Editorial Commentary: Arthroscopic Bankart Repair With Remplissage, Irrespective of Glenoid Bone Loss, May Be Advantageous Over Latarjet: Don't Widen the Lane, Just Fill in the Pothole!

Abstract

Anterior glenohumeral instability has an incidence of 21.9 individuals per 100,000 in the general population. When recurrent instability occurs, bone loss to the anteroinferior glenoid can occur. The concept of "on-track" and "off-track" Hill-Sachs lesions is significant in cases of bipolar bone loss, because if humeral-sided bony injury also requires treatment, a remplissage combined with arthroscopic Bankart repair (ABR) may be an alternative to a Latarjet procedure. The Latarjet often is touted as a "definitive," because it adds bone to increase the glenoid surface area that the humeral head must travel to dislocate, and adds the dynamic "sling effect" of the conjoint tendon to further tension the lower part of the subscapularis in abduction and reduce anterior-directed forces. However, compared with ABR plus remplissage, Latarjet shows a greater risk of complications: as high as a 7.37 times relative risk. As an evidence-based surgeon who believes in the power of soft-tissue repair plus ABR, I prefer to avoid the increased complication risks of a primary Latarjet when possible. Also, my patients describe the postoperative shoulder as feeling more like the contralateral, unaffected shoulder after ABR than Latarjet.