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.

BACKGROUND: Recurrent glenohumeral dislocation 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 2 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 glenohumeral dislocation treated between June 2014 and November 2019. Patients were stratified into 2 groups based on the surgical approach. Functional outcomes were assessed using the University of California at Los Angeles Activity score, Constant Murley score, and Rowe score. Post-operative ultrasound (US) evaluated tendon kinematics and the dynamic "hammock effect." Range of motion 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%). The mean number of pre-operative dislocation episodes was 4 ± 1.6 (range: 2-9). All patients practiced sports >2 times/wk, including 11 (20.8%) competitive athletes. No significant differences were found between groups regarding post-operative clinical scores (University of California at Los Angeles, Constant Murley score, Rowe), return to sports, range of motion, or reoperation rates. US analysis confirmed proper dynamic tensioning of the conjoint tendon in the novel group, successfully replicating the stabilizing hammock effect.

CONCLUSION: The novel conjoint tendon augmentation technique demonstrated clinical and functional noninferiority to the Latarjet procedure. This approach represents a bone-preserving alternative to the Latarjet procedure, avoiding coracoid osteotomy and hardware implantation. Dynamic US 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.