Similar outcomes, but significantly lower complication rate with arthroscopic Bankart repair with remplissage versus open or arthroscopic Latarjet for shoulder instability across a wide range of glenoid bone loss: a systematic review and meta-analysis.

Background: Synthesizing comparisons between the Latarjet procedure and arthroscopic Bankart repair with remplissage (ABRR) is clinically relevant given their overlapping indications and potential as viable surgical options for recurrent anterior shoulder instability. However, previous systematic reviews have exclusively focused on the open Latarjet (OL) approach and included follow-up durations of less than 2 years. Therefore, purpose of this systematic review is to compare mid- to long-term clinical outcomes of ABRR versus both the OL and the arthroscopic Latarjet (AL) procedures across a wide range of glenoid bone loss to further enhance surgical decision-making. Methods: A comprehensive search of the PubMed, Embase, and Web of Science databases was performed in accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analysis guidelines, for studies published between 2014 and 2024. Studies that compared outcomes between ABRR and either OL or AL and had a minimum clinical follow-up of 2 years were included. Patient-reported outcome measures (PROMs), range of motion (ROM), and recurrent instability, revision, and complication rates were collected. Qualitative and quantitative analyses were performed. Meta-analyses were conducted using R with the "Metafor" package. Results: Of the 5,005 abstracts screened, 6 studies were included. Three hundred thirty-three patients underwent ABRR (mean age 27.3 ± 8.3 years, 22.4% female) and 468 underwent OL or AL (mean age 28.4 ± 9.2 years, 20.1% female). PROMs and ROM improved postoperatively across both groups but demonstrated high heterogeneity. The ABRR group had significantly higher single assessment numeric evaluation scores (92.5 ± 12 vs. 89.1 ± 12.2, Conclusion: When compared across a wide range of glenoid bone loss levels, both ABRR and Latarjet procedures are effective for managing anterior shoulder instability, with comparably high PROMs and no significant differences in ROM. ABRR offers a safer surgical risk profile with significantly fewer complications and is a viable option in the appropriate patient population. However, there is likely a limit of glenoid bone loss at which ABRR may not be safely performed due to the elevated risk of recurrent instability.