This paired retrospective study compared arthroscopic Bankart repair against the open Latarjet coracoid bone block for recurrent anterior shoulder instability. 51 Latarjet patients were age-matched to 51 Bankart patients and followed for a mean of 5 years. The question: does soft-tissue-only Bankart repair recur more often than bony reconstruction?
The decision rule this paper reinforces: match the operation to the patient's risk profile, not to surgeon preference.
A young athlete who plays competitive contact sport or shows glenoid erosion carries a very high recurrence risk after isolated arthroscopic Bankart repair. Each of these factors independently multiplies recurrence odds more than tenfold. For these patients, favor a bony procedure.
The ISIS score operationalizes this. A score above 3 pushes toward Latarjet; a score of 3 or less supports Bankart. Use it preoperatively to select the right procedure.
A critical appraisal point for boards: this study was underpowered. The 24% versus 12% difference did not reach significance (P=0.12), so it demonstrates a trend, not proof. Do not misread a non-significant P value as evidence of equivalence. Finally, most Latarjet failures were technical (medial graft, unicortical screws). Correct graft position and bicortical fixation matter.
This paired retrospective study compared arthroscopic Bankart repair against the open Latarjet coracoid bone block for recurrent anterior shoulder instability. 51 Latarjet patients were age-matched to 51 Bankart patients and followed for a mean of 5 years. The question: does soft-tissue-only Bankart repair recur more often than bony reconstruction?
The decision rule this paper reinforces: match the operation to the patient's risk profile, not to surgeon preference.
A young athlete who plays competitive contact sport or shows glenoid erosion carries a very high recurrence risk after isolated arthroscopic Bankart repair. Each of these factors independently multiplies recurrence odds more than tenfold. For these patients, favor a bony procedure.
The ISIS score operationalizes this. A score above 3 pushes toward Latarjet; a score of 3 or less supports Bankart. Use it preoperatively to select the right procedure.
A critical appraisal point for boards: this study was underpowered. The 24% versus 12% difference did not reach significance (P=0.12), so it demonstrates a trend, not proof. Do not misread a non-significant P value as evidence of equivalence. Finally, most Latarjet failures were technical (medial graft, unicortical screws). Correct graft position and bicortical fixation matter.