Open Capsuloplasty with Conjoint Tendon Augmentation Versus Latarjet Procedure in Young Patients with Recurrent Shoulder Dislocation A Comparative Study of 53 Patients With 4.2 -Year Follow-up

ABSTRACT Background Recurrent glenohumeral dislocation (GHD) is a major challenge in sports medicine. Although the Latarjet procedure is often the gold standard for high-risk recurrence, it is associated with bone-block complications and high invasiveness. This study aims to evaluate the clinical and functional outcomes of a novel and less invasive conjoint tendon augmentation technique compared to the traditional Latarjet procedure. We primarily hypothesized that there would be no significant difference in clinical stability and functional outcomes between the two procedures at a minimum 2-year follow-up. Additionally, we aimed to evaluate the safety profile regarding bone-related complications. Methods A retrospective comparative study was conducted on patients with recurrent GHD treated between June 2014 and November 2019. Patients were stratified into two groups based on the surgical approach. Functional outcomes were assessed using the University of California at Los Angeles (UCLA) Activity score, Constant-Murley Score (CMS), and Rowe score. Postoperative ultrasound (US) evaluated tendon kinematics and the dynamic "hammock effect." Range of motion (ROM) and return-to-sport rates were also documented. Results A total of 53 patients were included (mean age 28.0 ± 3.22 years; range 18-38; mean follow-up 4.2 ± 0.8 years). The cohort comprised 38 males (72%) and 15 females (28%). Mean number of preoperative dislocation episodes was 4 ± 1.6 (range: 2-9). All patients practiced sports >2 times/week, including 11 (20.8%) competitive athletes. No significant differences were found between groups regarding postoperative clinical scores (UCLA, CMS, Rowe), return to sports, ROM, or reoperation rates. US analysis confirmed proper dynamic tensioning of the conjoint tendon in the novel group, successfully replicating the stabilizing hammock effect. Conclusions The novel conjoint tendon augmentation technique demonstrated clinical and functional non-inferiority to the Latarjet procedure. This approach represents a bone-preserving alternative to the Latarjet procedure, avoiding coracoid osteotomy and hardware implantation. Dynamic ultrasound confirmed a reliable hammock effect. Conjoint tendon augmentation is a viable alternative for patients without significant bony Bankart lesions who do not require revision surgery. Level of Evidence Level III; Retrospective Comparative Study