Clinical outcomes and complications in Latarjet versus free bone block procedures for anterior shoulder instability: a meta-analysis of comparative studies

The Latarjet procedure is thought to reduce recurrence by creating a dynamic restraint against instability, known as the "sling effect". Conversely, free bone block (FBB) techniques provide stability through bony augmentation alone, without relying on the sling effect. This study compares the clinical outcomes of the Latarjet procedure and FBB techniques in adult patients to determine whether the sling effect offers a significant advantage in reducing recurrence rates. A systematic search of PubMed, Embase, and MEDLINE databases was conducted on 03/03/2025. Only comparative studies that included data on recurrence rate, patient-reported outcome measures (PROMs), range of motion, or reoperation rates were selected for analysis. We assessed the risk of bias using RoB 2 and ROBINS-I tools and performed a meta-analysis. CRD42024517955. Ten studies met the inclusion criteria (665 patients, mean age 29, mean follow-up 37 months) and underwent meta-analysis: three retrospective, four prospective cohort studies, and three randomised controlled trials. The meta-analysis demonstrated no significant differences between the Latarjet procedure and FBB techniques in recurrence rates of shoulder instability (RR 1.05; 95% CI 0.53-2.10; P = 0.87), PROMs (ASES, Rowe, SSV, WOSI, and VAS), or reoperation rate. No publication bias was detected (Egger's P = 0.15). Regarding range of motion, no significant differences were observed in any of the parameters (abduction, external or internal rotation, and forward flexion). The limitations of our meta-analysis include high heterogeneity and serious risk of bias of studies. Our results suggest that FBB procedures are viable and safe alternative treatment options to the Latarjet technique. III.