Comparative Outcomes of the Latarjet Procedure Versus Iliac Crest Bone Graft Transfer in the Management of Bony Bankart Lesion in Recurrent Anterior Shoulder Dislocations: A Systematic Review.

Abstract

Significant anterior glenoid bone loss (> 15%) compromises the success of soft-tissue Bankart repair in recurrent shoulder instability. Bone-augmenting procedures-the coracoid-based Latarjet and the anatomic Eden-Hybinette/iliac-crest bone-graft transfer (ICBG)-are the most frequently deployed techniques, yet direct head-to-head evidence remains limited. To compare clinical and radiographic outcomes, complication profiles, and return-to-sport (RTS) rates after Latarjet versus ICBG for bony Bankart lesions. A PRISMA-conformant search of PubMed, Embase, Scopus, and Cochrane (inception-April 2025) identified studies reporting outcomes of either procedure with ≥ 2-year follow-up. Two reviewers independently screened articles, extracted data, and graded quality (MINORS/NOS). Primary outcome was recurrent instability; secondary outcomes were complication rate, graft-related issues, osteoarthritis progression, range-of-motion (ROM) loss, patient-reported outcome measures (PROMs), and RTS. Forty-eight studies (10 comparative, 32 Latarjet-only, 6 ICBG-only) encompassing 5842 shoulders met inclusion. Mean follow-up was 6.2 years. Comparative meta-analysis (4 studies; <i>n</i> = 310) showed no significant difference in recurrent instability (OR 1.72, 95% CI 0.79-3.73; <i>p</i> = 0.17) or overall complications (OR 1.11, 95% CI 0.56-2.23). ICBG had a lower risk of graft resorption (8% vs 22%, <i>p</i> = 0.03) but a higher incidence of donor-site morbidity (12%). Latarjet provided a small but significant external-rotation loss (mean 5.7°) yet enabled faster RTS (7.8 vs 10.4 months). PROM improvement (ASES, WOSI, Rowe) exceeded the minimal clinically important difference for both techniques without inter-group disparities. Both procedures reliably restore stability in the setting of bony Bankart lesions. Choice should be individualized: Latarjet offers earlier RTS and avoids extra-articular harvest morbidity, whereas ICBG preserves native coracoid anatomy and demonstrates superior graft integration. High-level prospective trials powered for clinical end-points are still required. Level III (systematic review of mostly level III-IV studies).