Recurrent Dislocation of Shoulder - Bankart repair versus Latarjet procedure (Coracoid transfer) which is better for patient?

14 Nov,2013

The debate for the best shoulder pain treatment and recurrent dislocated shoulder treatment rests largely between the two procedures in the headline. Bankart repair consists of soft tissue capsulo-labral repair and Latarjet involves osteotomizing (cutting) the vertical half of the coracoid bone and fixing it on anterior glenoid surface. Since I have worked both in France and US, I‘ve had the good fortune of witnessing the debate on both sides very closely. Scientifically it is difficult to prove one is better than the other because of paucity of level 1 evidence. However there are multiple scientific articles that can be cited which speak of the high chance of recurrence after bankart repair. e.g. in JBJS B 2005, Calvo et al says 18 % recurrence after bankart repair, JSES may 2005 Tauber et all analysed 41 cases of recurrence after primary surgery and found highest number of recurrence(60%) occurred after bankart repair(25 cases).


There may also be couple of articles, which speak about low recurrence after bankart repair as well. Conferences usually are not the best places where people will frankly admit their failures. But secretly many people have admitted that failures after bankart repair have gone up as the length of follow up has increased. Since, most surgeons in India and many surgeons in western countries also do not keep a regular record, or have long follow ups, it’s hardly believable what any such surgeon would say without hard data. Historically most surgeons will do bankart repair and would stand by it, but will not be able to prove anything because they do not have long follow ups. Failures of bankart start appearing only after 1-2 years so long follow-ups are definitely needed to prove any theory. Proponents of bankart repair ask that since most patients in India are low demand non-athletes, why should we do an extensive procedure like Latarjet? One of the favorite lines of surgeons in US is “Why should you take a bomb where a small gun can work?” However what they would agree is that Latarjet would give better results under all circumstances. In Mumbai since an average person places high stresses on his shoulder on account of his local train, bus travel etc, he can hardly be called low demand.

If “consumer is king” and “patient’s good is the only good to be considered”, Latarjet is the by far the better procedure. The French definitely score ahead here (photo: Dr.Laurent Lafosse, me and other Orthopods in France).

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