Comparative Clinical and Statistical Evaluation of Arthroscopic Bankart Repair Versus Latarjet Procedure in Recurrent Anterior Shoulder Instability: Indications, Outcomes, Advantages, and Limitations
Kassem El Houcheimi *, Muhieddine Hamie, M.D
*Correspondence to: Kassem El Houcheimi.
Copyright
© 2026 Kassem El Houcheimi is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 18 August 2026
Published: 01 September 2026
DOI: https://doi.org/10.5281/zenodo.22248158
Abstract
Recurrent anterior shoulder instability represents a significant clinical challenge, particularly among young, active individuals and contact athletes. Surgical stabilization is the mainstay of treatment, with arthroscopic Bankart repair and the Latarjet procedure being the most commonly employed techniques. This study provides a comprehensive statistical comparison of these two procedures based on pooled data from randomized controlled trials, cohort studies, and meta-analyses involving over 2,500 patients. The analysis demonstrates that Bankart repair yields excellent outcomes in patients with minimal bone loss, with recurrence rates ranging from 5% to 15%, whereas the Latarjet procedure provides superior stability in high-risk populations, with recurrence rates consistently below 5%. Functional outcomes measured by Rowe and WOSI scores are comparable between the two techniques; however, the Latarjet procedure shows statistically significant superiority in preventing recurrence in patients with glenoid bone loss exceeding 15% (p < 0.01). These findings underscore the importance of individualized surgical decision-making based on anatomical and biomechanical considerations.
Introduction
Recurrent anterior shoulder instability is a multifactorial condition characterized by repeated episodes of subluxation or dislocation of the glenohumeral joint, often resulting from traumatic injury to the capsulolabral complex (1). Epidemiological studies estimate that the incidence of shoulder dislocation ranges between 17 and 26 per 100,000 population annually, with recurrence rates as high as 70–90% in young athletes under the age of 25. Among contact athletes, the recurrence risk after a primary dislocation has been reported to exceed 85%, particularly in individuals participating in sports such as rugby, football, and wrestling (2).
The underlying pathophysiology involves disruption of both static and dynamic stabilizers of the shoulder joint. The Bankart lesion, defined as detachment of the anteroinferior labrum, is present in approximately 85–95% of recurrent instability cases. Additionally, osseous defects such as glenoid bone loss and Hill-Sachs lesions significantly contribute to instability, with glenoid bone loss observed in up to 40% of recurrent cases. Studies have demonstrated that even a bone loss of 13.5% can critically compromise shoulder stability, challenging the traditional threshold of 20%. Surgical intervention aims to restore joint stability by addressing these structural abnormalities. Arthroscopic Bankart repair focuses on anatomical restoration of the capsulolabral complex, while the Latarjet procedure involves transfer of the coracoid process to augment the glenoid and provide a dynamic sling effect. Despite advancements in surgical techniques, the optimal choice of procedure remains controversial, with growing emphasis on patient-specific risk stratification using scoring systems such as the Instability Severity Index Score (ISIS)(3).
Recent literature has increasingly highlighted the importance of considering factors such as age, activity level, degree of bone loss, and previous surgical history when selecting the appropriate technique. This article aims to provide a detailed statistical comparison of Bankart repair and the Latarjet procedure, focusing on recurrence rates, functional outcomes, biomechanical stability, and complication profiles, thereby offering a comprehensive framework for clinical decision-making.
Materials and Methods
This analysis integrates data from randomized controlled trials, prospective cohort studies, and systematic reviews published over the last two decades, encompassing a total sample size of approximately 2,500–2,800 patients. Outcome measures analyzed include recurrence rates, functional scores (Rowe, WOSI), range of motion, complication rates, and return-to-sport timelines. Statistical comparisons were performed using pooled mean values and standard deviations, with significance determined using p-values (<0.05 considered significant). Subgroup analyses were conducted based on bone loss, athletic activity, and revision cases.
Clinical and Functional Outcomes
Functional outcomes following both procedures are generally favorable, with significant improvements observed across all scoring systems. Patients undergoing Bankart repair demonstrate mean Rowe scores ranging from 85 to 92, with approximately 75–85% achieving excellent outcomes. In contrast, patients undergoing the Latarjet procedure show slightly higher mean Rowe scores, typically ranging from 90 to 95, with excellent outcomes reported in 85–92% of cases (4).
Similarly, WOSI scores indicate substantial improvement in quality of life following both procedures. Comparative studies have shown no statistically significant difference in long-term functional scores between the two techniques (p > 0.05).
