Objectives: The Latarjet procedure is a well-established surgical treatment for recurrent shoulder instability, particularly in athletes and patients with significant glenoid bone loss. However, current data shows higher recurrent instability and lower return-to-sport rates at pre-injury level in Latarjet as a revision surgery compared to Latarjet as a primary surgery. The purpose of this study was to compare outcomes and return-to-sport in patients who underwent Latarjet as a primary surgery versus Latarjet as a revision surgery. Methods: Latarjet surgery patients within the MOON shoulder instability cohort, treated between December 2012 and August 2023 who identified as contact athletes, were analyzed. Patients that did not have 2-year follow-up were excluded, unless surgical failure occurred before 2 years post-op. Primary Latarjet (Lat-prim) was defined as first surgical intervention for shoulder instability, while revision Latarjet (Lat-rev) was performed following failure of prior soft tissue stabilization surgery. Glenoid bone loss was categorized as present or absent as well as graded as 0-10%, 11-20%, 21-30% and greater than 30%. Outcomes data including recurrent subluxations, dislocations, and subsequent surgery were analyzed. Return-to-sport status and level were assessed. Patient Reported Outcomes (PROs) such as American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES), Western Ontario Shoulder Instability Index (WOSI), and the Shoulder Activity Level were analyzed. Baseline preoperative data and questionnaires, along with preoperative and post operative forms completed by treating surgeons, were recorded utilizing a REDCap database. Results: Of 138 Latarjet patients who met inclusion criteria, 61 were primary and 77 were revision. There was no significant difference in age, gender, minority status, whether the dominant arm was affected, whether the injury occurred during sport, and duration of symptoms between Lat-prim and Lat-rev (Table 1). BMI (26.0 +- 4.1 Lat-prim vs. 24.7 +- 3.4 Lat-rev, p=0.05) differed significantly between the groups. There was no significant difference in glenoid bone loss distribution between the cohorts (p=0.87). In the Lat-prim versus Lat-rev group, glenoid bone loss was 0-10% in 4 vs. 4 patients, 11-20% in 30 vs. 38 patients, 21-30% in 18 vs. 22 patients, and >30% in 1 vs. 1 patient. Recurrent subluxation, dislocation, and re-operation rates for the Lat-prim versus Lat-rev cohorts, respectively, were 21.3% vs. 29.9% (p=0.26), 0% vs. 3.9% (p=0.25), and 4.9% vs. 2.6% (p=0.65). Return-to-sport rates were similar between the groups (70.5% Lat-prim vs. 64.9% Lat-rev, p=0.14), with the majority of patients returning being able to perform at the same level or better than prior to surgery (72.1% Lat-prim vs. 75.5% Let-rev, p=0.85). There was no significant difference at baseline or at 2-year follow-up in WOSI, ASES, and SAS scores between Lat-prim and Lat-rev. Among patients with both baseline and 2-year follow-up data, matched pairs analysis demonstrated a significant improvement in WOSI and ASES scores in both groups (Table 2). There was no significant improvement in SAS score within either group. Conclusions: In this cohort of contact athletes undergoing Latarjet, no statistically significant differences were observed between primary and revision groups in glenoid bone loss, subluxations, dislocations, revision surgery, or return-to-sport outcomes. Both groups demonstrated high rates of return-to-sport, with many athletes returning to or exceeding pre-injury level. The results of this study show that Latarjet as a revision surgery provides functional outcomes comparable to Latarjet when performed as the primary surgery, even in high-demand populations such as contact athletes.
