing and had a large glenoid defect
preoperatively.
One patient who had a large glenoid defect and in whom
the coracoid graft had been positioned medially underwent
revision with an Eden-Hybinette procedure. He was
43 years old at the initial surgery and redislocated twice
2 years postoperatively. His shoulder remained stable after
the revision procedure.
Radiographic results
On initial postoperative radiographs, the coracoid graft was
positioned medially in 5 patients (7.4%), flush with the
glenoid in 54 patients (79.4%), and with lateral overhang in
9 patients (13.2%). Pseudarthrosis of the coracoid graft
occurred in 1 shoulder (1.5%). This patient did not expe-
rience recurrent instability. However, at the time of final
follow-up, she was 61 years old and her clinical result was
poor because of stage 2 arthritis and a rotator cuff tear.
Screw fracture was identified in 1 shoulder (1.5%) at
3 years after surgery, but the coracoid graft was united and
the clinical result was excellent. Screw loosening occurred
in 2 shoulders (2.9%), and both of them were removed.
Progression of preoperative arthritis was identified in 4 of
the 8 shoulders (50%) with preoperative arthritis; the arthritis
was stage 2 in 2 shoulders and stage 3 in 2 shoulders.
Postoperative arthritis in the patients without preoperative
Figure 4 Postoperative arthritis (Samilson-Prieto classification). (A) A normal shoulder without arthritis. (B) Stage 1: humeral or glenoid
osteophyte <3 mm. (C) Stage 2: humeral or glenoid osteophyte 3 to 7 mm. (D) Stage 3: humeral or glenoid osteophyte >7 mm.
Latarjet long-term follow-up 1695
arthritis was observed in 12 shoulders (20%). These were
stage 1 in 6 shoulders (10%), stage 2 in 2 (3.3%), and stage 3
in 4 (6.7%). Notably, we did not identify any stage 4 arthritis
(complete obliteration of the glenohumeral joint space). In
addition, even the shoulders with stage 3 arthritis showed
good clinical results (Table II).
Risk factors associated with arthritis
The 16 shoulders that had postoperative arthritis or pro-
gression of preoperative arthritis were compared with the
52 shoulders that had no arthritis or no progression of
preoperative arthritis to clarify the risk factors of post-
operative arthritis. These were evaluated with the Wilcoxon
rank sum test and Pearson c
2
test. Patient characteristics
included the length of follow-up, age at the time of surgery
and at the time of final follow-up, number of dislocations
and subluxations, type of sporting activity, and post-
operative Rowe score and SSV (Table III). Radiographic
characteristics included preoperative fracture of glenoid or
glenoid bone loss and postoperative position of coracoid
graft (Table IV). There were significant differences in the
age at the time of final follow-up (P¼.005), high-demand
sports activity (P¼.001), SSV (P¼.005), and lateral
overhang of the coracoid graft (P<.001).
On multivariate logistic regression analysis, older age at
the time of final follow-up, high-demand sports, and lateral
overhang of the coracoid graft were significantly associated
with postoperative arthritis.
Discussion
The present study shows that the Latarjet procedure pro-
vides excellent long-term clinical results (mean Rowe score
was 89.6 points and mean SSV was 90.9%) at a mean of
20 years postoperatively. The prevalence of postoperative
development of arthritis and progression of preoperative
arthritis was only 23.5%, which was mild arthritis (stage 1
or 2) in 14.7% or severe arthritis (stage 3) in 8.8%.
Others have previously reported on the long-term results
of the Latarjet procedure. Singer et al
32
reported on 14
Bristow-Latarjet procedures with a mean follow-up of
20.5 years. They demonstrated an excellent or good Rowe
score in 93% despite a 71% rate of glenohumeral arthritis
in the involved shoulders. Allain et al
2
reported on 58
Latarjet procedures with a mean follow-up of 14.3 years.
They reported good or excellent results in 88% according to
the Rowe score. Sixty-two percent of the patients had
postoperative arthritis, and severe arthritis was seen in 36%.
Hovelius et al
15,16
reported on the outcomes of 118
Bristow-Latarjet reconstructions at a mean follow-up of
15.2 years. They reported 98% good or excellent Rowe
scores and a 13.8% recurrence of instability (including
subluxations). Forty-nine percent of their patients had
arthritis at final follow-up.
