# Arthroscopic Latarjet yields better union and prevention of instability compared to arthroscopic bony Bankart repair in shoulders with recurrent anterior instability: a systematic review

Anselme Billaud, Laurent Baverel, Pierre Metais, Floris van Rooij, Ankitha Kumble, Guillaume Villatte, Edouard Dejour, Geoffroy Nourissat

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## To cite this version:

Anselme Billaud, Laurent Baverel, Pierre Metais, Floris van Rooij, Ankitha Kumble, et al., Arthroscopic Latarjet yields better union and prevention of instability compared to arthroscopic bony Bankart repair in shoulders with recurrent anterior instability: a systematic review. *Knee Surgery, Sports Traumatology, Arthroscopy*, 2023, 31 (12), pp.5994-6005. 10.1007/s00167-023-07655-x. hal-04611204

HAL Id: hal-04611204

https://uca.hal.science/hal-04611204

Submitted on 13 Jun 2024

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# Arthroscopic Latarjet yields better union and prevention of instability compared to arthroscopic bony Bankart repair in shoulders with recurrent anterior instability: a systematic review

Anselme Billaud, Laurent Baverel, Pierre Metais, Floris van Rooij, Ankitha Kumble, Guillaume Villatte, Edouard Dejour, Geoffroy Nourissat

<figure><img src="image_1.png" /></figure>

## To cite this version:

Anselme Billaud, Laurent Baverel, Pierre Metais, Floris van Rooij, Ankitha Kumble, et al., Arthroscopic Latarjet yields better union and prevention of instability compared to arthroscopic bony Bankart repair in shoulders with recurrent anterior instability: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 2023, 31 (12), pp.5994-6005. 10.1007/s00167-023-07655-x. hal-04611204

HAL Id: hal-04611204

https://uca.hal.science/hal-04611204v1

Submitted on 13 Jun 2024

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_2.png" /></figure>

Distributed under a Creative Commons Attribution 4.0 International License
1 **Title:** Arthroscopic Latarjet yields better union and prevention of instability compared to

2 arthroscopic bankart repairs in shoulders with recurrent anterior instability: a systematic

3 review
1 **Title:** Arthroscopic Latarjet yields better union and prevention of instability compared to

2 arthroscopic bankart repairs in shoulders with recurrent anterior instability: a systematic

3 review
4 Abstract

5 **Purpose:** To determine whether arthroscopic Latarjet procedure arthroscopic Latarjet or
6 arthroscopic bony Bankart repair arthroscopic bony Bankart repair provide better outcomes in
7 terms of rates of recurrent instability, non-union and complications, as well as clinical scores
8 and range of motion.

9 **Methods:** An electronic literature search was performed using PubMed, Embase®, and
10 Cochrane databases, applying the following keywords: “Arthroscopic bony bankart” OR
11 “Arthroscopic osseous bankart” AND “Arthroscopic Latarjet” OR “Arthroscopic coracoid
12 Bone block”.

13 **Results:** The systematic search returned 1,465 records, of which 29 were included
14 (arthroscopic bony Bankart repair, n=16; arthroscopic Latarjet, n=13). 37 datasets were
15 included for data extraction, on 1483 shoulders. Compared to arthroscopic Latarjet,
16 arthroscopic bony Bankart repair had significantly higher instability rates (0.14; CI, 0.10-
17 0.18; vs 0.04; CI, 0.02-0.06), significantly lower union rates (0.63; CI, 0.28-0.91 vs 0.98; CI,
18 0.93-1.00), and significantly lower pain on VAS (0.42; CI, 0.17-0.67 vs 1.17; CI, 0.96-
19 1.38). There were no significant differences in preoperative glenoid bone loss, follow-up,
20 complication rate, ROWE score, ASES score, external rotation, and anterior forward
21 elevation between arthroscopic Latarjet and arthroscopic bony Bankart repair.

22 **Conclusion:** Compared to arthroscopic Latarjet, arthroscopic bony Bankart repair results in
23 significantly (i) higher rates of recurrent instability (14% vs 4%), (ii) lower union rates (63%
24 vs 98%), but (iii) slightly lower pain on VAS (0.45 vs 1.17). There were no differences in
25 complication rates, clinical scores, or postoperative ranges of motion.

26 Level of Evidence: Level IV

27 **Keywords:** Arthroscopic Latarjet procedure, bony Bankart procedure, anterior instability,
28 outcomes
4 Abstract

5 **Purpose:** To determine whether arthroscopic Latarjet procedure arthroscopic Latarjet or
6 arthroscopic bony Bankart repair arthroscopic bony Bankart repair provide better outcomes in
7 terms of rates of recurrent instability, non-union and complications, as well as clinical scores
8 and range of motion.

9 **Methods:** An electronic literature search was performed using PubMed, Embase®, and
10 Cochrane databases, applying the following keywords: "Arthroscopic bony bankart" OR
11 "Arthroscopic osseous bankart" AND "Arthroscopic Latarjet" OR "Arthroscopic coracoid
12 Bone block".

13 **Results:** The systematic search returned 1,465 records, of which 29 were included
14 (arthroscopic bony Bankart repair, n=16; arthroscopic Latarjet, n=13). 37 datasets were
15 included for data extraction, on 1483 shoulders. Compared to arthroscopic Latarjet,
16 arthroscopic bony Bankart repair had significantly higher instability rates (0.14; CI, 0.10-
17 0.18; vs 0.04; CI, 0.02-0.06), significantly lower union rates (0.63; CI, 0.28-0.91 vs 0.98; CI,
18 0.93-1.00), and significantly lower pain on VAS (0.42; CI, 0.17-0.67 vs 1.17; CI, 0.96-
19 1.38). There were no significant differences in preoperative glenoid bone loss, follow-up,
20 complication rate, ROWE score, ASES score, external rotation, and anterior forward
21 elevation between arthroscopic Latarjet and arthroscopic bony Bankart repair.

22 **Conclusion:** Compared to arthroscopic Latarjet, arthroscopic bony Bankart repair results in
23 significantly (i) higher rates of recurrent instability (14% vs 4%), (ii) lower union rates (63%
24 vs 98%), but (iii) slightly lower pain on VAS (0.45 vs 1.17). There were no differences in
25 complication rates, clinical scores, or postoperative ranges of motion.

26 Level of Evidence: Level IV

27 **Keywords:** Arthroscopic Latarjet procedure, bony Bankart procedure, anterior instability,
28 outcomes
29 **Introduction**

Anterior shoulder instability often requires surgical treatment, particularly in young athletes who wish to resume sports [3,46,50]. The most common surgical treatments involve either labral or capsular repair in shoulders with no glenoid defects [34,51], or bone-block procedures in shoulders with glenoid defects [13,26,35]. The Latarjet technique is among the most popular bone-block procedures, as it proved effective at preventing recurrent dislocations [1,2,12,21,25,27,39] whether performed as an open or an arthroscopic procedure [15,33]. The Latarjet technique is however technically demanding and therefore has a considerable learning curve and requires alteration of native scapular anatomy [5,9,15].

38

More recently, arthroscopic bony Bankart repair arthroscopic bony Bankart repair[49] was introduced as a less invasive alternative to arthroscopic Latarjet, to treat anterior shoulder instability with traumatic glenoid defects, where the bone fragment is still present and could be sutured back onto the glenoid [4]. While arthroscopic bony Bankart repair demonstrated satisfactory bone union rates, it is associated with higher rates of recurrent instability compared to arthroscopic Latarjet [6,39,52,54], and may be insufficient to treat shoulders with irreparable ligamentous damage, attritional glenoid bone loss, or major bone deficiencies [15].

47

There is no consensus on the optimal treatment for recurrent anterior shoulder instability with traumatic glenoid defects. Therefore, the purpose of this study is to determine whether arthroscopic Latarjet or arthroscopic bony Bankart repair provide better outcomes for this population in terms of rates of recurrent instability, non-union and complications, as well as clinical scores and range of motion.
29 **Introduction**

30 Anterior shoulder instability often requires surgical treatment, particularly in young athletes
31 who wish to resume sports [3,46,50]. The most common surgical treatments involve either
32 labral or capsular repair in shoulders with no glenoid defects [34,51], or bone-block
33 procedures in shoulders with glenoid defects [13,26,35]. The Latarjet technique is among the
34 most popular bone-block procedures, as it proved effective at preventing recurrent
35 dislocations [1,2,12,21,25,27,39] whether performed as an open or an arthroscopic procedure
36 [15,33]. The Latarjet technique is however technically demanding and therefore has a
37 considerable learning curve and requires alteration of native scapular anatomy [5,9,15].

38

39 More recently, arthroscopic bony Bankart repair arthroscopic bony Bankart repair[49] was
40 introduced as a less invasive alternative to arthroscopic Latarjet, to treat anterior shoulder
41 instability with traumatic glenoid defects, where the bone fragment is still present and could
42 be sutured back onto the glenoid [4]. While arthroscopic bony Bankart repair demonstrated
43 satisfactory bone union rates, it is associated with higher rates of recurrent instability
44 compared to arthroscopic Latarjet [6,39,52,54], and may be insufficient to treat shoulders
45 with irreparable ligamentous damage, attritional glenoid bone loss, or major bone
46 deficiencies [15].

47

48 There is no consensus on the optimal treatment for recurrent anterior shoulder instability with
49 traumatic glenoid defects. Therefore, the purpose of this study is to determine whether
50 arthroscopic Latarjet or arthroscopic bony Bankart repair provide better outcomes for this
51 population in terms of rates of recurrent instability, non-union and complications, as well as
52 clinical scores and range of motion.
53

**Materials and Methods**

54

55

56

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58

59

*Search strategy*

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69

*Inclusion criteria*

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- Comparative or non-comparative studies on patients with recurrent anterior shoulder instability that underwent either primary arthroscopic Latarjet or primary arthroscopic bony Bankart repair with or without adjuvant procedures

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- Studies that measured preoperative glenoid bone loss using computed tomography (CT) scans

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- Studies that report pre- and post-operative clinical outcomes in terms of, recurrence of instability, non-union, complication rates, range of motion, or clinical scores

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## 53 Materials and Methods

The protocol for this systematic review was submitted to PROSPERO prior to commencement (registration number BLINDED) and conforms to the principles outlined in the handbook of the Cochrane Collaboration [19], along with the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) [37].

## 59 *Search strategy*

The authors conducted a structured electronic literature search on 06 July 2022 using the PubMed, Embase®, and Cochrane Central Register of Controlled Trials databases, applying the following keywords: “Arthroscopic bony bankart” OR “Arthroscopic osseous bankart” AND “Arthroscopic Latarjet” OR “Arthroscopic coracoid Bone block”. The full search strategy is presented in Appendix I. The search was limited to articles published between 2002 and 2022. After removal of duplicate records, each of two researchers (BLINDED) screened the titles and abstracts to determine the suitability for the review using the following predefined eligibility criteria:

## 69 *Inclusion criteria*

- Comparative or non-comparative studies on patients with recurrent anterior shoulder instability that underwent either primary arthroscopic Latarjet or primary arthroscopic bony Bankart repair with or without adjuvant procedures

- Studies that measured preoperative glenoid bone loss using computed tomography (CT) scans

- Studies that report pre- and post-operative clinical outcomes in terms of, recurrence of instability, non-union, complication rates, range of motion, or clinical scores
78 *Exclusion criteria:*

79 - Narrative or systematic reviews, case reports, expert opinions, editorials, letters to editors, computer simulations, cadaver or laboratory studies

81 - Studies published in languages other than English, French, German, Italian, Spanish, and Dutch to avoid translation errors.

83

84 *Study selection*

85 Studies that met the eligibility criteria during title and abstract screening underwent full-text screening by two researchers (BLINDED) and any disagreement was first discussed between the researchers, and if required, a third researcher (BLINDED) resolved any disagreement.

88 The reference lists of studies for full text review were searched, and an expert (BLINDED) was consulted to identify further relevant studies that may not have been captured by the database searches.

91

92 *Data extraction and quality assessment*

93 Data extraction was performed by two researchers (BLINDED) independently and their results were compared to ensure accuracy. Where there was disagreement in the documented value, the true value was ascertained by simultaneous review of the data in question by both researchers. The following information was extracted from the included studies; author(s), journal, year of publication, level of evidence, country where study was performed, conflicts of interest and funding declaration. Furthermore, the following clinical data was extracted: type of surgery, subgroup size, sex, age, preoperative glenoid bone loss, union rates (instead of non-union rates which were inconsistently defined and reported), recurrent instability rates (defined as recurrence of subluxation and/or dislocation), post-operative complication rates,
78 *Exclusion criteria:*

79 - Narrative or systematic reviews, case reports, expert opinions, editorials, letters to editors, computer simulations, cadaver or laboratory studies

81 - Studies published in languages other than English, French, German, Italian, Spanish, and Dutch to avoid translation errors.

83

84 *Study selection*

85 Studies that met the eligibility criteria during title and abstract screening underwent full-text screening by two researchers (BLINDED) and any disagreement was first discussed between the researchers, and if required, a third researcher (BLINDED) resolved any disagreement.

88 The reference lists of studies for full text review were searched, and an expert (BLINDED) was consulted to identify further relevant studies that may not have been captured by the database searches.

91

92 *Data extraction and quality assessment*

93 Data extraction was performed by two researchers (BLINDED) independently and their results were compared to ensure accuracy. Where there was disagreement in the documented value, the true value was ascertained by simultaneous review of the data in question by both researchers. The following information was extracted from the included studies; author(s), journal, year of publication, level of evidence, country where study was performed, conflicts of interest and funding declaration. Furthermore, the following clinical data was extracted: type of surgery, subgroup size, sex, age, preoperative glenoid bone loss, union rates (instead of non-union rates which were inconsistently defined and reported), recurrent instability rates (defined as recurrence of subluxation and/or dislocation), post-operative complication rates,
102

range of motion (ROM; ER1, arm at 0° of abduction; ER2, arm at 90° of abduction; AFE,
anterior forward elevation), clinical scores, and pain on VAS scale.

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105

Methodological quality of the eligible studies was assessed by two researchers (BLINDED)
according to the Joanna Briggs Institute (JBI) checklist, to appraise the reporting quality (10
items). Where there was disagreement between the researchers, consensus was achieved by
discussion and review.

