Hawkins Award 2024: Free bone graft transfer versus Latarjet procedure for treatment of anterior shoulder instability with glenoid bone loss: 5-year follow-up of a prospective randomized trial.

Abstract

Background: Free bone graft transfer (FBGT) and the Latarjet procedure are two competing techniques for the treatment of anterior shoulder instability with glenoid bone loss. In the current literature, there are no mid- to long-term prospective randomized comparative studies comparing both surgical methods.

Methods: This prospective, bi-center, randomized study enrolled 60 patients with anterior shoulder instability and more than 15% glenoid bone loss. The study cohort was randomly assigned in a 1:1 ratio to either an open FBGT surgery (J-bone graft technique) or an open Latarjet procedure. Clinical data, including Western Ontario Shoulder Index, Rowe Score, Subjective Shoulder Value, Visual Analogue Scale, satisfaction with the operation, sports and work limitations, range of motion and strength, as well as the extent of instability arthropathy were collected preoperatively and at 6, 12, 24, and 60 months postoperatively. The 5-year follow-up rate was 63.3% for the FBGT group and 66.6% for the Latarjet group.

Results: The primary outcome parameter (WOSI) showed no significant differences at the 5-year follow-up (J-Span 221 ±186, Latarjet 201±239; p= 0.529) and other time points. The secondary clinical scores also showed no significant differences between the two groups (Rowe score p= 0.596, Subjective Shoulder Value p= 0.368, Visual Analogue Scale p= 0.238, ASSOS score p= 0.594). Comparable results were observed regarding strength and motion, except for significantly better internal rotation in the FBGT group at all time points, including the 5-year follow-up (p= 0.004). A single recurrence of instability was observed in 3 patients of the FBGT group and 1 patient of the Latarjet group (p= 0.342). Postoperative hypesthesia at the iliac crest was reported in 3.3% of the FBGT patients. The degree of instability arthropathy showed a comparable increase in both cohorts (p= 0.154).

Conclusion: None of the two surgical methods showed clinical superiority at the 5-year follow-up, except for statistically better internal rotation in the FBGT group. Both cohorts showed comparable success in joint stabilization, but neither could prevent the progression of instability arthropathy.