AB169. SOH24AB_255. Does the Latarjet procedure for anterior shoulder instability put off-track lesions back on track: a systematic review

Background: The Latarjet procedure is used in the treatment of shoulder instability. In the presence of bipolar bone loss there is concern that the Latarjet procedure may not convert these lesions from ‘off-track’ to ‘on-track’, conferring risk for recurrent instability. This systematic review assesses whether the Latarjet procedure is sufficient to convert ‘off-track’ Hill-Sachs lesions back to ‘on-track’.

Methods: A systematic review of PubMed, Embase and the Cochrane Library was performed in October 2023. Data collected included demographic information, surgical factors and post-operative results. The primary outcome was the rate of post-operative ‘on-track’ lesions and of recurrent instability. Changes in glenoid diameter and Hill-Sachs lesion interval were also recorded.

Results: A total of 5 studies were included with 187 patients. Weighted mean age was 29.2±2.2 years old (range: 26–32.4 years) and 90.8% of patients were male. Mean follow-up time was 26.8 months. All patients had off-track Hill-Sachs lesions pre-operatively. Weighted mean post-operative glenoid diameter change was 8.4±5.8 mm (range: 5.1–15.8 mm). The weighted mean Hill-Sachs lesion interval was 25.6±4.5 mm (range: 22.7–30.7 mm). 88.6% of cases were converted to on-track lesions. The overall post-operative instability rate was 4.8%. The recurrence rate was significantly greater for off-track lesions (33.3%) than for on-track lesions (4.2%), odds ratio 11.4 (range: 3.5–37.0) (P=0.0001).

Conclusions: The Latarjet procedure results in the majority of Hill-Sachs lesions being converted to on-track lesions. However, due to bipolar bone loss approximately 1 in 9 cases will remain off track. In cases of failure to return on-track, there is an unacceptably high rate of recurrent instability.

Keywords: Hill-Sachs; instability; Latarjet; lesions; procedure