109

110

## Statistical analysis

111

When available in the original articles, outcomes were tabulated: continuous outcomes were
reported as means, standard deviations, and ranges, while categorical outcomes were reported
as proportions. Pooled estimates were calculated if mean and standard deviations were
available for at least 3 studies reported. When the standard deviation was not reported, the range
was used to calculate standard deviation using a method outlined by Hozo et al.[22].
Heterogeneity was evaluated by visual inspection of forest plots and using the I² statistic and
its connected χ² test, to provide a measure of the degree of inconsistency across studies.

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115

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118

Pooled estimates of raw means and their 95% confidence interval (CI) were calculated using
a random-effects model framework. Pooled estimates of proportions and their 95%
confidence intervals (CI) were calculated via Freeman-Tukey double arcsine transformation
using inverse-variance weighting within a random-effects model framework. P-values <0.05
were considered statistically significant. Statistical analyses were performed using R version
4.1.3 (R Foundation for Statistical Computing, Vienna, Austria) using the meta package.

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120

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122

123
102

range of motion (ROM; ER1, arm at 0° of abduction; ER2, arm at 90° of abduction; AFE,
anterior forward elevation), clinical scores, and pain on VAS scale.

104

105

Methodological quality of the eligible studies was assessed by two researchers (BLINDED)
according to the Joanna Briggs Institute (JBI) checklist, to appraise the reporting quality (10
items). Where there was disagreement between the researchers, consensus was achieved by
discussion and review.

109

110

*Statistical analysis*

111

When available in the original articles, outcomes were tabulated: continuous outcomes were
reported as means, standard deviations, and ranges, while categorical outcomes were reported
as proportions. Pooled estimates were calculated if mean and standard deviations were
available for at least 3 studies reported. When the standard deviation was not reported, the range
was used to calculate standard deviation using a method outlined by Hozo et al.[22].
Heterogeneity was evaluated by visual inspection of forest plots and using the I² statistic and
its connected χ² test, to provide a measure of the degree of inconsistency across studies.

112

113

114

115

116

117

118

Pooled estimates of raw means and their 95% confidence interval (CI) were calculated using
a random-effects model framework. Pooled estimates of proportions and their 95%
confidence intervals (CI) were calculated via Freeman-Tukey double arcsine transformation
using inverse-variance weighting within a random-effects model framework. P-values <0.05
were considered statistically significant. Statistical analyses were performed using R version
4.1.3 (R Foundation for Statistical Computing, Vienna, Austria) using the meta package.

119

120

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122

123
124 **Results**

125 The systematic search returned 1,465 records, of which 563 were duplicates, leaving 902 for
126 title and abstract screening (Figure 1). A total of 786 studies were excluded by examining
127 their titles and/or abstracts because: 500 were not relevant, 223 were editorials/conference
128 proceedings etc., 29 were reviews, 17 were published before 2002, and 17 were published in
129 languages other than those defined in the exclusion criteria. A further 87 studies were
130 excluded after full-text review. This left 29 eligible studies,[1,7,8,11,14,16-18,23,24,29-
131 32,38,40-45,47,48,53,55-59] of which 16 assessed arthroscopic bony Bankart repair, 13
132 assessed arthroscopic Latarjet (Table 1 and 2). All studies reported preoperative glenoid bone
133 loss: 21 reported mean preoperative glenoid bone loss, of which 4 created subgroups of
134 glenoid bone loss and reported the mean loss of each subgroup, while 8 used a threshold of
135 glenoid bone loss as a part of their inclusion criteria. Of the 29 eligible studies, 37 datasets
136 were included for data extraction, with a total of 1,483 shoulders (arthroscopic bony Bankart
137 repair, n=874; AL, n=609) (Table 3 and 4). Of the 37 included datasets, 12 datasets reported
138 on concomitant Hill-Sachs (arthroscopic bony Bankart repair, n=7 and arthroscopic Latarjet,
139 n=5) lesions.

140

141 *Quality assessment*

142 Of the 29 eligible studies, 2 were prospective and 27 were retrospective. Of the 29 studies, 3
143 did not report criteria for inclusion and 2 did not specify the presenting sites demographic
144 information. Furthermore, it was unclear in 4 studies whether the study had complete
145 inclusion of participants. Overall, all included studies had good to excellent scored according
146 to the JBI checklist (Table 5).

147

148 *Preoperative glenoid bone loss*
124 **Results**

125 The systematic search returned 1,465 records, of which 563 were duplicates, leaving 902 for
126 title and abstract screening (Figure 1). A total of 786 studies were excluded by examining
127 their titles and/or abstracts because: 500 were not relevant, 223 were editorials/conference
128 proceedings etc., 29 were reviews, 17 were published before 2002, and 17 were published in
129 languages other than those defined in the exclusion criteria. A further 87 studies were
130 excluded after full-text review. This left 29 eligible studies,[1,7,8,11,14,16-18,23,24,29-
131 32,38,40-45,47,48,53,55-59] of which 16 assessed arthroscopic bony Bankart repair, 13
132 assessed arthroscopic Latarjet (Table 1 and 2). All studies reported preoperative glenoid bone
133 loss: 21 reported mean preoperative glenoid bone loss, of which 4 created subgroups of
134 glenoid bone loss and reported the mean loss of each subgroup, while 8 used a threshold of
135 glenoid bone loss as a part of their inclusion criteria. Of the 29 eligible studies, 37 datasets
136 were included for data extraction, with a total of 1,483 shoulders (arthroscopic bony Bankart
137 repair, n=874; AL, n=609) (Table 3 and 4). Of the 37 included datasets, 12 datasets reported
138 on concomitant Hill-Sachs (arthroscopic bony Bankart repair, n=7 and arthroscopic Latarjet,
139 n=5) lesions.

140

141 *Quality assessment*

142 Of the 29 eligible studies, 2 were prospective and 27 were retrospective. Of the 29 studies, 3
143 did not report criteria for inclusion and 2 did not specify the presenting sites demographic
144 information. Furthermore, it was unclear in 4 studies whether the study had complete
145 inclusion of participants. Overall, all included studies had good to excellent scored according
146 to the JBI checklist (Table 5).

147

148 *Preoperative glenoid bone loss*
149

Of the 37 included datasets, preoperative glenoid bone loss was reported as part of their inclusion criteria in 7 and was reported as a mean in 26 datasets (arthroscopic bony Bankart repair, n=19; arthroscopic Latarjet, n=7). There was no significant difference in mean preoperative glenoid bone loss between shoulders treated by arthroscopic bony Bankart repair (17.6%; CI, 13.7–21.6; I²=99%) or arthroscopic Latarjet (18.9%; CI, 13.5–24.3; I²=98%) (Figure 2).

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## Follow-up

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Of the 37 included datasets, mean follow-up was reported in 24 (arthroscopic bony Bankart repair, n=13; arthroscopic Latarjet, n=11). There was no significant difference in mean follow-up between shoulders treated by arthroscopic bony Bankart repair (49.3 months; CI, 27.9–70.8; I²=100%) or arthroscopic Latarjet (29 months; CI, 20.7–37.3; I²=99%).

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## Recurrent instability

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Of the 37 included datasets, rates of recurrent instability were reported in 19 (arthroscopic bony Bankart repair, n=13; arthroscopic Latarjet, n=6). There was a statistically significant higher rate of instability following arthroscopic bony Bankart repair (0.14; CI, 0.10–0.18; I²=49%) compared to arthroscopic Latarjet (0.04; CI, 0.02–0.06; I²=0%) (Figure 3).

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## Union

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Of the 37 included datasets, union was reported in 14 (arthroscopic bony Bankart repair, n=5; arthroscopic Latarjet, n=9). All studies assessed union using postoperative CT scans, and there was a statistically significant lower union rate following arthroscopic bony Bankart repair (0.63; CI, 0.28–0.91; I²=96%) compared to arthroscopic Latarjet (0.98; CI, 0.93–1.00; I²=70%) (Figure 4).
149

Of the 37 included datasets, preoperative glenoid bone loss was reported as part of their inclusion criteria in 7 and was reported as a mean in 26 datasets (arthroscopic bony Bankart repair, n=19; arthroscopic Latarjet, n=7). There was no significant difference in mean preoperative glenoid bone loss between shoulders treated by arthroscopic bony Bankart repair (17.6%; CI, 13.7–21.6; I²=99%) or arthroscopic Latarjet (18.9%; CI, 13.5–24.3; I²=98%) (Figure 2).

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## Follow-up

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Of the 37 included datasets, mean follow-up was reported in 24 (arthroscopic bony Bankart repair, n=13; arthroscopic Latarjet, n=11). There was no significant difference in mean follow-up between shoulders treated by arthroscopic bony Bankart repair (49.3 months; CI, 27.9–70.8; I²=100%) or arthroscopic Latarjet (29 months; CI, 20.7–37.3; I²=99%).

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## Recurrent instability

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Of the 37 included datasets, rates of recurrent instability were reported in 19 (arthroscopic bony Bankart repair, n=13; arthroscopic Latarjet, n=6). There was a statistically significant higher rate of instability following arthroscopic bony Bankart repair (0.14; CI, 0.10–0.18; I²=49%) compared to arthroscopic Latarjet (0.04; CI, 0.02–0.06; I²=0%) (Figure 3).

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## Union

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Of the 37 included datasets, union was reported in 14 (arthroscopic bony Bankart repair, n=5; arthroscopic Latarjet, n=9). All studies assessed union using postoperative CT scans, and there was a statistically significant lower union rate following arthroscopic bony Bankart repair (0.63; CI, 0.28–0.91; I²=96%) compared to arthroscopic Latarjet (0.98; CI, 0.93–1.00; I²=70%) (Figure 4).
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## Postoperative complications

176 Of the 37 included datasets, complication rates were reported in 15 (arthroscopic bony Bankart repair, n=3; arthroscopic Latarjet, n=12), of which 3 reported rates instead of absolute values [23,57]. There was no statistical difference in complication rate following arthroscopic bony Bankart repair (0.01; CI, 0.00-0.07; I²=0%) compared to arthroscopic Latarjet (0.03; CI, 0.00-0.06; I²=47%) (Figure 5).

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## Clinical scores

183 There were no significant differences between arthroscopic bony Bankart repair and arthroscopic Latarjet, in terms of ROWE score (92.78 vs 92.47), and ASES score (94.26 vs 92.16). However, arthroscopic bony Bankart repair demonstrated significantly lower pain on VAS (0.42) compared to arthroscopic Latarjet (1.17; p<0.01).

187

## Range of motion

189 There were no significant differences between arthroscopic bony Bankart repair and arthroscopic Latarjet, in terms of ER1 (59.5° vs 57.26°), and AFE (167.93° vs 170.90°).
174

## Postoperative complications

176 Of the 37 included datasets, complication rates were reported in 15 (arthroscopic bony Bankart repair, n=3; arthroscopic Latarjet, n=12), of which 3 reported rates instead of absolute values [23,57]. There was no statistical difference in complication rate following arthroscopic bony Bankart repair (0.01; CI, 0.00-0.07; I²=0%) compared to arthroscopic Latarjet (0.03; CI, 0.00-0.06; I²=47%) (Figure 5).

181

## Clinical scores

183 There were no significant differences between arthroscopic bony Bankart repair and arthroscopic Latarjet, in terms of ROWE score (92.78 vs 92.47), and ASES score (94.26 vs 92.16). However, arthroscopic bony Bankart repair demonstrated significantly lower pain on VAS (0.42) compared to arthroscopic Latarjet (1.17; p<0.01).

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## Range of motion

189 There were no significant differences between arthroscopic bony Bankart repair and arthroscopic Latarjet, in terms of ER1 (59.5° vs 57.26°), and AFE (167.93° vs 170.90°).
191

Discussion

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The most important findings of this meta-analysis are that, compared to arthroscopic Latarjet, arthroscopic bony Bankart repair results in significantly (i) higher rates of recurrent instability (14% vs 4%), (ii) lower union rates (63% vs 98%), but (iii) slightly lower pain on VAS (0.45 vs 1.17). There were however no significant differences in complication rates, clinical scores, or postoperative ranges of motion. The null hypothesis that the two procedures would result in comparable outcomes is therefore refuted. The clinical relevance of these findings is that, while arthroscopic bony Bankart repair demonstrated comparable clinical scores to arthroscopic Latarjet, the latter might be more suitable in patients prone to recurrent instability or non-union. It is worth noting, however, that the present meta-analysis did not account for the surgeon experience and learning curves, which should also be considered when choosing the surgical technique.

The present systematic review included studies that had good to excellent scores according to the JBI checklist. A previous systematic review by Longo et al.[36] compared outcomes of all surgical treatments for traumatic anterior Glenohumeral instability with Glenoid and/or humeral bony defects. Longo et al.[36] found that shoulders with Glenoid bone loss <25% were most frequently treated with arthroscopic Bankart repair (50%) or arthroscopic bony Bankart repair (32%), while shoulders with Glenoid bone loss >25% were most frequently managed by open reconstruction with bone graft (37%), arthroscopic Bristow procedure (26%), or open Latarjet procedure (OLP) (22%). The present meta-analysis found no significant difference in mean preoperative Glenoid bone loss between shoulders treated with arthroscopic bony Bankart repair (17.6%; CI, 13.7-21.6) versus arthroscopic Latarjet (18.9%; CI, 13.5-24.3). However, it remains unclear whether the choice of procedure should be based on the extent of Glenoid bone loss, or rather on the size of the remaining bone fragment
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The most important findings of this meta-analysis are that, compared to arthroscopic Latarjet, arthroscopic bony Bankart repair results in significantly (i) higher rates of recurrent instability (14% vs 4%), (ii) lower union rates (63% vs 98%), but (iii) slightly lower pain on VAS (0.45 vs 1.17). There were however no significant differences in complication rates, clinical scores, or postoperative ranges of motion. The null hypothesis that the two procedures would result in comparable outcomes is therefore refuted. The clinical relevance of these findings is that, while arthroscopic bony Bankart repair demonstrated comparable clinical scores to arthroscopic Latarjet, the latter might be more suitable in patients prone to recurrent instability or non-union. It is worth noting, however, that the present meta-analysis did not account for the surgeon experience and learning curves, which should also be considered when choosing the surgical technique.

