Results and return to sports at 5 years after Latarjet for anterior instability with or without pre-operative glenoid bone loss.

INTRODUCTION: The Latarjet procedure provides reliable functional outcomes and a high rate of return to sport in the treatment of anterior shoulder instability. While traditionally indicated in cases of significant glenoid bone loss (GBL) or engaging Hill-Sachs lesions, its use has progressively expanded to a broader range of clinical situations. However, few studies have specifically evaluated outcomes of the Latarjet procedure according to the degree of preoperative GBL. HYPOTHESIS: We hypothesized that preoperative glenoid bone loss does not significantly influence clinical outcomes or return to sport following the open Latarjet procedure. METHOD: This multicenter retrospective study included patients who underwent open Latarjet as a primary procedure before June 2017, with a minimum follow-up of 5 years. Preoperative CT or CTA was required for inclusion. Patients were divided into three groups according to preoperative GBL (<5%, 5-15%, and >15%), based on commonly used but arbitrary thresholds in the literature. Clinical outcomes were assessed using Rowe, Walch-Duplay, Simple Shoulder Value (SSV), and Shoulder Instability-Return to Sport after Injury (SIRSI) scores. Return to sport, complications, and radiographic outcomes were also analyzed. RESULTS: Return to sport was 80% at 1 year and 85% at final follow-up, with 48% returning to the same level. The recurrence rate was 6%, and subjective apprehension persisted in 17% of patients. The overall complication rate was 8%, including hardware-related complications, with a screw removal rate of 2%. Preoperative GBL did not significantly influence clinical outcomes or return to sport. Osteoarthritis was observed in 25% of cases (13% for GBL < 5%, 29% for GBL 5-15%, and 34% for GBL > 15%). Radiographic osteoarthritis increased with preoperative GBL (13%, 29%, and 34% respectively; p = 0.03). DISCUSSION: At medium-term follow-up, the Latarjet procedure provides reliable clinical outcomes, a low recurrence rate, and a high rate of return to sport, regardless of preoperative GBL. These findings support the use of the Latarjet procedure across a wide spectrum of anterior shoulder instability, although a proportion of patients continue to experience apprehension and do not return to their previous level of sport. LEVEL OF EVIDENCE: IV.