Despite the satisfactory clinical outcomes of the Latarjet
procedure, the high prevalence of postoperative arthritis
after the procedure is concerning. Our rate of postoperative
development of arthritis and progression of arthritis
(23.5%) was relatively lower than in the aforementioned
reports (49%-71%). Notably, we did not identify any stage
4 arthritis (complete obliteration of the glenohumeral joint
space). Even our patients with arthritis demonstrated good
clinical outcomes (Table II). However, we presume that this
relates to the fact that none of our patients had stage 4
arthritis. This difference in arthritis is unlikely to be related
to the patient population because the patient demographics
are similar between the cohorts. We believe that the sur-
gical technique therefore has a substantial influence on the
long-term development of arthritis after coracoid transfer.
In the studies by Allain et al and Singer et al,
2,32
patients
underwent a tenotomy of the subscapularis muscle, which
was reattached after coracoid grafting. This approach may
lead to an external rotation deficit after the subscapularis is
repaired, which may lead to arthritis in the long term
because of change in glenohumeral joint contact forces.
Allain et al
2
described a mean 20loss of external rotation
postoperatively overall and a mean 29loss of external
rotation in 18 patients in whom they repaired the
Table I Patients with recurrence
Age at
surgery, sex
Timing Type Cause Sport Glenoid
defect
Hyperlaxity Coracoid
position
Revision
17, M 2 years 1 subluxation No trauma Tennis Flush No
43, M 2 years 2 dislocations Kite flying Mountain bike DMedial Eden-Hybinette
20, M 5 years 1 subluxation Ski trauma Ski DFlush No
21, F 19 years 1 dislocation Elevation None DMedial No
Glenoid defect þ, significant bone loss sign was shown on comparative glenoid profile views
11
; Hyperlaxity þ, external rotation at side more than
90 degree bilaterally.
Table II Postoperative clinical results by stage of post-
operative osteoarthritis
Stage of OA at
final follow-up
Postoperative
Rowe score
SSV (%)
No OA (n ¼48) 90.7 92.1
Stage 1 (n ¼10) 89 92
Stage 2 (n ¼4) 78.8 83.3
Stage 3 (n ¼6) 85.8 82.3
OA, osteoarthritis; SSV, subjective shoulder value.
1696 N. Mizuno et al.
subscapularis with an overlapping technique. Singer et al
32
described that 86% of patients had an external rotation
deficit, and their mean external rotation was only 19in the
patients with grade 3 arthropathy. We used a horizontal
subscapularis splitting technique that does not require
reattachment of the tendon. Maynou et al
21
recently
described improved functional outcomes and greater pres-
ervation in external rotation in patients who underwent a
subscapularis split compared with a tenotomy during the
Latarjet procedure. Therefore, the subscapularis split
approach may contribute to our lower rate of long-term
arthritis. However, because we did not measure external
rotation in the majority of patients, this cannot be
confirmed. Finally, Allain et al
2
described lateral overhang
of the coracoid graft in 53% of their patients and noted that
this position was associated with the development of
arthritis. In the current study, the coracoid graft was posi-
tioned laterally in only 13% of cases.
Graft technique may also affect recurrence of instability
and subsequent arthritis. In the study by Hovelius et al,
16
for
instance, a Bristow-Latarjet technique was used in which the
base of the coracoid was opposed to the glenoid with a single
screw. They observed a 13.4% rate of recurrence. We used a
classic Latarjet technique in which the inferior surface of the
coracoid was secured to the glenoid with 2 screws. This
technique provides a more anatomic restoration of glenoid
bone stock compared with the Bristow technique and there-
fore may more accurately restore glenohumeral joint contact
forces. In addition, this technique may relate to our recur-
rence rate of only 5.9%. Our low recurrence rate may
partially account for our lower rate of postoperative arthritis
because an increasing number of dislocations has been
associated with glenohumeral arthritis.
7
We observed a medialized position of coracoid graft in 2
of 4 shoulders with recurrence. Furthermore, one patient
had a large glenoid bone defect and the other had hyper-
laxity. Large glenoid defects and hyperlaxity have previ-
ously been associated with recurrent instability.
5
Whereas
these factors are beyond the surgeon’s control, it appears
that anatomic coracoid graft positioning is important to
prevention of recurrent instability.
Postoperative arthritis after treatment of glenohumeral
instability has ranged from 35% to 71% at long-term
follow-up.
2,9,10,12,15,22,26,28,29,32
Reported risk factors for
arthritis have included age at initial dislocation and at the
time of surgery, number of preoperative dislocations,
excessive anterior tissue tightening, intra-articular hard-
ware, lateral overhang of the bone block, and longer follow-
up.