The present systematic review included studies that had good to excellent scores according to the JBI checklist. A previous systematic review by Longo et al.[36] compared outcomes of all surgical treatments for traumatic anterior glenohumeral instability with glenoid and/or humeral bony defects. Longo et al.[36] found that shoulders with glenoid bone loss <25% were most frequently treated with arthroscopic Bankart repair (50%) or arthroscopic bony Bankart repair (32%), while shoulders with glenoid bone loss >25% were most frequently managed by open reconstruction with bone graft (37%), arthroscopic Bristow procedure (26%), or open Latarjet procedure (OLP) (22%). The present meta-analysis found no significant difference in mean preoperative glenoid bone loss between shoulders treated with arthroscopic bony Bankart repair (17.6%; CI, 13.7–21.6) versus arthroscopic Latarjet (18.9%; CI, 13.5–24.3). However, it remains unclear whether the choice of procedure should be based on the extent of glenoid bone loss, or rather on the size of the remaining bone fragment
present that could be sutured back onto the glenoid. It is worth noting that arthroscopic bony
Bankart repair may be insufficient to treat shoulders with irreparable ligamentous damage,
attribitional glenoid bone loss, or major bone deficiencies [15], where bone block procedures
may be the only treatment option. A recent systematic review by Hurley et al.[28] compared
outcomes of ABR alone versus ABR with remplissage versus OLP, to treat anterior shoulder
instability in patients with concomitant Hill-Sachs lesions. Hurley et al.[28] found higher
rates of recurrent instability following ABR alone (16.8%) compared to OLP (7.0%) and
ABR with remplissage (3.2%). A study by Horinek et al. [20] compared OLP with ABR with
remplissage, for anterior shoulder instability and found no difference in terms of clinical
scores, return to sport, and satisfaction. In the present meta-analysis, only one study
performed arthroscopic bony Bankart repair with remplissage (in 11 of 312 patients) [47] but
did not report the outcomes of this subgroup. Furthermore, out of the 29 included studies in
the present meta-analysis, Hill-Sachs lesions were reported in 15 studies, and their prevalence
ranged from 24% to 100%. It was not possible to perform a subgroup analysis of the
outcomes of this pathology as the type of Hill-Sachs lesion was not consistently reported,
which could affect the rate of recurrent instability [10,36].

232

The results of the present meta-analysis should be interpreted with the following limitations
in mind. All included studies were case series, although the level of quality was good to fair.
Furthermore, the thresholds of glenoid bone loss reported were heterogenous across studies
which makes it difficult to determine whether the choice for arthroscopic bony Bankart repair
or arthroscopic Latarjet should be based on the extent of preoperative glenoid bone loss. This
meta-analysis did not evaluate Hill-Sachs lesions which could have affected recurrent
instability rates [10,36] as the specific lesions were not consistently reported. Additionally,
there is need for a more standardised method of reporting outcomes as a great number of
present that could be sutured back onto the glenoid. It is worth noting that arthroscopic bony
Bankart repair may be insufficient to treat shoulders with irreparable ligamentous damage,
attribitional glenoid bone loss, or major bone deficiencies [15], where bone block procedures
may be the only treatment option. A recent systematic review by Hurley et al.[28] compared
outcomes of ABR alone versus ABR with remplissage versus OLP, to treat anterior shoulder
instability in patients with concomitant Hill-Sachs lesions. Hurley et al.[28] found higher
rates of recurrent instability following ABR alone (16.8%) compared to OLP (7.0%) and
ABR with remplissage (3.2%). A study by Horinek et al. [20] compared OLP with ABR with
remplissage, for anterior shoulder instability and found no difference in terms of clinical
scores, return to sport, and satisfaction. In the present meta-analysis, only one study
performed arthroscopic bony Bankart repair with remplissage (in 11 of 312 patients) [47] but
did not report the outcomes of this subgroup. Furthermore, out of the 29 included studies in
the present meta-analysis, Hill-Sachs lesions were reported in 15 studies, and their prevalence
ranged from 24% to 100%. It was not possible to perform a subgroup analysis of the
outcomes of this pathology as the type of Hill-Sachs lesion was not consistently reported,
which could affect the rate of recurrent instability [10,36].

232

The results of the present meta-analysis should be interpreted with the following limitations
in mind. All included studies were case series, although the level of quality was good to fair.
Furthermore, the thresholds of glenoid bone loss reported were heterogenous across studies
which makes it difficult to determine whether the choice for arthroscopic bony Bankart repair
or arthroscopic Latarjet should be based on the extent of preoperative glenoid bone loss. This
meta-analysis did not evaluate Hill-Sachs lesions which could have affected recurrent
instability rates [10,36] as the specific lesions were not consistently reported. Additionally,
there is need for a more standardised method of reporting outcomes as a great number of
241

different clinical scores were reported, making it difficult to quantitatively compare studies.

242

Finally, it is worth noting that, while there was no statistically significant difference in follow-up between the two techniques, the mean follow-up for arthroscopic bony Bankart repair was almost 2 years longer than for arthroscopic Latarjet, which could introduce bias in the comparisons.

243

244

245

246

247

## Conclusion

248

This systematic review and meta-analysis found that, compared to arthroscopic Latarjet, arthroscopic bony Bankart repair results in significantly (i) higher rates of recurrent instability (14% vs 4%), (ii) lower union rates (63% vs 98%), but (iii) slightly lower pain on VAS (0.45 vs 1.17). There were however no significant differences in complication rates, clinical scores, or postoperative ranges of motion.

249

250

251

252
241

different clinical scores were reported, making it difficult to quantitatively compare studies.

242

Finally, it is worth noting that, while there was no statistically significant difference in follow-up between the two techniques, the mean follow-up for arthroscopic bony Bankart repair was almost 2 years longer than for arthroscopic Latarjet, which could introduce bias in the comparisons.

243

244

245

246

247

## Conclusion

248

This systematic review and meta-analysis found that, compared to arthroscopic Latarjet, arthroscopic bony Bankart repair results in significantly (i) higher rates of recurrent instability (14% vs 4%), (ii) lower union rates (63% vs 98%), but (iii) slightly lower pain on VAS (0.45 vs 1.17). There were however no significant differences in complication rates, clinical scores, or postoperative ranges of motion.

249

250

251

252
253 References

254 1. Ali J, Altintas B, Pulatkan A, Boykin RE, Aksoy DO, Bilsel K (2020) Open Versus Arthroscopic Latarjet Procedure for the Treatment of Chronic Anterior Glenohumeral Instability With Glenoid Bone Loss. Arthroscopy 36 (4):940-949.

257 2. Ali ZS, Hurley ET, Jamal MS, Horan MP, Montgomery C, Pauzenberger L, Millett PJ, Mullett H (2021) Low rate of recurrent instability following the open Latarjet procedure as a revision procedure for failed prior stabilization surgery. Knee Surg Sports Traumatol Arthrosc 29 (7):2110-2117.

261 3. Baverel L, Colle PE, Saffarini M, Anthony Odri G, Barth J (2018) Open Latarjet Procedures Produce Better Outcomes in Competitive Athletes Compared With Recreational Athletes: A Clinical Comparative Study of 106 Athletes Aged Under 30 Years. Am J Sports Med 46 (6):1408-1415.

265 4. Bedi A, Ryu RK (2009) The treatment of primary anterior shoulder dislocations. Instr Course Lect 58:293-304.

267 5. Bockmann B, Nebelung W, Gröger F, Leuzinger J, Agneskirchner J, Brunner U, Seybold D, Streich J, Bartsch S, Schicktanz K, Maier D, Königshausen M, Patzer T, Venjakob AJ (2023) The arthroscopic treatment of anterior shoulder instability with glenoid bone loss shows similar clinical results after Latarjet procedure and iliac crest autograft transfer. Knee Surg Sports Traumatol Arthrosc 31 (10):4566-4574.

272 6. Bohu Y, Abadie P, van Rooij F, Nover L, Berhouet J, Hardy A (2021) Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores. Knee Surg Sports Traumatol Arthrosc 29 (8):2606-2615.

275 7. Boileau P, Saliken D, Gendre P, Seeto BL, d'Ollonne T, Gonzalez JF, Bronsard N (2019) Arthroscopic Latarjet: Suture-Button Fixation Is a Safe and Reliable Alternative to Screw Fixation. Arthroscopy 35 (4):1050-1061.

278 8. Bonnevialle N, Girard M, Dalmas Y, Martinel V, Faruch M, Mansat P (2021) Short-Term Bone Fusion With Arthroscopic Double-Button Latarjet Versus Open-Screw Latarjet. Am J Sports Med 49 (6):1596-1603.

281 9. Buda M, D'Ambrosi R, Bellato E, Blonna D, Cappellari A, Delle Rose G, Merolla G, Committee SIR (2021) Failed Latarjet procedure: a systematic review of surgery revision options. J Orthop Traumatol 22 (1):24.

284 10. Calandra JJ, Baker CL, Uribe J (1989) The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy 5 (4):254-257.

286 11. Calvo C, Calvo J, Rojas D, Valencia M, Calvo E (2021) Clinical Relevance of Persistent Off-Track Hill-Sachs Lesion After Arthroscopic Latarjet Procedure. Am J Sports Med 49 (8):2006-2012.
253 **References**

254 1. Ali J, Altintas B, Pulatkan A, Boykin RE, Aksoy DO, Bilsel K (2020) Open Versus Arthroscopic Latarjet Procedure for the Treatment of Chronic Anterior Glenohumeral Instability With Glenoid Bone Loss. Arthroscopy 36 (4):940-949.

257 2. Ali ZS, Hurley ET, Jamal MS, Horan MP, Montgomery C, Pauzenberger L, Millett PJ, Mullett H (2021) Low rate of recurrent instability following the open Latarjet procedure as a revision procedure for failed prior stabilization surgery. Knee Surg Sports Traumatol Arthrosc 29 (7):2110-2117.

261 3. Baverel L, Colle PE, Saffarini M, Anthony Odri G, Barth J (2018) Open Latarjet Procedures Produce Better Outcomes in Competitive Athletes Compared With Recreational Athletes: A Clinical Comparative Study of 106 Athletes Aged Under 30 Years. Am J Sports Med 46 (6):1408-1415.

265 4. Bedi A, Ryu RK (2009) The treatment of primary anterior shoulder dislocations. Instr Course Lect 58:293-304.

267 5. Bockmann B, Nebelung W, Gröger F, Leuzinger J, Agneskirchner J, Brunner U, Seybold D, Streich J, Bartsch S, Schicktanz K, Maier D, Königshausen M, Patzer T, Venjakob AJ (2023) The arthroscopic treatment of anterior shoulder instability with glenoid bone loss shows similar clinical results after Latarjet procedure and iliac crest autograft transfer. Knee Surg Sports Traumatol Arthrosc 31 (10):4566-4574.

272 6. Bohu Y, Abadie P, van Rooij F, Nover L, Berhouet J, Hardy A (2021) Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores. Knee Surg Sports Traumatol Arthrosc 29 (8):2606-2615.

275 7. Boileau P, Saliken D, Gendre P, Seeto BL, d'Ollonne T, Gonzalez JF, Bronsard N (2019) Arthroscopic Latarjet: Suture-Button Fixation Is a Safe and Reliable Alternative to Screw Fixation. Arthroscopy 35 (4):1050-1061.

278 8. Bonnevialle N, Girard M, Dalmas Y, Martinel V, Faruch M, Mansat P (2021) Short-Term Bone Fusion With Arthroscopic Double-Button Latarjet Versus Open-Screw Latarjet. Am J Sports Med 49 (6):1596-1603.

281 9. Buda M, D'Ambrosi R, Bellato E, Blonna D, Cappellari A, Delle Rose G, Merolla G, Committee SIR (2021) Failed Latarjet procedure: a systematic review of surgery revision options. J Orthop Traumatol 22 (1):24.

284 10. Calandra JJ, Baker CL, Uribe J (1989) The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy 5 (4):254-257.

286 11. Calvo C, Calvo J, Rojas D, Valencia M, Calvo E (2021) Clinical Relevance of Persistent Off-Track Hill-Sachs Lesion After Arthroscopic Latarjet Procedure. Am J Sports Med 49 (8):2006-2012.
289
290
291

12. Cerciello S, Corona K, Morris BJ, Santagada DA, Maccauro G (2019) Early Outcomes and Perioperative Complications of the Arthroscopic Latarjet Procedure: Systematic Review and Meta-analysis. Am J Sports Med 47 (9):2232-2241.

292
293
294

13. Chillemi C, Guerrisi M, Paglialunga C, Salate Santone F, Osimani M (2021) Latarjet procedure for anterior shoulder instability: a 24-year follow-up study. Arch Orthop Trauma Surg 141 (2):189-196.

295
296
297

14. Dumont GD, Fogerty S, Rosso C, Lafosse L (2014) The arthroscopic latarjet procedure for anterior shoulder instability: 5-year minimum follow-up. Am J Sports Med 42 (11):2560-2566.

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15. From the American Association of Neurological Surgeons ASoNC, Interventional Radiology Society of Europe CIRACoNSESoMINTESoNESOSfCA, Interventions SoIRSoNS, World Stroke O, Sacks D, Baxter B, Campbell BCV, Carpenter JS, Cognard C, Dippel D, Eesa M, Fischer U, Hausegger K, Hirsch JA, Shazam Hussain M, Jansen O, Jayaraman MV, Khalessi AA, Kluck BW, Lavine S, Meyers PM, Ramee S, Rufenacht DA, Schirmer CM, Vorwerk D (2018) Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke. Int J Stroke 13 (6):612-632.

306
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16. Giacomo GD, Pugliese M, Peebles AM, Provencher MT (2022) Bone Fragment Resorption and Clinical Outcomes of Traumatic Bony Bankart Lesion Treated With Arthroscopic Repair Versus Open Latarjet. Am J Sports Med 50 (5):1336-1343.

309
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311

17. Godin JA, Altintas B, Horan MP, Hussain ZB, Pogorzelski J, Fritz EM, Millett PJ (2019) Midterm Results of the Bony Bankart Bridge Technique for the Treatment of Bony Bankart Lesions. Am J Sports Med 47 (1):158-164.