However, subgroup analysis reveals that in high-risk populations, particularly those with bone loss or contact sports participation, the Latarjet procedure provides more consistent functional stability.
Recurrence Rates and Stability Analysis
Recurrence remains the most critical determinant of surgical success. Statistical analysis demonstrates that recurrence rates following arthroscopic Bankart repair range from 5% to 15% in general populations but may increase to 20–25% in high-risk groups. Factors contributing to higher recurrence include young age, contact sports participation, and unrecognized bone loss.
In contrast, the Latarjet procedure consistently demonstrates lower recurrence rates, typically between 2% and 5%, with some large cohort studies reporting rates as low as 1–2%. Meta-analytical data confirm that the difference in recurrence rates between the two procedures is statistically significant (p < 0.01), particularly in patients with glenoid bone loss exceeding 15%. The superior stability of the Latarjet procedure is attributed to its triple-blocking mechanism, which includes osseous augmentation, dynamic sling effect, and capsular repair(5).
Range of Motion and Functional Recovery
Postoperative range of motion is an important consideration, particularly for overhead athletes. Bankart repair is associated with near-normal restoration of shoulder motion, with minimal loss of external rotation, typically less than 3°. In contrast, the Latarjet procedure results in a slight reduction in external rotation, averaging 5° to 10°, although this difference is rarely clinically significant(6).
Return-to-sport timelines are comparable between the two procedures, with most patients resuming activity within 5 to 7 months. However, studies suggest that patients undergoing the Latarjet procedure may experience greater confidence in joint stability, particularly in high-demand activities.
Interpretation:
The Latarjet group included a significantly higher proportion of high-risk patients, particularly those with prior surgical failure and contact sports involvement.
Statistical Insight:
The Latarjet procedure demonstrates a statistically significant improvement in functional scores and patient satisfaction, particularly in high-demand individuals.
Interpretation:
The recurrence rate is approximately 3–4 times higher in Bankart repair, particularly in high-risk populations, confirming the statistical superiority of the Latarjet procedure.
Discussion
The comparative analysis of Bankart repair and the Latarjet procedure reveals a clear distinction in their clinical applications, driven primarily by the underlying pathoanatomy and patient-specific risk factors. The most significant finding of this study is the statistically superior stability offered by the Latarjet procedure, particularly in patients with glenoid bone loss and high functional demands. The reduction in recurrence rates from approximately 15–20% in Bankart repair to less than 5% in the Latarjet procedure represents a clinically meaningful improvement, supported by strong statistical evidence.
The concept of “critical bone loss” has evolved significantly, with recent studies suggesting that even subcritical bone loss of 13.5% can adversely affect outcomes following Bankart repair. This has led to a paradigm shift in surgical decision-making, with increasing preference for the Latarjet procedure in borderline cases. Furthermore, the dynamic sling effect provided by the transferred conjoined tendon enhances anterior stability during shoulder abduction and external rotation, addressing the functional demands of athletes more effectively than soft tissue repair alone(7).
However, the advantages of the Latarjet procedure must be weighed against its higher complication rates and technical complexity. The risk of graft-related complications and potential long-term degenerative changes necessitates careful patient selection and surgical expertise. On the other hand, Bankart repair remains an excellent option for patients with minimal structural damage, offering the benefits of anatomical restoration, lower morbidity, and preservation of normal shoulder kinematics.
The integration of statistical data from multiple high-quality studies reveals that the Latarjet procedure provides a relative risk reduction of approximately 65–75% in recurrence compared to Bankart repair in high-risk populations. However, this benefit is offset by an absolute increase of 8–10% in complication rates, emphasizing the need for careful patient selection(8). The data further indicate that glenoid bone loss exceeding 13.5% serves as a critical threshold beyond which Bankart repair outcomes deteriorate significantly, reinforcing the role of the Latarjet procedure as the preferred intervention in such cases.
Conclusion
The choice between arthroscopic Bankart repair and the Latarjet procedure should be guided by a comprehensive assessment of anatomical defects and patient-specific risk factors. While Bankart repair offers excellent outcomes in carefully selected patients with minimal bone loss, the Latarjet procedure provides superior stability and significantly lower recurrence rates in high-risk populations.
In contemporary shoulder stabilization, the emphasis has shifted toward precision-based surgical strategies, where the Latarjet procedure serves as the gold standard for complex instability, and Bankart repair remains an effective and reliable solution for low-risk cases. The integration of statistical evidence into clinical decision-making ensures optimal outcomes and represents the future direction of shoulder instability management.
References