This systematic review and meta-analysis of 70 studies (4540 shoulders) compares Latarjet versus free bone block (FBB) procedures for anterior shoulder instability with glenoid bone loss. Outcomes analyzed include recurrent instability, complications, osteoarthritis progression, return to sports, and patient-reported outcomes at minimum 2-year follow-up. The central question: are FBB procedures a legitimate alternative to Latarjet, or only a salvage option?
The question of whether FBB is only a salvage procedure after failed Latarjet — or a first-line option. Has lacked high-quality comparative data. This meta-analysis is the first to pool outcomes across both procedure types on a large scale (4540 shoulders).
For a patient with glenoid bone loss and no prior surgery, both Latarjet and FBB are defensible first-line choices. Recurrent instability rates are equivalent (~3-5%). Choose based on anatomy, surgeon experience, and patient-specific factors such as contact sport participation or revision complexity.
When counseling a patient about ICBG autograft, explicitly discuss donor site morbidity: approximately 1 in 4 patients develops sensory disturbance from lateral femoral cutaneous nerve injury, and roughly 1 in 15 develops superficial infection at the harvest site. Distal tibial allograft avoids these risks while offering a hyaline cartilage glenoid surface.
The 56% prior surgery rate in the FBB group means you cannot read this paper as showing FBB is equivalent to Latarjet in matched patients. FBB was used in harder cases. Future RCTs in primary instability patients are needed before definitive recommendations can be made.
Outcomes of the Latarjet Procedure versus Free Bone Block Procedures for Anterior Shoulder Instability: a Systematic Review and Meta-Analysis
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This systematic review and meta-analysis of 70 studies (4540 shoulders) compares Latarjet versus free bone block (FBB) procedures for anterior shoulder instability with glenoid bone loss. Outcomes analyzed include recurrent instability, complications, osteoarthritis progression, return to sports, and patient-reported outcomes at minimum 2-year follow-up. The central question: are FBB procedures a legitimate alternative to Latarjet, or only a salvage option?
The question of whether FBB is only a salvage procedure after failed Latarjet — or a first-line option. Has lacked high-quality comparative data. This meta-analysis is the first to pool outcomes across both procedure types on a large scale (4540 shoulders).
For a patient with glenoid bone loss and no prior surgery, both Latarjet and FBB are defensible first-line choices. Recurrent instability rates are equivalent (~3-5%). Choose based on anatomy, surgeon experience, and patient-specific factors such as contact sport participation or revision complexity.
When counseling a patient about ICBG autograft, explicitly discuss donor site morbidity: approximately 1 in 4 patients develops sensory disturbance from lateral femoral cutaneous nerve injury, and roughly 1 in 15 develops superficial infection at the harvest site. Distal tibial allograft avoids these risks while offering a hyaline cartilage glenoid surface.
The 56% prior surgery rate in the FBB group means you cannot read this paper as showing FBB is equivalent to Latarjet in matched patients. FBB was used in harder cases. Future RCTs in primary instability patients are needed before definitive recommendations can be made.