312
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314

18. Guo S, Jiang C (2021) "Double-Pulley" Dual-Row Technique for Arthroscopic Fixation of Large Bony Bankart Lesion: Minimum 2-Year Follow-up With CT Evaluation. Orthop J Sports Med 9 (9):23259671211029239.

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19. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods G, Cochrane Statistical Methods G (2011) The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 343:d5928. doi: 10.1136/bmj.d5928

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20. Horinek JL, Menendez ME, Narbona P, Ladermann A, Barth J, Denard PJ (2022) Arthroscopic Bankart Repair With Remplissage as an Alternative to Latarjet for Anterior Glenohumeral Instability With More Than 15% Glenoid Bone Loss. Orthop J Sports Med 10 (12):23259671221142257.

323
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326

21. Horner NS, Moroz PA, Bhullar R, Habib A, Simunovic N, Wong I, Bedi A, Ayeni OR (2018) Open versus arthroscopic Latarjet procedures for the treatment of shoulder instability: a systematic review of comparative studies. BMC Musculoskelet Disord 19 (1):255. doi: 10.1186/s12891-018-2188-2
12. Cerciello S, Corona K, Morris BJ, Santagada DA, Maccauro G (2019) Early Outcomes and Perioperative Complications of the Arthroscopic Latarjet Procedure: Systematic Review and Meta-analysis. Am J Sports Med 47 (9):2232-2241.

13. Chillemi C, Guerrisi M, Paglialunga C, Salate Santone F, Osimani M (2021) Latarjet procedure for anterior shoulder instability: a 24-year follow-up study. Arch Orthop Trauma Surg 141 (2):189-196.

14. Dumont GD, Fogerty S, Rosso C, Lafosse L (2014) The arthroscopic latarjet procedure for anterior shoulder instability: 5-year minimum follow-up. Am J Sports Med 42 (11):2560-2566.

15. From the American Association of Neurological Surgeons ASoNC, Interventional Radiology Society of Europe CIRACoNSESoMINTESoNESOSfCA, Interventions SoIRSoNS, World Stroke O, Sacks D, Baxter B, Campbell BCV, Carpenter JS, Cognard C, Dippel D, Eesa M, Fischer U, Hausegger K, Hirsch JA, Shazam Hussain M, Jansen O, Jayaraman MV, Khalessi AA, Kluck BW, Lavine S, Meyers PM, Ramee S, Rufenacht DA, Schirmer CM, Vorwerk D (2018) Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke. Int J Stroke 13 (6):612-632.

16. Giacomo GD, Pugliese M, Peebles AM, Provencher MT (2022) Bone Fragment Resorption and Clinical Outcomes of Traumatic Bony Bankart Lesion Treated With Arthroscopic Repair Versus Open Latarjet. Am J Sports Med 50 (5):1336-1343.

17. Godin JA, Altintas B, Horan MP, Hussain ZB, Pogorzelski J, Fritz EM, Millett PJ (2019) Midterm Results of the Bony Bankart Bridge Technique for the Treatment of Bony Bankart Lesions. Am J Sports Med 47 (1):158-164.

18. Guo S, Jiang C (2021) "Double-Pulley" Dual-Row Technique for Arthroscopic Fixation of Large Bony Bankart Lesion: Minimum 2-Year Follow-up With CT Evaluation. Orthop J Sports Med 9 (9):23259671211029239.

19. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods G, Cochrane Statistical Methods G (2011) The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 343:d5928. doi: 10.1136/bmj.d5928

20. Horinek JL, Menendez ME, Narbona P, Ladermann A, Barth J, Denard PJ (2022) Arthroscopic Bankart Repair With Remplissage as an Alternative to Latarjet for Anterior Glenohumeral Instability With More Than 15% Glenoid Bone Loss. Orthop J Sports Med 10 (12):23259671221142257.

21. Horner NS, Moroz PA, Bhullar R, Habib A, Simunovic N, Wong I, Bedi A, Ayeni OR (2018) Open versus arthroscopic Latarjet procedures for the treatment of shoulder instability: a systematic review of comparative studies. BMC Musculoskelet Disord 19 (1):255. doi: 10.1186/s12891-018-2188-2
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330 23. Hurley ET, Ben Ari E, Lorentz NA, Mojica ES, Colasanti CA, Matache BA, Jazrawi LM, Virk M, Meislin RJ (2021) Both Open and Arthroscopic Latarjet Result in Excellent Outcomes and Low Recurrence Rates for Anterior Shoulder Instability. Arthrosc Sports Med Rehabil 3 (6):e1955-e1960. doi: 10.1016/j.asmr.2021.09.017

334 24. Hurley ET, Colasanti CA, Lorentz NA, Matache BA, Campbell KA, Jazrawi LM, Meislin RJ (2022) No Difference in Outcomes After Arthroscopic Bankart Repair With Remplissage or Arthroscopic Latarjet Procedure for Anterior Shoulder Instability. Arthrosc Sports Med Rehabil 4 (3):e853-e859.

338 25. Hurley ET, Jamal MS, Ali ZS, Montgomery C, Pauzenberger L, Mullett H (2019) Long-term outcomes of the Latarjet procedure for anterior shoulder instability: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg 28 (2):e33-e39.

342 26. Hurley ET, Manjunath AK, Matache BA, Jia NW, Virk M, Jazrawi LM, Meislin RJ (2021) No difference in 90-day complication rate following open versus arthroscopic Latarjet procedure. Knee Surg Sports Traumatol Arthrosc 29 (7):2333-2337.

345 27. Hurley ET, Montgomery C, Jamal MS, Shimozono Y, Ali Z, Pauzenberger L, Mullett H (2019) Return to Play After the Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review. Am J Sports Med 47 (12):3002-3008.

348 28. Hurley ET, Toale JP, Davey MS, Colasanti CA, Pauzenberger L, Strauss EJ, Mullett H (2020) Remplissage for anterior shoulder instability with Hill-Sachs lesions: a systematic review and meta-analysis. J Shoulder Elbow Surg 29 (12):2487-2494.

351 29. Kany J, Pankappilly B, Guinand R, Kumar HA, Amaravati RS, Valenti P (2013) "Bipolar Fixation". Techniques in Shoulder & Elbow Surgery 14 (1):10-16.

353 30. Kim YK, Cho SH, Son WS, Moon SH (2014) Arthroscopic repair of small and medium-sized bony Bankart lesions. Am J Sports Med 42 (1):86-94.

355 31. Kitayama S, Sugaya H, Takahashi N, Matsuki K, Kawai N, Tokai M, Ohnishi K, Ueda Y, Hoshika S, Kitamura N, Yasuda K, Moriishi J (2015) Clinical Outcome and Glenoid Morphology After Arthroscopic Repair of Chronic Osseous Bankart Lesions: A Five to Eight-Year Follow-up Study. J Bone Joint Surg Am 97 (22):1833-1843.

359 32. Kordasiewicz B, Kicinski M, Malachowski K, Boszczyk A, Chaberek S, Pomianowski S (2019) Arthroscopic Latarjet Stabilization: Analysis of the Learning Curve in the First 90 Primary Cases: Early Clinical Results and Computed Tomography Evaluation. Arthroscopy 35 (12):3221-3237.
327
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330
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23. Hurley ET, Ben Ari E, Lorentz NA, Mojica ES, Colasanti CA, Matache BA, Jazrawi LM, Virk M, Meislin RJ (2021) Both Open and Arthroscopic Latarjet Result in Excellent Outcomes and Low Recurrence Rates for Anterior Shoulder Instability. Arthrosc Sports Med Rehabil 3 (6):e1955-e1960. doi: 10.1016/j.asmr.2021.09.017

334
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24. Hurley ET, Colasanti CA, Lorentz NA, Matache BA, Campbell KA, Jazrawi LM, Meislin RJ (2022) No Difference in Outcomes After Arthroscopic Bankart Repair With Remplissage or Arthroscopic Latarjet Procedure for Anterior Shoulder Instability. Arthrosc Sports Med Rehabil 4 (3):e853-e859.

338
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340
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25. Hurley ET, Jamal MS, Ali ZS, Montgomery C, Pauzenberger L, Mullett H (2019) Long-term outcomes of the Latarjet procedure for anterior shoulder instability: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg 28 (2):e33-e39.

342
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345
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347

27. Hurley ET, Montgomery C, Jamal MS, Shimozono Y, Ali Z, Pauzenberger L, Mullett H (2019) Return to Play After the Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review. Am J Sports Med 47 (12):3002-3008.

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351
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29. Kany J, Pankappilly B, Guinand R, Kumar HA, Amaravati RS, Valenti P (2013) "Bipolar Fixation". Techniques in Shoulder & Elbow Surgery 14 (1):10-16.

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31. Kitayama S, Sugaya H, Takahashi N, Matsuki K, Kawai N, Tokai M, Ohnishi K, Ueda Y, Hoshika S, Kitamura N, Yasuda K, Moriishi J (2015) Clinical Outcome and Glenoid Morphology After Arthroscopic Repair of Chronic Osseous Bankart Lesions: A Five to Eight-Year Follow-up Study. J Bone Joint Surg Am 97 (22):1833-1843.

359
360
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32. Kordasiewicz B, Kicinski M, Malachowski K, Boszczyk A, Chaberek S, Pomianowski S (2019) Arthroscopic Latarjet Stabilization: Analysis of the Learning Curve in the First 90 Primary Cases: Early Clinical Results and Computed Tomography Evaluation. Arthroscopy 35 (12):3221-3237.
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398
399

43. Nakagawa S, Mae T, Yoneda K, Kinugasa K, Nakamura H (2017) Influence of Glenoid Defect Size and Bone Fragment Size on the Clinical Outcome After Arthroscopic Bankart Repair in Male Collision/Contact Athletes. Am J Sports Med 45 (9):1967-1974.
33. Lafosse L, Boyle S, Gutierrez-Aramberri M, Shah A, Meller R (2010) Arthroscopic latarjet procedure. Orthop Clin North Am 41 (3):393-405.

34. Levy DM, Cole BJ, Bach BR, Jr. (2016) History of surgical intervention of anterior shoulder instability. J Shoulder Elbow Surg 25 (6):e139-150.

35. Lho T, Lee J, Oh KS, Chung SW (2023) Latarjet procedure for failed Bankart repair provides better stability and return to sports, but worse postoperative pain and external rotation limitations with more complications, compared to revision Bankart repair: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 31 (8):3541-3558.

36. Longo UG, Loppini M, Rizzello G, Romeo G, Huijsmans PE, Denaro V (2014) Glenoid and humeral head bone loss in traumatic anterior glenohumeral instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 22 (2):392-414.

37. McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, and the P-DTAG, Clifford T, Cohen JF, Deeks JJ, Gatsonis C, Hooft L, Hunt HA, Hyde CJ, Korevaar DA, Leeflang MMG, Macaskill P, Reitsma JB, Rodin R, Rutjes AWS, Salameh JP, Stevens A, Takwoingi Y, Tonelli M, Weeks L, Whiting P, Willis BH (2018) Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement. JAMA 319 (4):388-396.

38. Millett PJ, Horan MP, Martetschlager F (2013) The "bony Bankart bridge" technique for restoration of anterior shoulder stability. Am J Sports Med 41 (3):608-614.

39. Murphy AI, Hurley ET, Hurley DJ, Pauzenberger L, Mullett H (2019) Long-term outcomes of the arthroscopic Bankart repair: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg 28 (11):2084-2089.

40. Nakagawa S, Hirose T, Uchida R, Ohori T, Mae T (2022) Remaining Large Bone Fragment of a Bony Bankart Lesion in Shoulders With a Subcritical Glenoid Defect: Association With Recurrent Anterior Instability. Am J Sports Med 50 (1):189-194.

41. Nakagawa S, Hirose T, Uchida R, Yokoi H, Ohori T, Sahara W, Mae T (2022) A Glenoid Defect of 13.5% or Larger Is Not Always Critical in Male Competitive Rugby and American Football Players Undergoing Arthroscopic Bony Bankart Repair: Contribution of Resultant Large Bone Fragment. Arthroscopy 38 (3):673-681.

42. Nakagawa S, Mae T, Sato S, Okimura S, Kuroda M (2017) Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes. Orthop J Sports Med 5 (9):2325967117726494.

43. Nakagawa S, Mae T, Yoneda K, Kinugasa K, Nakamura H (2017) Influence of Glenoid Defect Size and Bone Fragment Size on the Clinical Outcome After Arthroscopic Bankart Repair in Male Collision/Contact Athletes. Am J Sports Med 45 (9):1967-1974.
400 44. Nakagawa S, Ozaki R, Take Y, Mae T, Hayashida K (2015) Bone fragment union and remodeling after arthroscopic bony bankart repair for traumatic anterior shoulder instability with a glenoid defect: influence on postoperative recurrence of instability. Am J Sports Med 43 (6):1438-1447.

404 45. Nakagawa S, Uchida R, Yokoi H, Sahara W, Mae T (2019) Changes of Bipolar Bone Defect Size After Arthroscopic Bankart Repair for Traumatic Anterior Shoulder Instability: Evaluation Using a Scoring System and Influence on Postoperative Recurrence. Orthop J Sports Med 7 (11):2325967119885345.

408 46. Neyton L, Young A, Dawidziak B, Visona E, Hager JP, Fournier Y, Walch G (2012) Surgical treatment of anterior instability in rugby union players: clinical and radiographic results of the Latarjet-Patte procedure with minimum 5-year follow-up. J Shoulder Elbow Surg 21 (12):1721-1727.

412 47. Park I, Lee JH, Hyun HS, Oh MJ, Shin SJ (2018) Effects of Bone Incorporation After Arthroscopic Stabilization Surgery for Bony Bankart Lesion Based on Preoperative Glenoid Defect Size. Am J Sports Med 46 (9):2177-2184.

415 48. Park JY, Lee SJ, Lhee SH, Lee SH (2012) Follow-up computed tomography arthrographic evaluation of bony Bankart lesions after arthroscopic repair. Arthroscopy 28 (4):465-473.

418 49. Rai S, Tamang N, Sharma LK, Marasini RP, Singh JL, Khanal K, Ghimire Kc M, Sherchan B (2021) Comparative study of arthroscopic Bankart repair versus open Latarjet procedure for recurrent shoulder dislocation. J Int Med Res 49 (4):3000605211007328.

