Outcomes of Latarjet Versus Distal Tibia Allograft for Anterior Shoulder Instability Repair: A Matched Cohort Analysis

• Published in: The American journal of sports medicine Vol. 46; no. 5; pp. 1030 - 1038
• Main Authors: Frank, Rachel M., Romeo, Anthony A., Richardson, Catherine, Sumner, Shelby, Verma, Nikhil N., Cole, Brian J., Nicholson, Gregory P., Provencher, Matthew T.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-04-2018; Sage Publications Ltd
• Subjects: Adult; Arthroplasty - adverse effects; Arthroplasty - methods; Athletic Injuries - surgery; Clinical outcomes; Cohort analysis; Cohort Studies; Female; Humans; Joint Instability - surgery; Male; Postoperative Complications; Recurrence; Reoperation; Retrospective Studies; Shoulder; Shoulder Dislocation - surgery; Shoulder Joint - surgery; Sports medicine; Surgeons; Surgery; Tibia - transplantation; Transplantation, Homologous; Young Adult; anterior instability; shoulder; rotator cuff; Latarjet
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546517744203

Background:
Anterior glenoid reconstruction with fresh distal tibia allograft (DTA) has been described for management of recurrent shoulder instability, with encouraging early outcomes; however, no comparative data with the Latarjet procedure are available.
Purpose:
The purpose of this study was to compare the clinical outcomes between patients undergoing DTA and a matched cohort of patients undergoing Latarjet.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A review was conducted of prospectively collected data for patients with a minimum 15% anterior glenoid bone loss who underwent shoulder stabilization via either the DTA or Latarjet procedure and had a minimum follow-up of 2 years. Consecutive patients undergoing DTA were matched in a 1-to-1 format to patients undergoing Latarjet by age, body mass index, history of contact sports, and number of previous shoulder operations. Patients were evaluated pre- and postoperatively with a physical examination and the following outcome assessments: Simple Shoulder Test, visual analog scale, American Shoulder and Elbow Surgeons, Western Ontario Shoulder Instability Index, and Single Assessment Numeric Evaluation. Complications, reoperations, and episodes of recurrent instability were analyzed. Statistical analysis was performed with Student t tests, with P < .05 considered significant.
Results:
A total of 100 patients (50 Latarjet, 50 DTA) with a mean ± SD age of 25.6 ± 6.1 years were analyzed at 45 ± 20 months (range, 24-111) after surgery. Thirty-two patients (64%) in each group underwent prior ipsilateral shoulder surgery (range, 1-3). Patients undergoing DTA had significantly greater glenoid bone loss defects when compared with patients undergoing Latarjet (28.6% ± 7.4% vs 22.4% ± 10.3%, P = .001). Patients in both groups experienced significant improvements in all outcome scores after surgery (P < .05 for all). No significant differences were found in postoperative scores between the Latarjet and DTA groups: visual analog scale (0.67 ± 0.97 vs 1.83 ± 2.31), American Shoulder and Elbow Surgeons (91.06 ± 8.78 vs 89.74 ± 12.66), Western Ontario Shoulder Instability Index (74.30 ± 21.84 vs 89.69 ± 5.50), or Single Assessment Numeric Evaluation (80.68 ± 7.21 vs 90.08 ± 13.39) (P > .05 for all). However, patients in the Latarjet group had superior Simple Shoulder Test outcomes (P = .011). There were 10 complications (10%) for the entire cohort, including 5 in the Latarjet group (3 of which required reoperation) and 5 in the DTA group (3 of which required reoperation). The overall recurrent instability rate was 1% (1 patient).
Conclusion:
Fresh DTA reconstruction for recurrent anterior shoulder instability results in a clinically stable joint with similar clinical outcomes as the Latarjet procedure. Longer-term studies are needed to determine if these results are maintained over time.