Long-term Clinical Outcomes of Screw Removal Versus Unrevised Patients Following Open Latarjet Procedure for Recurrent Anterior Shoulder Instability: A Matched-Pair Analysis.

BACKGROUND

Recurrent anterior shoulder instability often requires surgical intervention, with 2 prominent approaches: anatomic (eg, Bankart) and nonanatomic (eg, Latarjet) procedures. While most surgeons favor arthroscopic Bankart, the open Latarjet procedure offers advantages such as quicker recovery and lower redislocation rates. On the other hand, complications include postoperative pain due to an impingement between hardware and soft tissue, resolved through screw removal.

PURPOSE/HYPOTHESIS: The purpose of this study was (1) to assess the Walch-Duplay score for functional outcomes and (2) to examine Subjective Shoulder Value (SSV), Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) scores, as well as satisfaction and return-to-sports rate. It was hypothesized that screw removal does not significantly affect functional outcomes.

STUDY

DESIGN

Cohort study; Level of evidence 3.

METHODS

Clinical data from a single-operator series of 692 shoulders treated for anterior instability with Latarjet technique between 2007 and 2021 were analyzed. Those who underwent revision surgery, previously underwent surgery on the shoulder, and had concomitant shoulder injuries were excluded. A total of 530 shoulders were eligible, and of these, 41 shoulders needed screw removal (7.7%). Propensity score matching yielded 41 pairs of shoulders split between the screw removal and no revision group.

RESULTS

At a mean follow-up of 85.0 months, the Walch-Duplay functional score was 76 ± 19 (median, 80; range, 15.0-100.0) and 81 ± 22 (median, 85; range, 0.0-100.0) ) in patients for no revision and screw removal, respectively (P = .15); SSV was 82 ± 15 (median, 85; range, 40.0-100) and 86 ± 14 (median, 90; range 40.0-100.0) (P = .14), respectively; SANE was 89 ± 19 (median, 100; range 0.0-100.0) and 89 ± 14 (median, 95; range 50.0-100) (P = .16), respectively; and VAS was 0.7 ± 1.3 (median, 0; range, 0-5) and 1.1 ± 1.5 (median, 1; range 0-5) (P = .06). Satisfaction and return-to-sport rates were statistically significantly lower in the screw removal group (P = .03 and P = .04, respectively).

CONCLUSION

Our results confirm that screw removal after the open Latarjet procedure does not substantially affect functional outcomes. However, we acknowledge a lower return to sports and worse satisfaction scores in the screw removal group.