422 50. Ranalletta M, Rossi LA, Bertona A, Tanoira I, Hidalgo IA, Maignon GD, Bongiovanni SL (2018) Modified Latarjet Without Capsulolabral Repair in Rugby Players With Recurrent Anterior Glenohumeral Instability and Significant Glenoid Bone Loss. Am J Sports Med 46 (4):795-800.

426 51. Rao AJ, Verma NN, Trenhaile SW (2017) The "Floating Labrum": Bankart Lesion Repair With Anterior Capsular Extension Using 2 Anterior Working Portals. Arthrosc Tech 6 (5):e1607-e1611. doi: 10.1016/j.eats.2017.06.017

429 52. Rattier S, Druel T, Hirakawa Y, Gröger F, van Rooij F, Neyton L (2022) Use of Cannulated Screws for Primary Latarjet Procedures. Orthop J Sports Med 10 (8):23259671221117802.

432 53. Shah N, Nadiri MN, Torrance E, Funk L (2018) Arthroscopic repair of bony Bankart lesions in collision athletes. Shoulder Elbow 10 (3):201-206.

434 54. Shanmugaraj A, Chai D, Sarraj M, Gohal C, Horner NS, Simunovic N, Athwal GS, Ayeni OR (2021) Surgical stabilization of pediatric anterior shoulder instability yields
400 44. Nakagawa S, Ozaki R, Take Y, Mae T, Hayashida K (2015) Bone fragment union and remodeling after arthroscopic bony bankart repair for traumatic anterior shoulder instability with a glenoid defect: influence on postoperative recurrence of instability. Am J Sports Med 43 (6):1438-1447.

404 45. Nakagawa S, Uchida R, Yokoi H, Sahara W, Mae T (2019) Changes of Bipolar Bone Defect Size After Arthroscopic Bankart Repair for Traumatic Anterior Shoulder Instability: Evaluation Using a Scoring System and Influence on Postoperative Recurrence. Orthop J Sports Med 7 (11):2325967119885345.

408 46. Neyton L, Young A, Dawidziak B, Visona E, Hager JP, Fournier Y, Walch G (2012) Surgical treatment of anterior instability in rugby union players: clinical and radiographic results of the Latarjet-Patte procedure with minimum 5-year follow-up. J Shoulder Elbow Surg 21 (12):1721-1727.

412 47. Park I, Lee JH, Hyun HS, Oh MJ, Shin SJ (2018) Effects of Bone Incorporation After Arthroscopic Stabilization Surgery for Bony Bankart Lesion Based on Preoperative Glenoid Defect Size. Am J Sports Med 46 (9):2177-2184.

415 48. Park JY, Lee SJ, Lhee SH, Lee SH (2012) Follow-up computed tomography arthrographic evaluation of bony Bankart lesions after arthroscopic repair. Arthroscopy 28 (4):465-473.

418 49. Rai S, Tamang N, Sharma LK, Marasini RP, Singh JL, Khanal K, Ghimire Kc M, Sherchan B (2021) Comparative study of arthroscopic Bankart repair versus open Latarjet procedure for recurrent shoulder dislocation. J Int Med Res 49 (4):3000605211007328.

422 50. Ranalletta M, Rossi LA, Bertona A, Tanoira I, Hidalgo IA, Maignon GD, Bongiovanni SL (2018) Modified Latarjet Without Capsulolabral Repair in Rugby Players With Recurrent Anterior Glenohumeral Instability and Significant Glenoid Bone Loss. Am J Sports Med 46 (4):795-800.

426 51. Rao AJ, Verma NN, Trenhaile SW (2017) The "Floating Labrum": Bankart Lesion Repair With Anterior Capsular Extension Using 2 Anterior Working Portals. Arthrosc Tech 6 (5):e1607-e1611. doi: 10.1016/j.eats.2017.06.017

429 52. Rattier S, Druel T, Hirakawa Y, Gröger F, van Rooij F, Neyton L (2022) Use of Cannulated Screws for Primary Latarjet Procedures. Orthop J Sports Med 10 (8):23259671221117802.

432 53. Shah N, Nadiri MN, Torrance E, Funk L (2018) Arthroscopic repair of bony Bankart lesions in collision athletes. Shoulder Elbow 10 (3):201-206.

434 54. Shanmugaraj A, Chai D, Sarraj M, Gohal C, Horner NS, Simunovic N, Athwal GS, Ayeni OR (2021) Surgical stabilization of pediatric anterior shoulder instability yields
436 high recurrence rates: a systematic review. Knee Surg Sports Traumatol Arthrosc 29
437 (1):192-201.

438 55. Shao Z, Zhao Y, Luo H, Jiang Y, Song Q, Cheng X, Cui G (2022) Clinical and
439 Radiologic Outcomes of All-Arthroscopic Latarjet Procedure With Modified Suture
440 Button Fixation: Excellent Bone Healing With a Low Complication Rate.
441 Arthroscopy 38 (7):2157-2165 e2157.

442 56. Wang Y, Zhou ZY, Zhang YJ, He CR, Xue CC, Xu WD, Wang ZM (2020) Early
443 Follow-Up of Arthroscopic Latarjet Procedure with Screw or Suture-Button Fixation
444 for Recurrent Anterior Shoulder Instability. Orthop Surg 12 (5):1350-1361.

445 57. Zeng Z, Liu C, Liu Y, Huang Y (2021) Early outcomes of the arthroscopic Latarjet
446 procedure in a series of 37 patients with shoulder instability. BMC Musculoskelet
447 Disord 22 (1):845.

448 58. Zhu Y, Jiang C, Song G (2017) Arthroscopic Versus Open Latarjet in the Treatment
449 of Recurrent Anterior Shoulder Dislocation With Marked Glenoid Bone Loss: A
450 Prospective Comparative Study. Am J Sports Med 45 (7):1645-1653.

451 59. Zhu YM, Jiang C, Song G, Lu Y, Li F (2017) Arthroscopic Latarjet Procedure With
452 Anterior Capsular Reconstruction: Clinical Outcome and Radiologic Evaluation With
453 a Minimum 2-Year Follow-Up. Arthroscopy 33 (12):2128-2135.

454

455
436 high recurrence rates: a systematic review. Knee Surg Sports Traumatol Arthrosc 29
437 (1):192-201.

438 55. Shao Z, Zhao Y, Luo H, Jiang Y, Song Q, Cheng X, Cui G (2022) Clinical and
439 Radiologic Outcomes of All-Arthroscopic Latarjet Procedure With Modified Suture
440 Button Fixation: Excellent Bone Healing With a Low Complication Rate.
441 Arthroscopy 38 (7):2157-2165 e2157.

442 56. Wang Y, Zhou ZY, Zhang YJ, He CR, Xue CC, Xu WD, Wang ZM (2020) Early
443 Follow-Up of Arthroscopic Latarjet Procedure with Screw or Suture-Button Fixation
444 for Recurrent Anterior Shoulder Instability. Orthop Surg 12 (5):1350-1361.

445 57. Zeng Z, Liu C, Liu Y, Huang Y (2021) Early outcomes of the arthroscopic Latarjet
446 procedure in a series of 37 patients with shoulder instability. BMC Musculoskelet
447 Disord 22 (1):845.

448 58. Zhu Y, Jiang C, Song G (2017) Arthroscopic Versus Open Latarjet in the Treatment
449 of Recurrent Anterior Shoulder Dislocation With Marked Glenoid Bone Loss: A
450 Prospective Comparative Study. Am J Sports Med 45 (7):1645-1653.

451 59. Zhu YM, Jiang C, Song G, Lu Y, Li F (2017) Arthroscopic Latarjet Procedure With
452 Anterior Capsular Reconstruction: Clinical Outcome and Radiologic Evaluation With
453 a Minimum 2-Year Follow-Up. Arthroscopy 33 (12):2128-2135.

454

455
456 **Figure legend**

457 **Figure 1:** Flowchart of study inclusion

458 **Figure 2:** Forest plot on glenoid defect size

459 **Figure 4:** Forest plot on recurrent instability

460 **Figure 5:** Forest plot on union

461 **Figure 6:** Forest plot on postoperative complications

462

463 **Supplementary material:**

464 **Figure 1:** Forest plot on follow-up

465 **Figure 2:** Forest plot on ROWE score

466 **Figure 3:** Forest plot on ASES score

467 **Figure 4:** Forest plot on pain on VAS

468 **Figure 5:** Forest plot on external rotation 1

469 **Figure 6:** Forest plot on active forward elevation

470 **Appendix 1: Search strategy**

471
456 **Figure legend**

457 **Figure 1:** Flowchart of study inclusion

458 **Figure 2:** Forest plot on glenoid defect size

459 **Figure 4:** Forest plot on recurrent instability

460 **Figure 5:** Forest plot on union

461 **Figure 6:** Forest plot on postoperative complications

462

463 **Supplementary material:**

464 **Figure 1:** Forest plot on follow-up

465 **Figure 2:** Forest plot on ROWE score

466 **Figure 3:** Forest plot on ASES score

467 **Figure 4:** Forest plot on pain on VAS

468 **Figure 5:** Forest plot on external rotation 1

469 **Figure 6:** Forest plot on active forward elevation

470 **Appendix 1: Search strategy**

471
<figure><img src="image_3.png" /></figure>
<figure><img src="image_3.png" /></figure>
<table><thead><tr><th>Author, Year</th><th>n Shoulders</th><th>Mean</th><th>SD</th><th>Glenoid defect size</th><th>MRAW</th><th>95%-CI</th></tr></thead><tbody><tr><td colspan="7"><strong>Surgery = Bony Bankart</strong></td></tr><tr><td>Di Giacomo, 2022 (≥13.5%)</td><td>40</td><td>16.10</td><td>2.7000</td><td>+</td><td>16.10</td><td>[15.26; 16.94]</td></tr><tr><td>Di Giacomo, 2022 (&lt;13.5%)</td><td>23</td><td>23.90</td><td>2.4000</td><td>+</td><td>23.90</td><td>[22.92; 24.88]</td></tr><tr><td>Nakagawa, 2022 (a) (13.5-20%)</td><td>60</td><td>16.20</td><td>2.1000</td><td>+</td><td>16.20</td><td>[15.67; 16.73]</td></tr><tr><td>Nakagawa, 2022 (a) (&gt;20%)</td><td>36</td><td>23.80</td><td>3.2000</td><td>+</td><td>23.80</td><td>[22.75; 24.85]</td></tr><tr><td>Guo, 2021</td><td>25</td><td>27.50</td><td>9.3000</td><td>→</td><td>27.50</td><td>[23.85; 31.15]</td></tr><tr><td>Godin, 2019</td><td>13</td><td>22.50</td><td>8.6711</td><td>→</td><td>22.50</td><td>[17.79; 27.21]</td></tr><tr><td>Nakagawa, 2019</td><td>69</td><td>9.50</td><td>7.2500</td><td>→</td><td>9.50</td><td>[7.79; 11.21]</td></tr><tr><td>Park, 2018 (&lt;10%)</td><td>30</td><td>5.30</td><td>4.8000</td><td>→</td><td>5.30</td><td>[3.58; 7.02]</td></tr><tr><td>Park, 2018 (10-15%)</td><td>12</td><td>16.40</td><td>4.7000</td><td>→</td><td>16.40</td><td>[13.74; 19.06]</td></tr><tr><td>Park, 2018 (15-20%)</td><td>26</td><td>19.20</td><td>6.1000</td><td>→</td><td>19.20</td><td>[16.86; 21.54]</td></tr><tr><td>Park, 2018 (&gt;20%)</td><td>17</td><td>27.00</td><td>5.1000</td><td>→</td><td>27.00</td><td>[24.58; 29.42]</td></tr><tr><td>Nakagawa, 2017 (a)</td><td>93</td><td>11.30</td><td>.</td><td>.</td><td>11.30</td><td>.</td></tr><tr><td>Nakagawa, 2017 (b)</td><td>113</td><td>9.50</td><td>.</td><td>.</td><td>9.50</td><td>.</td></tr><tr><td>Kitayama 2015</td><td>34</td><td>20.40</td><td>.</td><td>.</td><td>20.40</td><td>.</td></tr><tr><td>Nakagawa, 2015</td><td>81</td><td>16.80</td><td>.</td><td>.</td><td>16.80</td><td>.</td></tr><tr><td>Kim, 2014 (&lt;12.5%)</td><td>16</td><td>8.80</td><td>2.0000</td><td>→</td><td>8.80</td><td>[7.82; 9.78]</td></tr><tr><td>Kim, 2014 (12.5%-25%)</td><td>18</td><td>17.50</td><td>2.7500</td><td>→</td><td>17.50</td><td>[16.23; 18.77]</td></tr><tr><td>Millett, 2013</td><td>12</td><td>29.00</td><td>9.3095</td><td>→</td><td>29.00</td><td>[23.73; 34.27]</td></tr><tr><td>Park, 2012</td><td>31</td><td>14.10</td><td>8.6000</td><td>→</td><td>14.10</td><td>[11.07; 17.13]</td></tr><tr><td><strong>Random effects model</strong></td><td><strong>749</strong></td><td></td><td></td><td></td><td><strong>18.31</strong></td><td><strong>[14.35; 22.28]</strong></td></tr></tbody></table>

Heterogeneity: *I*² = 99%, *τ*² = 49.1806, *p* < 0.01

<table><thead><tr><th colspan="7">Surgery = Latarjet</th></tr></thead><tbody><tr><td>Hurley, 2022</td><td>26</td><td>19.10</td><td>4.7000</td><td>→</td><td>19.10</td><td>[17.29; 20.91]</td></tr><tr><td>Shao, 2022</td><td>30</td><td>21.60</td><td>8.6000</td><td>→</td><td>21.60</td><td>[18.52; 24.68]</td></tr><tr><td>Bonneville, 2021</td><td>17</td><td>10.60</td><td>4.5000</td><td>→</td><td>10.60</td><td>[8.46; 12.74]</td></tr><tr><td>Calvo, 2021</td><td>51</td><td>18.80</td><td>.</td><td>.</td><td>18.80</td><td>.</td></tr><tr><td>Hurley, 2021</td><td>30</td><td>18.60</td><td>4.7000</td><td>→</td><td>18.60</td><td>[16.92; 20.28]</td></tr><tr><td>Ali, 2020</td><td>33</td><td>15.00</td><td>5.0000</td><td>→</td><td>15.00</td><td>[13.29; 16.71]</td></tr><tr><td>Zhu, 2017 (a)</td><td>46</td><td>23.60</td><td>2.7000</td><td>→</td><td>23.60</td><td>[22.82; 24.38]</td></tr><tr><td>Zhu, 2017 (b)</td><td>52</td><td>23.30</td><td>2.8000</td><td>→</td><td>23.30</td><td>[22.54; 24.06]</td></tr><tr><td><strong>Random effects model</strong></td><td><strong>285</strong></td><td></td><td></td><td></td><td><strong>18.86</strong></td><td><strong>[14.51; 23.21]</strong></td></tr></tbody></table>

