A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair

Background: The Bankart repair and Latarjet procedure are both viable surgical options for recurrent traumatic anterior instability of the shoulder joint. The anatomic repair is the more popular option, with 90% of surgeons internationally choosing the Bankart repair as the initial treatment. There has been no previous review directly comparing the 2 techniques. Hence, we aimed to systematically review studies to compare the outcomes of Bankart repairs vs. the Latarjet procedure for recurrent instability of the shoulder. Methods: Six electronic databases were searched for original, English-language studies comparing the Bankart and Latarjet procedures. Studies were critically appraised using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Data were extracted from the text, tables, and figures of the selected studies. Results: Eight comparative studies were identified with 795 shoulders; 416 of them underwent open or arthroscopic Bankart repairs, and 379 were repaired by the open Latarjet procedure. Primary and revision procedures were studied. The Latarjet procedure conferred significantly lower risk of recurrence and redislocation. There was no significant difference in the rates of complication requiring reoperation between the two procedures. Rowe scores were higher and loss of external rotation lower in the Latarjet group compared with the Bankart repair group. Conclusions: Our studies demonstrate that the Latarjet procedure is a viable and possibly superior alternative to the Bankart repair, offering greater stability with no significant increase in complication rate. However, the studies identified were retrospective and of limited quality, and therefore randomized controlled trials with large populations of patients or prospective assessment of national orthopedic registries should be employed to confirm our findings. Level of evidence: Level III; Meta-Analysis (C) 2016 Journal of Shoulder and Elbow Surgery Board of Trustees.