2,4,7,10,12-15,22,23,26,28,29,36,37
Our results confirm these
findings, particularly older age at the final follow-up and
lateral overhang of the coracoid graft. With respect to older
age, the natural history of the glenohumeral joint must be
considered. However, because the natural history of a
healthy glenohumeral joint has not been well defined, we
cannot compare the prevalence of arthritis in the normal
population to that in our patients who underwent a Latarjet
procedure. Kavaja et al
18
reported the long-term results of
74 arthroscopic Bankart repairs with mean follow-up of
13 years and also obtained radiographs of the nonaffected
shoulder. Their patient population was similar to that of our
study, with a mean age of 29 years at the time of surgery.
They identified arthritis in 22% of nonaffected shoulders,
which was similar to our prevalence of postoperative
arthritis and progression of preoperative arthritis (23.5%).
This suggests that postoperative arthritis is caused not only
by the Latarjet procedure but also by the natural history of
the glenohumeral joint. We also observed that contact
sports were associated with an increased risk for develop-
ment of arthritis in the long term despite a low rate of
recurrence. It is possible that these individuals subject their
shoulder to more microtrauma of the articular surface,
Table IV Radiographic comparison of patients with or
without postoperative arthritis or progression of arthritis
Postoperative
OA or progression
of OA (n ¼16)
No OA or no
progression of
OA (n ¼52)
P
value
Bony Bankart 9 (56.3%) 15 (28.8%) .161
Glenoid bone
defect
6 (37.5%) 9 (17.3%) .416
Position of
coracoid
graft
Medial 1 (6.3%) Medial 4 (7.7%) .847
Flush 8 (50%) Flush 46 (88.5%) .001
Lateral overhang
7 (43.7%)
Lateral overhang
2 (3.8%)
<.001
OA, osteoarthritis.
Table III Comparison of patients with and without post-
operative arthritis or progression of osteoarthritis
Postoperative
OA or
progression
of OA
(n ¼16)
No OA or no
progression
of OA
(n ¼52)
P
value
Follow-up period
(months)
243 240 .461
Age at surgery
(years)
34.4 27.8 .107
Age at final
follow-up
(years)
54.4 46.9 .048
Sports activity Competitive
4 (25%)
Competitive
22 (42.3%)
.213
High demand
8 (50%)
High demand
5 (9.6%)
.001
No. of dislocations/
subluxations
3.3/4.3 5.6/4.4 .125/.857
Postoperative Rowe
score
86.3 90.3 .148
SSV (%) 85.2 92.1 .005
SSV, subjective shoulder value.
Latarjet long-term follow-up 1697
which results in arthritis in the long term; this may be
particularly important because the Latarjet reconstruction
does not reproduce the normal anatomy of the gleno-
humeral joint. Lateral overhang of the coracoid graft is a
well-known risk factor for postoperative arthritis.
2,15
Therefore, from a technical standpoint, the most impor-
tant variable within the surgeon’s control is to avoid lateral
overhang of the coracoid graft.
There are several limitations to this study. This was a
retrospective review, and because of the length of follow-up,
a limited percentage of patients returned for evaluation. The
low follow-up rate is a significant weakness and has the po-
tential to introduce bias because of incomplete study results.
We did not have a comparison or control group. Hovelius
et al
17
reported a comparative study of Bristow-Latarjet and
Bankart repair during a 17-year follow-up and concluded that
a Bristow-Latarjet repair was more reliable than a Bankart
repair with anchors. We, however, did not compare alterna-
tive procedures, so we cannot comment if the Latarjet pro-
cedure offers a better long-term result or a lower risk of
arthritis compared with other procedures. Also, because we
did not compare approaches or assess external rotation, we
cannot prove that a subscapularis split technique is superior
to a tenotomy. The small number of patients with radio-
graphic evidence of arthritis also made statistical analysis of
data difficult. Furthermore, we used plain radiographs to
detect arthritis. A computed tomography scan may more
accurately detect arthritis, and further studies with such
evaluation may be useful.
Conclusion
The Latarjet procedure provides excellent long-term
functional outcome. The prevalence of postoperative
development of arthritis and progression of preoperative
arthritis is 23.5% at 20 years of follow-up, but the ma-
jority of arthritis is mild. Risk factors for development of
osteoarthritis after Latarjet reconstruction include old
age at final follow-up, high-demand sports activity, and
lateral overhang of the coracoid graft.
Disclaimer
The authors, their immediate families, and any research
foundation with which they are affiliated did not receive
any financial payments or other benefits from any
commercial entity related to the subject of this article.
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