Heterogeneity: *I*² = 97%, *τ*² = 21.3161, *p* < 0.01

<figure><img src="image_4.png" /></figure>

475

476

477 F3
<table><thead><tr><th>Author, Year</th><th>n Shoulders</th><th>Mean</th><th>SD</th><th>Glenoid defect size</th><th>MRAW</th><th>95%-CI</th></tr></thead><tbody><tr><td colspan="7"><strong>Surgery = Bony Bankart</strong></td></tr><tr><td>Di Giacomo, 2022 (≥13.5%)</td><td>40</td><td>16.10</td><td>2.7000</td><td>+</td><td>16.10</td><td>[15.26; 16.94]</td></tr><tr><td>Di Giacomo, 2022 (&lt;13.5%)</td><td>23</td><td>23.90</td><td>2.4000</td><td>+</td><td>23.90</td><td>[22.92; 24.88]</td></tr><tr><td>Nakagawa, 2022 (a) (13.5-20%)</td><td>60</td><td>16.20</td><td>2.1000</td><td>+</td><td>16.20</td><td>[15.67; 16.73]</td></tr><tr><td>Nakagawa, 2022 (a) (&gt;20%)</td><td>36</td><td>23.80</td><td>3.2000</td><td>+</td><td>23.80</td><td>[22.75; 24.85]</td></tr><tr><td>Guo, 2021</td><td>25</td><td>27.50</td><td>9.3000</td><td>→</td><td>27.50</td><td>[23.85; 31.15]</td></tr><tr><td>Godin, 2019</td><td>13</td><td>22.50</td><td>8.6711</td><td>→</td><td>22.50</td><td>[17.79; 27.21]</td></tr><tr><td>Nakagawa, 2019</td><td>69</td><td>9.50</td><td>7.2500</td><td>→</td><td>9.50</td><td>[7.79; 11.21]</td></tr><tr><td>Park, 2018 (&lt;10%)</td><td>30</td><td>5.30</td><td>4.8000</td><td>→</td><td>5.30</td><td>[3.58; 7.02]</td></tr><tr><td>Park, 2018 (10-15%)</td><td>12</td><td>16.40</td><td>4.7000</td><td>→</td><td>16.40</td><td>[13.74; 19.06]</td></tr><tr><td>Park, 2018 (15-20%)</td><td>26</td><td>19.20</td><td>6.1000</td><td>→</td><td>19.20</td><td>[16.86; 21.54]</td></tr><tr><td>Park, 2018 (&gt;20%)</td><td>17</td><td>27.00</td><td>5.1000</td><td>→</td><td>27.00</td><td>[24.58; 29.42]</td></tr><tr><td>Nakagawa, 2017 (a)</td><td>93</td><td>11.30</td><td>.</td><td>→</td><td>11.30</td><td></td></tr><tr><td>Nakagawa, 2017 (b)</td><td>113</td><td>9.50</td><td>.</td><td>→</td><td>9.50</td><td></td></tr><tr><td>Kitayama 2015</td><td>34</td><td>20.40</td><td>.</td><td>→</td><td>20.40</td><td></td></tr><tr><td>Nakagawa, 2015</td><td>81</td><td>16.80</td><td>.</td><td>→</td><td>16.80</td><td></td></tr><tr><td>Kim, 2014 (&lt;12.5%)</td><td>16</td><td>8.80</td><td>2.0000</td><td>→</td><td>8.80</td><td>[7.82; 9.78]</td></tr><tr><td>Kim, 2014 (12.5%-25%)</td><td>18</td><td>17.50</td><td>2.7500</td><td>→</td><td>17.50</td><td>[16.23; 18.77]</td></tr><tr><td>Millett, 2013</td><td>12</td><td>29.00</td><td>9.3095</td><td>→</td><td>29.00</td><td>[23.73; 34.27]</td></tr><tr><td>Park, 2012</td><td>31</td><td>14.10</td><td>8.6000</td><td>→</td><td>14.10</td><td>[11.07; 17.13]</td></tr><tr><td><strong>Random effects model</strong></td><td><strong>749</strong></td><td></td><td></td><td></td><td><strong>18.31</strong></td><td><strong>[14.35; 22.28]</strong></td></tr></tbody></table>

Heterogeneity: *I*² = 99%, *τ*² = 49.1806, *p* < 0.01

<table><thead><tr><th colspan="7">Surgery = Latarjet</th></tr></thead><tbody><tr><td>Hurley, 2022</td><td>26</td><td>19.10</td><td>4.7000</td><td>→</td><td>19.10</td><td>[17.29; 20.91]</td></tr><tr><td>Shao, 2022</td><td>30</td><td>21.60</td><td>8.6000</td><td>→</td><td>21.60</td><td>[18.52; 24.68]</td></tr><tr><td>Bonneville, 2021</td><td>17</td><td>10.60</td><td>4.5000</td><td>→</td><td>10.60</td><td>[8.46; 12.74]</td></tr><tr><td>Calvo, 2021</td><td>51</td><td>18.80</td><td>.</td><td>→</td><td>18.80</td><td></td></tr><tr><td>Hurley, 2021</td><td>30</td><td>18.60</td><td>4.7000</td><td>→</td><td>18.60</td><td>[16.92; 20.28]</td></tr><tr><td>Ali, 2020</td><td>33</td><td>15.00</td><td>5.0000</td><td>→</td><td>15.00</td><td>[13.29; 16.71]</td></tr><tr><td>Zhu, 2017 (a)</td><td>46</td><td>23.60</td><td>2.7000</td><td>→</td><td>23.60</td><td>[22.82; 24.38]</td></tr><tr><td>Zhu, 2017 (b)</td><td>52</td><td>23.30</td><td>2.8000</td><td>→</td><td>23.30</td><td>[22.54; 24.06]</td></tr><tr><td><strong>Random effects model</strong></td><td><strong>285</strong></td><td></td><td></td><td></td><td><strong>18.86</strong></td><td><strong>[14.51; 23.21]</strong></td></tr></tbody></table>

Heterogeneity: *I*² = 97%, *τ*² = 21.3161, *p* < 0.01

<figure><img src="image_4.png" /></figure>

475

476

477 F3
<table><thead><tr><th>Author, Year</th><th>Recurrence Cohort Size</th><th>Proportion</th><th>95%-CI</th></tr></thead><tbody><tr><td colspan="4"><strong>Surgery = Bony Bankart</strong></td></tr><tr><td>Di Giacomo, 2022 (≥13.5%)</td><td>3</td><td>40</td><td>0.07 [0.02; 0.20]</td></tr><tr><td>Di Giacomo, 2022 (&lt;13.5%)</td><td>3</td><td>23</td><td>0.13 [0.03; 0.34]</td></tr><tr><td>Nakagawa, 2022 (a) (13.5-20%)</td><td>7</td><td>60</td><td>0.12 [0.05; 0.23]</td></tr><tr><td>Nakagawa, 2022 (b)</td><td>18</td><td>80</td><td>0.23 [0.14; 0.33]</td></tr><tr><td>Nakagawa, 2019</td><td>15</td><td>69</td><td>0.22 [0.13; 0.33]</td></tr><tr><td>Shah, 2018 (&gt;25%)</td><td>2</td><td>22</td><td>0.09 [0.01; 0.29]</td></tr><tr><td>Nakagawa, 2017 (a)</td><td>22</td><td>93</td><td>0.24 [0.15; 0.34]</td></tr><tr><td>Nakagawa, 2017 (b)</td><td>23</td><td>113</td><td>0.20 [0.13; 0.29]</td></tr><tr><td>Kitayama 2015</td><td>1</td><td>34</td><td>0.03 [0.00; 0.15]</td></tr><tr><td>Nakagawa, 2015</td><td>12</td><td>81</td><td>0.15 [0.08; 0.24]</td></tr><tr><td>Kany, 2013</td><td>1</td><td>23</td><td>0.04 [0.00; 0.22]</td></tr><tr><td>Millett, 2013</td><td>1</td><td>12</td><td>0.08 [0.00; 0.38]</td></tr><tr><td>Park, 2012</td><td>2</td><td>31</td><td>0.06 [0.01; 0.21]</td></tr><tr><td colspan="2"><strong>Random effects model</strong></td><td><strong>681</strong></td><td><strong>0.14 [0.10; 0.18]</strong></td></tr></tbody></table>

Heterogeneity: I² = 49%, τ² = 0.0053, p = 0.02

<table><tbody><tr><td colspan="4"><strong>Surgery = Latarjet</strong></td></tr><tr><td>Hurley, 2022</td><td>2</td><td>26</td><td>0.08 [0.01; 0.25]</td></tr><tr><td>Calvo, 2021</td><td>3</td><td>51</td><td>0.06 [0.01; 0.16]</td></tr><tr><td>Hurley, 2021</td><td>2</td><td>30</td><td>0.07 [0.01; 0.22]</td></tr><tr><td>Ali, 2020</td><td>1</td><td>33</td><td>0.03 [0.00; 0.16]</td></tr><tr><td>Boileau, 2019 (&gt;20%)</td><td>4</td><td>121</td><td>0.03 [0.01; 0.08]</td></tr><tr><td>Kordasiewicz, 2019 (&gt;10%)</td><td>3</td><td>90</td><td>0.03 [0.01; 0.09]</td></tr><tr><td colspan="2"><strong>Random effects model</strong></td><td><strong>351</strong></td><td><strong>0.04 [0.02; 0.06]</strong></td></tr></tbody></table>

Heterogeneity: I² = 0%, τ² = 0, p = 0.81

<figure><img src="image_5.png" /></figure>

<table><thead><tr><th>Author, Year</th><th>Union Cohort Size</th><th>Proportion</th><th>95%-CI</th></tr></thead><tbody><tr><td colspan="4"><strong>Surgery = Bony Bankart</strong></td></tr><tr><td>Nakagawa, 2022 (b)</td><td>48</td><td>80</td><td>0.60 [0.48; 0.71]</td></tr><tr><td>Guo, 2021</td><td>25</td><td>25</td><td>1.00 [0.86; 1.00]</td></tr><tr><td>Nakagawa, 2019</td><td>17</td><td>69</td><td>0.25 [0.15; 0.36]</td></tr><tr><td>Nakagawa, 2017 (a)</td><td>26</td><td>93</td><td>0.28 [0.19; 0.38]</td></tr><tr><td>Park, 2012</td><td>26</td><td>31</td><td>0.84 [0.66; 0.95]</td></tr><tr><td colspan="2"><strong>Random effects model</strong></td><td><strong>298</strong></td><td><strong>0.63 [0.28; 0.91]</strong></td></tr></tbody></table>

Heterogeneity: I² = 96%, τ² = 0.1527, p < 0.01

<figure><img src="image_6.png" /></figure>

<table><tbody><tr><td colspan="4"><strong>Surgery = Latarjet</strong></td></tr><tr><td>Shao, 2022</td><td>29</td><td>30</td><td>0.97 [0.83; 1.00]</td></tr><tr><td>Bonnevialle, 2021</td><td>12</td><td>17</td><td>0.71 [0.44; 0.90]</td></tr><tr><td>Calvo, 2021</td><td>51</td><td>51</td><td>1.00 [0.93; 1.00]</td></tr><tr><td>Wang, 2020 (screw) (&gt;20%)</td><td>6</td><td>6</td><td>1.00 [0.54; 1.00]</td></tr><tr><td>Wang, 2020 (button) (&gt;20%)</td><td>6</td><td>6</td><td>1.00 [0.54; 1.00]</td></tr><tr><td>Boileau, 2019 (&gt;20%)</td><td>115</td><td>121</td><td>0.95 [0.90; 0.98]</td></tr><tr><td>Kordasiewicz, 2019 (&gt;10%)</td><td>81</td><td>90</td><td>0.90 [0.82; 0.95]</td></tr><tr><td>Zhu, 2017 (a)</td><td>46</td><td>46</td><td>1.00 [0.92; 1.00]</td></tr><tr><td>Zhu, 2017 (b)</td><td>52</td><td>52</td><td>1.00 [0.93; 1.00]</td></tr><tr><td colspan="2"><strong>Random effects model</strong></td><td><strong>419</strong></td><td><strong>0.98 [0.93; 1.00]</strong></td></tr></tbody></table>

Heterogeneity: I² = 70%, τ² = 0.0168, p < 0.01

<figure><img src="image_7.png" /></figure>
<figure><img src="image_5.png" /></figure>

<figure><img src="image_6.png" /></figure>
<figure><img src="image_8.png" /></figure>

