Revision Latarjet Outcomes Match Primary Procedure in Contact Athletes

Anterior shoulder instability, characterised by recurrent dislocations or subluxations, frequently afflicts young, active individuals, especially those participating in contact sports. The high-energy mechanisms involved in sports like rugby, American football, and ice hockey often lead to significant glenoid bone loss, a critical predictor of surgical failure if not adequately addressed. For these patients, the Latarjet procedure, involving the transfer of the coracoid process with its attached conjoint tendon to the anterior glenoid, directly addresses bone deficiency and provides a sling effect, enhancing stability.¹

Despite its efficacy, a subset of patients experiences failure after primary Latarjet, necessitating revision surgery. Historically, revision shoulder stabilisation procedures, particularly those involving bone transfer, have been associated with less predictable outcomes and higher complication rates compared to primary interventions. This uncertainty often leads to apprehension among both patients and surgeons regarding the potential for successful return to high-level athletic activity. The question has always been whether a second Latarjet could genuinely restore function and confidence to the same degree as the first, especially in athletes whose careers depend on robust shoulder stability.²

The numbers on revision stability

A comprehensive analysis of contact athletes undergoing revision Latarjet surgery demonstrated that these patients achieved functional outcomes and return-to-sport rates comparable to those who underwent a primary Latarjet procedure. The study cohort included a significant number of athletes from high-impact sports, providing a clinically relevant population for evaluating surgical efficacy. Patients in the revision group showed a mean Western Ontario Shoulder Instability Index (WOSI) score improvement of 65% from baseline, a change statistically indistinguishable from the 68% improvement seen in the primary Latarjet group (P=.41).³

Return to contact sport was a critical endpoint for this athletic population. The revision Latarjet group saw 85% of patients return to their pre-injury level of contact sport, compared to 88% in the primary Latarjet group (P=.62). This high rate of return, coupled with similar functional scores, challenges the long-held assumption that revision procedures inherently lead to inferior athletic outcomes. The mean time to return to sport was also comparable, at 7.2 months for revision patients versus 6.8 months for primary patients, suggesting no significant delay in rehabilitation or recovery trajectory.³

Recurrence of instability, defined as a re-dislocation or subluxation event, is the most feared complication following shoulder stabilisation. The revision Latarjet group experienced a re-dislocation rate of 5% at a mean follow-up of 48 months, which was statistically similar to the 4% rate observed in the primary Latarjet cohort (P=.78). This low recurrence rate underscores the technical precision and robust biological healing achieved even in a revision setting. Furthermore, the rate of revision surgery for persistent instability after the initial revision Latarjet was only 2%, indicating durable stability for the vast majority of patients.⁴

Complication rates were also scrutinised. The overall complication rate for revision Latarjet was 12%, slightly higher than the 9% observed in the primary group, but this difference did not reach statistical significance (P=.18). The most common complications in the revision group included transient nerve palsies (3%), hardware-related issues requiring removal (4%), and graft non-union (2%). These rates are consistent with those reported in the literature for primary Latarjet procedures, suggesting that the increased technical complexity of revision surgery does not necessarily translate to a disproportionate increase in adverse events.⁴

Patient satisfaction, often a subjective but crucial measure of surgical success, was high across both groups. Using a visual analogue scale (VAS) for satisfaction, revision patients reported a mean score of 8.7 out of 10, while primary patients reported 8.9 out of 10 (P=.33). This indicates that patients undergoing revision Latarjet perceived their outcomes as highly satisfactory, aligning with the objective functional and stability data. The ability to return to their desired level of athletic activity played a significant role in this reported satisfaction.⁵

The success of revision Latarjet hinges on meticulous preoperative planning and precise surgical execution. Key factors identified for positive outcomes include accurate assessment of residual glenoid bone loss, careful removal of previous hardware, and optimal positioning of the new coracoid graft. In cases of significant bone loss or previous graft malposition, surgeons often employ advanced imaging techniques, such as 3D CT scans, to guide graft placement and ensure adequate coverage of the glenoid defect. The use of larger grafts or supplemental fixation may also be considered in complex revision scenarios.⁵

Still, the open-label design is the obvious caveat. While functional scores and objective measures like re-dislocation rates provide strong evidence, the lack of blinding could introduce some reporting bias, particularly for subjective outcomes like patient satisfaction. The study was not powered to detect subtle differences in specific subgroups, such as those with extreme bone loss or multiple prior surgeries, and that gap matters for refining surgical indications. The mean follow-up of 48 months, while respectable, may not capture very late recurrences or degenerative changes that could emerge over a longer period, especially in a young, active population.⁶

The patient population, exclusively contact athletes, limits the generalisability of these findings to less active individuals or those with different instability mechanisms. The demands placed on the shoulder by a professional rugby player differ significantly from those of a recreational swimmer, and the success criteria for each group would vary accordingly. The specific surgical techniques employed for revision Latarjet can also vary widely between surgeons and institutions, potentially influencing outcomes. Standardisation of revision techniques could further improve predictability.⁶

Another consideration is the potential for donor site morbidity from the coracoid transfer. While generally low, complications such as fracture or nerve injury at the donor site can occur. In a revision setting, the integrity of the remaining coracoid and surrounding structures must be carefully assessed. The long-term effects of repeated bone transfers on the glenoid articular cartilage also warrant further investigation, as cumulative surgical trauma could theoretically accelerate degenerative changes, although this was not a prominent finding in the current follow-up period.⁷

The mechanism of failure after primary Latarjet is multifaceted, often involving inadequate initial bone block positioning, insufficient graft healing, or progressive bone loss. Understanding these failure modes is crucial for successful revision. For instance, if the initial graft was placed too medially, it may not adequately restore the glenoid arc, leading to persistent instability. In such cases, the revision procedure must address the specific anatomical deficiency that led to the initial failure, rather than simply repeating the previous technique.⁷

The data firmly establishes revision Latarjet as a robust option for contact athletes facing recurrent instability after a primary procedure. It offers a path back to high-level sport with outcomes that closely mirror those achieved with the initial surgery. The next trial needs to show whether specific patient profiles or failure mechanisms predict superior outcomes with particular revision strategies, further refining patient selection and surgical technique.