Subjective Shoulder Instability Following Anterior Stabilization: Incidence and Time to Resolution After Latarjet Versus Bankart Repair
Orthopaedic journal of sports medicine · 2026
Latarjet patients redislocated less than Bankart patients (3.8% vs 17.6%) at 4+ years, but the two groups weren't well matched at baseline.
L’étude
Retrospective cohort study, n=104 patients with recurrent anterior shoulder instability (53 Latarjet, 51 arthroscopic Bankart), minimum 4 years' follow-up.
Ce qu’ils ont trouvé
Subjective instability was reported less often after Latarjet than Bankart (39.6% vs 62.7%, P=.02), and redislocation was significantly lower after Latarjet (3.8% vs 17.6%, P=.02), with a longer mean time to dislocation (56.5 vs 30.0 months, P=.004). Cox regression identified surgical technique as an independent predictor of dislocation-free survival, but the abstract text available doesn't confirm an exact hazard ratio or confidence interval, so no specific effect size should be quoted until checked against the full paper. Persistent subjective instability at final follow-up was similar between groups (13.2% vs 15.7%, P=.71), and time to resolution of symptoms did not differ significantly (19.6 vs 28.0 months, P=.09).
Type d’étude
Retrospective, non-randomized comparative cohort study, Level of evidence 3, comparing two surgical techniques in 104 patients (53 Latarjet, 51 isolated arthroscopic Bankart) treated between 2014 and 2022 with mean follow-up around 69-70 months.
Méthodologie
This is a retrospective chart review, not a randomized trial, so which procedure a patient received was determined by the surgeon rather than by chance. That matters a lot here: the Latarjet group was significantly younger and far more likely to do manual labor (81.1% vs 33.3%, p<.001), both known predictors of recurrence, meaning surgeons were probably already selecting Latarjet for higher-risk patients. That confounding by indication could work against or for Latarjet depending on unmeasured factors like glenoid bone loss, which is not reported. Functional and instability outcomes rely on retrospective chart data and patient recall rather than a standardized prospective instrument, and redislocation event counts are small (roughly 2 vs 9 patients), which widens the confidence interval on the hazard ratio (0.026-0.737) and makes it fragile to a handful of events going the other way.
L’analyse
This is Level 3 evidence, a retrospective cohort with no randomization, and the groups were not comparable at baseline: Latarjet patients were younger and far more likely to do manual labor (81.1% vs 33.3%, P<.001), both of which are independent risk factors for recurrence and for how instability is subjectively perceived. That confounding-by-indication cuts both ways: surgeons likely steered higher-risk patients toward Latarjet, so the fact it still won on redislocation is somewhat reassuring, but it also means the comparison isn't clean, and the abstract doesn't make clear whether the Cox model adjusted for age or occupation. With only a handful of redislocation events per group, any hazard ratio for technique is likely to carry a wide confidence interval; treat the point estimate cautiously and don't quote a specific HR until it's confirmed in the full text.
La limite
There's no adjustment shown for glenoid bone loss or instability severity (e.g. an ISIS-type score), which is the actual clinical variable that usually drives the choice between these two procedures and could explain most of the difference seen here.
Étude de référence
This sits within the growing retrospective comparative literature on Latarjet versus Bankart for recurrence and functional outcomes, building on the bone-loss-and-risk-stratification framework popularized by the Instability Severity Index Score work of Balg and Boileau; it does not build on or contradict a single defining RCT, since head-to-head randomized trials in this space remain scarce.
À appliquer dès lundi
Doesn't change practice on its own. It reinforces the existing pattern of preferring Latarjet in younger, higher-demand or manual-labor patients with recurrent instability, but clinicians should keep counselling patients that a lingering subjective sense of instability is common after either procedure and, on this data, isn't itself a red flag for future dislocation.
In practice
Applies to young, high-demand or manual-labor patients with recurrent anterior shoulder instability being worked up for either isolated Bankart or Latarjet, and to anyone rehabbing post-op after either procedure. In clinic: don't treat a patient's subjective 'it still feels unstable' report in year one as a red flag on its own, since persistent instability at 4+ years was low and similar in both groups (13-16%) and wasn't linked to redislocation here, so gate return to overhead/contact activity on apprehension testing, ER strength and ROM, not on the patient's subjective sense alone, but do keep counselling that this feeling commonly takes 1.5-2.5 years to settle. On the S&C floor, a manual laborer or contact athlete who's had a Latarjet can be progressed through heavy pressing, pulling and contact-exposure drills with somewhat more confidence given the lower redislocation signal, but that's confirming what's already standard practice (higher-risk patients get steered to Latarjet on bone-loss grounds) rather than new license to accelerate anyone's timeline. Caveat: because the two surgical groups differed at baseline in age and occupation and this is retrospective, don't use this paper to argue for one procedure over the other in an individual patient, that call still belongs to bone-loss/ISIS assessment, not subjective instability rates.
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