483

484

485 T1

<table><caption>Table 1: Study characteristics of the studies on arthroscopic Latarjet</caption><thead><tr><th>Year</th><th>Author</th><th>Journals</th><th>Declare COIs</th><th>Have COI</th><th>Declare funding</th><th>Have funding</th><th>Level of evidence</th><th>Country</th></tr></thead><tbody><tr><td colspan="9"><strong>Latarjet</strong></td></tr><tr><td>2022</td><td>Hurley</td><td>Arthrosc Sports Med Rehabil</td><td>Y</td><td>Y</td><td>Y</td><td>Y</td><td>III</td><td>USA</td></tr><tr><td>2022</td><td>Shao</td><td>Arthroscopy</td><td>Y</td><td>N</td><td>Y</td><td>Y</td><td>IV</td><td>China</td></tr><tr><td>2021</td><td>Bonneville</td><td>AJSM</td><td>Y</td><td>Y</td><td>N</td><td>NR</td><td>III</td><td>France</td></tr><tr><td>2021</td><td>Calvo</td><td>AJSM</td><td>Y</td><td>Y</td><td>N</td><td>NR</td><td>IV</td><td>Spain</td></tr><tr><td>2021</td><td>Hurley</td><td>Arthrosc Sports Med Rehabil</td><td>Y</td><td>Y</td><td>N</td><td>NR</td><td></td><td>USA</td></tr><tr><td>2021</td><td>Zeng</td><td>BMC Musculoskeletal Disorders</td><td>Y</td><td>N</td><td>Y</td><td>Y</td><td></td><td>China</td></tr><tr><td>2020</td><td>Ali</td><td>Arthroscopy</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>III</td><td>Turkey</td></tr><tr><td>2020</td><td>Wang</td><td>Orthop. Surgery</td><td>Y</td><td>N</td><td>Y</td><td>N</td><td></td><td>China</td></tr><tr><td>2019</td><td>Boileau</td><td>Arthroscopy</td><td>Y</td><td>Y</td><td>N</td><td>NR</td><td>IV</td><td>France</td></tr><tr><td>2019</td><td>Kordasiewicz</td><td>KSSTA</td><td>Y</td><td>N</td><td>Y</td><td>N</td><td></td><td>Poland</td></tr><tr><td>2017 (a)</td><td>Zhu</td><td>AJSM</td><td>Y</td><td>N</td><td>Y</td><td>Y</td><td>IV</td><td>China</td></tr><tr><td>2017 (b)</td><td>Zhu</td><td>Arthroscopy</td><td>Y</td><td>Y</td><td>Y</td><td>N</td><td>III</td><td>China</td></tr><tr><td>2014</td><td>Dumont</td><td>AJSM</td><td>Y</td><td>Y</td><td>N</td><td>NR</td><td>IV</td><td>France</td></tr></tbody></table>

486

487 T2
<figure><img src="image_7.png" /></figure>

483

484

485 T1

<table><caption>Table 1: Study characteristics of the studies on arthroscopic Latarjet</caption><thead><tr><th>Year</th><th>Author</th><th>Journals</th><th>Declare COIs</th><th>Have COI</th><th>Declare funding</th><th>Have funding</th><th>Level of evidence</th><th>Country</th></tr></thead><tbody><tr><td colspan="9"><strong>Latarjet</strong></td></tr><tr><td>2022</td><td>Hurley</td><td>Arthrosc Sports Med Rehabil</td><td>Y</td><td>Y</td><td>Y</td><td>Y</td><td>III</td><td>USA</td></tr><tr><td>2022</td><td>Shao</td><td>Arthroscopy</td><td>Y</td><td>N</td><td>Y</td><td>Y</td><td>IV</td><td>China</td></tr><tr><td>2021</td><td>Bonneville</td><td>AJSM</td><td>Y</td><td>Y</td><td>N</td><td>NR</td><td>III</td><td>France</td></tr><tr><td>2021</td><td>Calvo</td><td>AJSM</td><td>Y</td><td>Y</td><td>N</td><td>NR</td><td>IV</td><td>Spain</td></tr><tr><td>2021</td><td>Hurley</td><td>Arthrosc Sports Med Rehabil</td><td>Y</td><td>Y</td><td>N</td><td>NR</td><td></td><td>USA</td></tr><tr><td>2021</td><td>Zeng</td><td>BMC Musculoskeletal Disorders</td><td>Y</td><td>N</td><td>Y</td><td>Y</td><td></td><td>China</td></tr><tr><td>2020</td><td>Ali</td><td>Arthroscopy</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>III</td><td>Turkey</td></tr><tr><td>2020</td><td>Wang</td><td>Orthop. Surgery</td><td>Y</td><td>N</td><td>Y</td><td>N</td><td></td><td>China</td></tr><tr><td>2019</td><td>Boileau</td><td>Arthroscopy</td><td>Y</td><td>Y</td><td>N</td><td>NR</td><td>IV</td><td>France</td></tr><tr><td>2019</td><td>Kordasiewicz</td><td>KSSTA</td><td>Y</td><td>N</td><td>Y</td><td>N</td><td></td><td>Poland</td></tr><tr><td>2017 (a)</td><td>Zhu</td><td>AJSM</td><td>Y</td><td>N</td><td>Y</td><td>Y</td><td>IV</td><td>China</td></tr><tr><td>2017 (b)</td><td>Zhu</td><td>Arthroscopy</td><td>Y</td><td>Y</td><td>Y</td><td>N</td><td>III</td><td>China</td></tr><tr><td>2014</td><td>Dumont</td><td>AJSM</td><td>Y</td><td>Y</td><td>N</td><td>NR</td><td>IV</td><td>France</td></tr></tbody></table>

486

487 T2
<table><caption>Table 2: Study characteristics of studies on arthroscopic bony Bankart repair</caption><thead><tr><th>Year</th><th>Author</th><th>Journals</th><th>Declare COIs</th><th>Have COI</th><th>Declare funding</th><th>Have funding</th><th>Level of evidence</th><th>Country</th></tr></thead><tbody><tr><td colspan="9"><strong>Bankart</strong></td></tr><tr><td>2022</td><td>Di Giacomo</td><td>AJSM</td><td>Y</td><td>Y</td><td>Y</td><td>Y</td><td>III</td><td>Italy and USA</td></tr><tr><td>2022 (a)</td><td>Nakagawa</td><td>AJSM</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>IV</td><td>Japan</td></tr><tr><td>2022 (b)</td><td>Nakagawa</td><td>Arthroscopy</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>III</td><td>Japan</td></tr><tr><td>2021</td><td>Guo</td><td>OJSM</td><td>N</td><td>NR</td><td>N</td><td>NR</td><td>IV</td><td>China</td></tr><tr><td>2019</td><td>Godin</td><td>AJSM</td><td>Y</td><td>Y</td><td>Y</td><td>Y</td><td>IV</td><td>USA</td></tr><tr><td>2019</td><td>Nakagawa</td><td>OJSM</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>III</td><td>Japan</td></tr><tr><td>2018</td><td>Park</td><td>AJSM</td><td>Y</td><td>Y</td><td>Y</td><td>Y</td><td>III</td><td>Korea</td></tr><tr><td>2018</td><td>Shah</td><td>Shoulder and Elbow</td><td>Y</td><td>N</td><td>Y</td><td>N</td><td></td><td>UK</td></tr><tr><td>2017 (a)</td><td>Nakagawa</td><td>AJSM</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>III</td><td>Japan</td></tr><tr><td>2017 (b)</td><td>Nakagawa</td><td>OJSM</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>III</td><td>Japan</td></tr><tr><td>2015</td><td>Kitayama</td><td>JBJS-Am</td><td>Y</td><td>N</td><td>Y</td><td>N</td><td>IV</td><td>Japan</td></tr><tr><td>2015</td><td>Nakagawa</td><td>AJSM</td><td>Y</td><td>N</td><td>N</td><td>N</td><td>III</td><td>Japan</td></tr><tr><td>2014</td><td>Kim</td><td>AJSM</td><td>Y</td><td>Y</td><td>N</td><td>NR</td><td>IV</td><td>Korea</td></tr><tr><td>2013</td><td>Kany</td><td>Tech Should Surg</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td></td><td>India/France</td></tr><tr><td>2013</td><td>Millett</td><td>AJSM</td><td>Y</td><td>Y</td><td>Y</td><td>Y</td><td>IV</td><td>USA</td></tr><tr><td>2012</td><td>Park</td><td>Arthroscopy</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>IV</td><td>South Korea</td></tr></tbody></table>

488

489 T3

<table><caption>Table 3: Patient demographics of studies on arthroscopic Latarjet</caption><thead><tr><th colspan="2">Studies</th><th colspan="10">Patient demographics</th></tr><tr><th>Year</th><th>Author</th><th>Subgroups</th><th>Number of shoulders</th><th>Men (%)</th><th>Women (%)</th><th>Age (mean)</th><th>±SD</th><th>Mean follow-up (months)</th><th>±SD</th><th>(Range)</th><th>BMI (mean)</th><th>±SD</th><th>Smoking (%)</th><th>Dominant (%)</th><th>Hill-Sachs lemons (%)</th></tr></thead><tbody><tr><td colspan="15"><strong>Latarjet</strong></td></tr><tr><td>2022</td><td>Hurley</td><td></td><td>26</td><td>81%</td><td>19%</td><td>32 ±13</td><td>52</td><td>38 ±3</td><td>(24 - 90)</td><td></td><td></td><td></td><td>80%</td><td>100%</td></tr><tr><td>2022</td><td>Shao</td><td></td><td>30</td><td>70%</td><td>30%</td><td>27 ±6</td><td></td><td></td><td></td><td></td><td></td><td></td><td>47%</td><td>100%</td></tr><tr><td>2021</td><td>Bonnevialle</td><td></td><td>17</td><td>82%</td><td>18%</td><td>22 ±5</td><td></td><td></td><td></td><td></td><td></td><td>23%</td><td>59%</td><td></td></tr><tr><td>2021</td><td>Calvo</td><td></td><td>51</td><td>94%</td><td>6%</td><td>30 ±8</td><td></td><td></td><td></td><td></td><td></td><td></td><td>55%</td><td></td></tr><tr><td>2021</td><td>Hurley</td><td></td><td>30</td><td>83%</td><td>17%</td><td>32 ±12</td><td>46</td><td></td><td></td><td></td><td></td><td></td><td></td><td>100%</td></tr><tr><td>2021</td><td>Zeng</td><td></td><td>37</td><td>100%</td><td>0%</td><td>25 ±5</td><td>13</td><td>(8 - 22)</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2020</td><td>Ali</td><td></td><td>33</td><td>88%</td><td>12%</td><td>30 ±7</td><td>30</td><td>(24 - 50)</td><td></td><td></td><td></td><td></td><td>55%</td><td>24%</td></tr><tr><td rowspan="2">2020</td><td rowspan="2">Wang</td><td>screw</td><td>6</td><td>100%</td><td>0%</td><td>23 ±6</td><td>25</td><td>(10 - 53)</td><td>23.4 ±2</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>button</td><td>6</td><td>100%</td><td>0%</td><td>23 ±5</td><td></td><td></td><td>24.9 ±5</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2019</td><td>Boileau</td><td></td><td>121</td><td>79%</td><td>21%</td><td>27</td><td>26</td><td>(24 - 27)</td><td></td><td></td><td></td><td></td><td>65%</td><td></td></tr><tr><td>2019</td><td>Kordasiewicz</td><td></td><td>90</td><td>89%</td><td>11%</td><td>26 ±6</td><td>24 ±7</td><td>(13 - 50)</td><td></td><td></td><td></td><td></td><td>61%</td><td></td></tr><tr><td>2017(a)</td><td>Zhu</td><td></td><td>46</td><td>78%</td><td>22%</td><td>32 ±10</td><td></td><td></td><td></td><td></td><td></td><td></td><td>83%</td><td></td></tr><tr><td>2017 (b)</td><td>Zhu</td><td></td><td>52</td><td>81%</td><td>19%</td><td>32 ±10</td><td>28</td><td>(24 - 42)</td><td></td><td></td><td></td><td></td><td>69%</td><td></td></tr><tr><td>2014</td><td>Dumont</td><td></td><td>64</td><td>86%</td><td>14%</td><td>29</td><td>76</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>

490
<table><caption>Table 2: Study characteristics of studies on arthroscopic bony Bankart repair</caption><thead><tr><th>Year</th><th>Author</th><th>Journals</th><th>Declare COIs</th><th>Have COI</th><th>Declare funding</th><th>Have funding</th><th>Level of evidence</th><th>Country</th></tr></thead><tbody><tr><td colspan="9"><strong>Bankart</strong></td></tr><tr><td>2022</td><td>Di Giacomo</td><td>AJSM</td><td>Y</td><td>Y</td><td>Y</td><td>Y</td><td>III</td><td>Italy and USA</td></tr><tr><td>2022 (a)</td><td>Nakagawa</td><td>AJSM</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>IV</td><td>Japan</td></tr><tr><td>2022 (b)</td><td>Nakagawa</td><td>Arthroscopy</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>III</td><td>Japan</td></tr><tr><td>2021</td><td>Guo</td><td>OJSM</td><td>N</td><td>NR</td><td>N</td><td>NR</td><td>IV</td><td>China</td></tr><tr><td>2019</td><td>Godin</td><td>AJSM</td><td>Y</td><td>Y</td><td>Y</td><td>Y</td><td>IV</td><td>USA</td></tr><tr><td>2019</td><td>Nakagawa</td><td>OJSM</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>III</td><td>Japan</td></tr><tr><td>2018</td><td>Park</td><td>AJSM</td><td>Y</td><td>Y</td><td>Y</td><td>Y</td><td>III</td><td>Korea</td></tr><tr><td>2018</td><td>Shah</td><td>Shoulder and Elbow</td><td>Y</td><td>N</td><td>Y</td><td>N</td><td></td><td>UK</td></tr><tr><td>2017 (a)</td><td>Nakagawa</td><td>AJSM</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>III</td><td>Japan</td></tr><tr><td>2017 (b)</td><td>Nakagawa</td><td>OJSM</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>III</td><td>Japan</td></tr><tr><td>2015</td><td>Kitayama</td><td>JBJS-Am</td><td>Y</td><td>N</td><td>Y</td><td>N</td><td>IV</td><td>Japan</td></tr><tr><td>2015</td><td>Nakagawa</td><td>AJSM</td><td>Y</td><td>N</td><td>N</td><td>N</td><td>III</td><td>Japan</td></tr><tr><td>2014</td><td>Kim</td><td>AJSM</td><td>Y</td><td>Y</td><td>N</td><td>NR</td><td>IV</td><td>Korea</td></tr><tr><td>2013</td><td>Kany</td><td>Tech Should Surg</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td></td><td>India/France</td></tr><tr><td>2013</td><td>Millett</td><td>AJSM</td><td>Y</td><td>Y</td><td>Y</td><td>Y</td><td>IV</td><td>USA</td></tr><tr><td>2012</td><td>Park</td><td>Arthroscopy</td><td>Y</td><td>N</td><td>N</td><td>NR</td><td>IV</td><td>South Korea</td></tr></tbody></table>

