Results of Combined All-Arthroscopic Latarjet With Hill-Sachs Remplissage for Significant Bipolar Glenohumeral Bone Loss

Arthroscopic Latarjet using suture-button fixation has shown good clinical results and low recurrent instability in patients with significant glenoid bone loss. However, the presence of an associated significant Hill-Sachs lesion (HSL) is a risk factor for recurrent instability after isolated Latarjet. The aim of the study is to report the clinical and radiographic results of a series of consecutive patients treated with all-arthroscopic Latarjet combined with Hill-Sachs Remplissage (HSR). Monocentric prospective study including 41 patients (mean age 28 ± 7 years) who underwent arthroscopic combined procedure between 2014–2019 with minimum 2 years follow-up (mean 40 ± 13 months). Indications were glenoid bone loss >10% (mean 23.9% ± 7.5%) and large, deep HSL (Calandra 3). Five (13%) patients had signs of osteoarthrosis stage I preoperatively, four (10%) had a previous stabilization surgery (3 cases of isolated Bankart repair and 1 case of Bankart repair combined with HSR), and five (13%) were epileptic. The HSR was performed first followed by the guided Latarjet procedure. Primary outcome measures included shoulder stability and function represented by Walch-Duplay and Rowe scores, and subjective shoulder value (SSV) for daily life and sports. Secondary outcome measures included assessment of coracoid bone block position and union, and glenohumeral osteoarthritis using X-rays and computer tomography (CT) at last follow-up. Three patients (7%) had a recurrence of instability: one due to seizure, one following a fall with the arm hyperextended, and one related to lysis of the bone block. Two patients were revised because of recurrent instability with arthroscopic distal clavicle autograft. There were no infections, neurologic complications or hardware failures. The Walch-Duplay score was 90 (95% CI 76.8–93.2) and the Rowe score 95 (95% CI 77.2–92.2). The Median SSV averaged 96% (95% CI 87.5–97.0) for daily life and 90% (95% CI 75.7–90.2) for sport practice. Mean external rotation with the arm at side was 60° (95%CI 59–70) with a median loss of 10° (95%CI 3–17) compared to the contralateral side. Among patients playing sport preoperatively, 36 patients (95%) were able to return to sport: 25 (67%) at the same level and 7 (18%) at a lower level. The coracoid bone graft was flush with the glenoid surface in 96% of the cases and below the equator in 89%. The graft developed nonunion in 11%, fractured in 5% (the two patients with recurrence after a trauma and after seizure). Seven patients (18%) had radiographical signs of grade I osteoarthritis at last follow-up. Combined all-arthroscopic Latarjet and HSR is an efficient solution for dealing with significant bipolar glenohumeral bone loss. The combined procedure deserves consideration in a high-risk patient population with recurrent anterior instability, significant glenohumeral bone loss, after failed previous stabilization procedures and/or seizure.