488

489 T3

<table><caption>Table 3: Patient demographics of studies on arthroscopic Latarjet</caption><thead><tr><th colspan="2">Studies</th><th colspan="10">Patient demographics</th></tr><tr><th>Year</th><th>Author</th><th>Subgroups</th><th>Number of shoulders</th><th>Men (%)</th><th>Women (%)</th><th>Age (mean)</th><th>±SD</th><th>Mean follow-up (months)</th><th>±SD</th><th>(Range)</th><th>BMI (mean)</th><th>±SD</th><th>Smoking (%)</th><th>Dominant (%)</th><th>Hill-Sachs lemons (%)</th></tr></thead><tbody><tr><td colspan="15"><strong>Latarjet</strong></td></tr><tr><td>2022</td><td>Hurley</td><td></td><td>26</td><td>81%</td><td>19%</td><td>32 ±13</td><td>52</td><td>38 ±3</td><td>(24 - 90)</td><td></td><td></td><td></td><td>80%</td><td>100%</td></tr><tr><td>2022</td><td>Shao</td><td></td><td>30</td><td>70%</td><td>30%</td><td>27 ±6</td><td></td><td></td><td></td><td></td><td></td><td></td><td>47%</td><td>100%</td></tr><tr><td>2021</td><td>Bonnevialle</td><td></td><td>17</td><td>82%</td><td>18%</td><td>22 ±5</td><td></td><td></td><td></td><td></td><td></td><td>23%</td><td>59%</td><td></td></tr><tr><td>2021</td><td>Calvo</td><td></td><td>51</td><td>94%</td><td>6%</td><td>30 ±8</td><td></td><td></td><td></td><td></td><td></td><td></td><td>55%</td><td></td></tr><tr><td>2021</td><td>Hurley</td><td></td><td>30</td><td>83%</td><td>17%</td><td>32 ±12</td><td>46</td><td></td><td></td><td></td><td></td><td></td><td></td><td>100%</td></tr><tr><td>2021</td><td>Zeng</td><td></td><td>37</td><td>100%</td><td>0%</td><td>25 ±5</td><td>13</td><td>(8 - 22)</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2020</td><td>Ali</td><td></td><td>33</td><td>88%</td><td>12%</td><td>30 ±7</td><td>30</td><td>(24 - 50)</td><td></td><td></td><td></td><td></td><td>55%</td><td>24%</td></tr><tr><td rowspan="2">2020</td><td rowspan="2">Wang</td><td>screw</td><td>6</td><td>100%</td><td>0%</td><td>23 ±6</td><td>25</td><td>(10 - 53)</td><td>23.4 ±2</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>button</td><td>6</td><td>100%</td><td>0%</td><td>23 ±5</td><td></td><td></td><td>24.9 ±5</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2019</td><td>Boileau</td><td></td><td>121</td><td>79%</td><td>21%</td><td>27</td><td>26</td><td>(24 - 27)</td><td></td><td></td><td></td><td></td><td>65%</td><td></td></tr><tr><td>2019</td><td>Kordasiewicz</td><td></td><td>90</td><td>89%</td><td>11%</td><td>26 ±6</td><td>24 ±7</td><td>(13 - 50)</td><td></td><td></td><td></td><td></td><td>61%</td><td></td></tr><tr><td>2017(a)</td><td>Zhu</td><td></td><td>46</td><td>78%</td><td>22%</td><td>32 ±10</td><td></td><td></td><td></td><td></td><td></td><td></td><td>83%</td><td></td></tr><tr><td>2017 (b)</td><td>Zhu</td><td></td><td>52</td><td>81%</td><td>19%</td><td>32 ±10</td><td>28</td><td>(24 - 42)</td><td></td><td></td><td></td><td></td><td>69%</td><td></td></tr><tr><td>2014</td><td>Dumont</td><td></td><td>64</td><td>86%</td><td>14%</td><td>29</td><td>76</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>

490
<table><caption>Table 4: Patient demographics of studies on arthroscopic bony Bankart repair</caption><thead><tr><th colspan="3">Studies</th><th colspan="10">Patient demographics</th></tr><tr><th>Year</th><th>Author</th><th>Subgroups</th><th>Number of shoulders</th><th>Men (%)</th><th>Women (%)</th><th>Age (mean)</th><th>±SD</th><th>(Range)</th><th>Mean follow-up (months)</th><th>±SD</th><th>(Range)</th><th>Dominant (%)</th><th>Hill-Sachs lesions (%)</th></tr></thead><tbody><tr><td colspan="14"><strong>Bankart</strong></td></tr><tr><td>2022</td><td>Di Giacomo</td><td>≥13.5%</td><td>40</td><td>100%</td><td>0%</td><td>26</td><td>(19 – 35)</td><td>60</td><td></td><td>(58 – 68)</td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>&lt;13.5%</td><td>23</td><td>100%</td><td>0%</td><td>26</td><td>(19 – 35)</td><td>60</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2022 (a)</td><td>Nakagawa</td><td>Overall</td><td>96</td><td>89%</td><td>11%</td><td></td><td></td><td></td><td>29</td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>13.5% to ≥20%</td><td>60</td><td>85%</td><td>15%</td><td>24 ±10</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>&gt;20%</td><td>36</td><td>94%</td><td>6%</td><td>22 ±7</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2022 (b)</td><td>Nakagawa</td><td>Overall</td><td>80</td><td></td><td></td><td></td><td></td><td></td><td>29 ±11</td><td>(24 – 67)</td><td></td><td>16%</td><td></td></tr><tr><td></td><td></td><td>&lt;13.5%</td><td>38</td><td></td><td></td><td>18 ±3</td><td>(14 – 26)</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>≥13.5%</td><td>42</td><td></td><td></td><td>19 ±4</td><td>(14 – 29)</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2021</td><td>Guo</td><td></td><td>25</td><td>72%</td><td>28%</td><td>43 ±15</td><td></td><td></td><td>41</td><td>(24 – 60)</td><td></td><td></td><td></td></tr><tr><td>2019</td><td>Godin</td><td></td><td>13</td><td>100%</td><td>0%</td><td>40</td><td></td><td></td><td>81</td><td>(61 – 108)</td><td>39%</td><td>100%</td><td></td></tr><tr><td>2019</td><td>Nakagawa</td><td></td><td>69</td><td>100%</td><td>0%</td><td>18</td><td>(14 – 27)</td><td></td><td></td><td>(24)</td><td></td><td>15%</td><td></td></tr><tr><td>2018</td><td>Park*</td><td>Overall</td><td>85</td><td>91%</td><td>9%</td><td>26 ±10</td><td></td><td></td><td></td><td></td><td>71%</td><td></td><td></td></tr><tr><td></td><td></td><td>&lt;10%</td><td>30</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>10-15%</td><td>12</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>15-20%</td><td>26</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>&gt;20%</td><td>17</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2018</td><td>Shah</td><td>(&gt;25%)</td><td>22</td><td>95%</td><td>5%</td><td>30</td><td>(17 – 66)</td><td>28</td><td>(24 – 35)</td><td>45%</td><td></td><td></td><td></td></tr><tr><td>2017 (a)</td><td>Nakagawa</td><td></td><td>93</td><td>100%</td><td>0%</td><td>17</td><td>(14 – 27)</td><td></td><td></td><td></td><td></td><td>62%</td><td></td></tr><tr><td>2017 (b)</td><td>Nakagawa</td><td></td><td>113</td><td>89%</td><td>11%</td><td>18</td><td></td><td></td><td></td><td></td><td></td><td>100%</td><td></td></tr><tr><td>2015</td><td>Kitayama</td><td></td><td>34</td><td>91%</td><td>9%</td><td>24</td><td>(15 – 34)</td><td>74</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2015</td><td>Nakagawa</td><td></td><td>81</td><td>90%</td><td>10%</td><td>23</td><td>(14 – 69)</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2014</td><td>Kim</td><td>&lt;12.5%</td><td>16</td><td>100%</td><td>0%</td><td>25</td><td>(17 – 41)</td><td>34</td><td></td><td>75%</td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>12.5%-25%</td><td>18</td><td>89%</td><td>11%</td><td>32</td><td>(19 – 43)</td><td>35</td><td></td><td>61%</td><td></td><td></td><td></td></tr><tr><td>2013</td><td>Kany</td><td></td><td>26</td><td>88%</td><td>12%</td><td>27</td><td>(15 – 39)</td><td></td><td></td><td></td><td></td><td>74%</td><td></td></tr><tr><td>2013</td><td>Millett</td><td></td><td>15</td><td>87%</td><td>13%</td><td>44</td><td>(24 – 70)</td><td>32</td><td>(24 – 53)</td><td>47%</td><td></td><td>90%</td><td></td></tr><tr><td>2012</td><td>Park</td><td></td><td>31</td><td>94%</td><td>6%</td><td>23</td><td>(15 – 55)</td><td>31</td><td>(13 – 51)</td><td></td><td></td><td></td><td></td></tr></tbody></table>

<footnote>*11 of 223 shoulders has additional remplissage due to engaged Hill-Sachs lesions</footnote>
<table><caption>Table 4: Patient demographics of studies on arthroscopic bony Bankart repair</caption><thead><tr><th rowspan="2">Year</th><th rowspan="2">Author</th><th rowspan="2">Subgroups</th><th colspan="10">Patient demographics</th></tr><tr><th>Number of shoulders</th><th>Men (%)</th><th>Women (%)</th><th>Age (mean)</th><th>±SD</th><th>(Range)</th><th>Mean follow-up (months)</th><th>±SD</th><th>(Range)</th><th>Dominant (%)</th><th>Hill-Sachs lesions (%)</th></tr></thead><tbody><tr><td colspan="14" style="text-align: left; font-weight: bold;">Bankart</td></tr><tr><td>2022</td><td>Di Giacomo</td><td>≥13.5%</td><td>40</td><td>100%</td><td>0%</td><td>26</td><td>(19 – 35)</td><td>60</td><td></td><td></td><td>(58 – 68)</td><td></td><td></td></tr><tr><td></td><td></td><td>&lt;13.5%</td><td>23</td><td>100%</td><td>0%</td><td>26</td><td>(19 – 35)</td><td>60</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2022 (a)</td><td>Nakagawa</td><td>Overall</td><td>96</td><td>89%</td><td>11%</td><td></td><td></td><td>29</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>13.5% to ≥20%</td><td>60</td><td>85%</td><td>15%</td><td>24 ±10</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>&gt;20%</td><td>36</td><td>94%</td><td>6%</td><td>22 ±7</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2022 (b)</td><td>Nakagawa</td><td>Overall</td><td>80</td><td></td><td></td><td></td><td></td><td>29 ±11</td><td>(24 – 67)</td><td></td><td></td><td></td><td>16%</td></tr><tr><td></td><td></td><td>&lt;13.5%</td><td>38</td><td></td><td></td><td>18 ±3</td><td>(14 – 26)</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>≥13.5%</td><td>42</td><td></td><td></td><td>19 ±4</td><td>(14 – 29)</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2021</td><td>Guo</td><td></td><td>25</td><td>72%</td><td>28%</td><td>43 ±15</td><td></td><td>41</td><td>(24 – 60)</td><td></td><td></td><td></td><td></td></tr><tr><td>2019</td><td>Godin</td><td></td><td>13</td><td>100%</td><td>0%</td><td>40</td><td></td><td>81</td><td>(61 – 108)</td><td>39%</td><td></td><td></td><td>100%</td></tr><tr><td>2019</td><td>Nakagawa</td><td></td><td>69</td><td>100%</td><td>0%</td><td>18</td><td>(14 – 27)</td><td></td><td>(24)</td><td></td><td></td><td></td><td>15%</td></tr><tr><td>2018</td><td>Park*</td><td>Overall</td><td>85</td><td>91%</td><td>9%</td><td>26 ±10</td><td></td><td></td><td></td><td></td><td></td><td>71%</td><td></td></tr><tr><td></td><td></td><td>&lt;10%</td><td>30</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>10-15%</td><td>12</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>15-20%</td><td>26</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td>&gt;20%</td><td>17</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2018</td><td>Shah</td><td>(&gt;25%)</td><td>22</td><td>95%</td><td>5%</td><td>30</td><td>(17 – 66)</td><td>28</td><td>(24 – 35)</td><td></td><td></td><td>45%</td><td></td></tr><tr><td>2017 (a)</td><td>Nakagawa</td><td></td><td>93</td><td>100%</td><td>0%</td><td>17</td><td>(14 – 27)</td><td></td><td></td><td></td><td></td><td></td><td>62%</td></tr><tr><td>2017 (b)</td><td>Nakagawa</td><td></td><td>113</td><td>89%</td><td>11%</td><td>18</td><td></td><td></td><td></td><td></td><td></td><td></td><td>100%</td></tr><tr><td>2015</td><td>Kitayama</td><td></td><td>34</td><td>91%</td><td>9%</td><td>24</td><td>(15 – 34)</td><td>74</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2015</td><td>Nakagawa</td><td></td><td>81</td><td>90%</td><td>10%</td><td>23</td><td>(14 – 69)</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>2014</td><td>Kim</td><td>&lt;12.5%</td><td>16</td><td>100%</td><td>0%</td><td>25</td><td>(17 – 41)</td><td>34</td><td></td><td></td><td></td><td>75%</td><td></td></tr><tr><td></td><td></td><td>12.5%-25%</td><td>18</td><td>89%</td><td>11%</td><td>32</td><td>(19 – 43)</td><td>35</td><td></td><td></td><td></td><td>61%</td><td></td></tr><tr><td>2013</td><td>Kany</td><td></td><td>26</td><td>88%</td><td>12%</td><td>27</td><td>(15 – 39)</td><td></td><td></td><td></td><td></td><td></td><td>74%</td></tr><tr><td>2013</td><td>Millett</td><td></td><td>15</td><td>87%</td><td>13%</td><td>44</td><td>(24 – 70)</td><td>32</td><td>(24 – 53)</td><td>47%</td><td></td><td></td><td>90%</td></tr><tr><td>2012</td><td>Park</td><td></td><td>31</td><td>94%</td><td>6%</td><td>23</td><td>(15 – 55)</td><td>31</td><td>(13 – 51)</td><td></td><td></td><td></td><td></td></tr></tbody></table>

<footnote>*11 of 223 shoulders has additional remplissage due to engaged Hill-Sachs lesions</footnote>