{"paper_id":"1080f3c9-3475-46c2-a9d0-e563637b2193","body_text":"Mid term Functional Outcomes of Open Latarjet Procedure with Congruent Arc Modification in Recurrent Anterior Shoulder Instability: A Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mid term Functional Outcomes of Open Latarjet Procedure with Congruent Arc Modification in Recurrent Anterior Shoulder Instability: A Retrospective Cohort Study SAURAV NARAYAN NANDA, Sumit kaushik, Ashok Gachhayat This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7666858/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Recurrent anterior shoulder instability associated with significant glenoid bone loss poses a high risk of failure with isolated soft tissue repair. The open Latarjet procedure with congruent arc modification has been proposed to enhance stability and graft coverage, but clinical evidence remains limited. Methods: A retrospective cohort study was conducted on patients undergoing open Latarjet with congruent arc modification between January 2015 and December 2020. Inclusion criteria were ≥3 anterior dislocations, ≥15% glenoid bone loss, and ≥24 months of follow-up. Functional outcomes (Western Ontario Shoulder Instability Index [WOSI], Rowe score), range of motion, complications, and graft union (CT) were assessed. Kaplan–Meier survival analysis estimated recurrence-free survival. Results: Eighty patients (62 males, 18 females; mean age 28.5 ± 6.4 years) were included with a mean follow-up of 4.5 ± 1.2 years. WOSI scores improved from 46.7 ± 12.3 to 79.4 ± 15.8 (p < 0.001), and Rowe scores from 32.5 ± 9.6 to 85.6 ± 10.7 (p < 0.001), both exceeding MCID thresholds. Forward flexion (+15°) and abduction (+20°) improved significantly, while external rotation showed a mild, non-significant reduction (–10°, p = 0.079). Complications occurred in 10 patients (12.5%), including graft nonunion (5%), transient axillary nerve symptoms (3.8%), recurrence (2.5%), and graft malposition (1.3%). Graft union was confirmed in 95% of patients, and recurrence-free survival was 97.5% at 5 years. Conclusion: The open Latarjet procedure with congruent arc modification provides excellent mid-term functional outcomes, durable stability, and low recurrence in patients with recurrent anterior shoulder instability and glenoid bone loss. Orthopedic Surgery Latarjet congruent arc shoulder instability glenoid bone loss functional outcomes Figures Figure 1 Figure 2 Figure 3 Introduction Recurrent anterior shoulder instability in young, active patients is frequently associated with glenoid bone loss, particularly when it exceeds 15% of the inferior glenoid diameter. In such cases, isolated soft tissue repair carries a high risk of failure [1,2]. The Latarjet procedure addresses this by transferring the coracoid to the glenoid rim, offering both bony augmentation and dynamic stability via the conjoint tendon [3]. The congruent arc modification rotates the coracoid by 90° to increase articular arc coverage and surface contact, potentially enhancing stability and reducing graft-related complications [4–6]. Although biomechanical advantages have been demonstrated, clinical outcome data remain limited. This study aimed to evaluate mid-term functional outcomes, range of motion, complications, and graft survival following open Latarjet with congruent arc modification. We hypothesized that this technique would provide clinically meaningful functional improvements with low recurrence rates. Methodology This retrospective cohort study was conducted at a tertiary orthopedic center. Patient Selection Patients who underwent open Latarjet with congruent arc modification between January 2015 and December 2020 were identified from the institutional surgical registry. Inclusion criteria were: Open Latarjet procedure performed with congruent arc modification, and Minimum clinical follow-up of 24 months. Exclusion criteria included multidirectional or posterior instability, massive irreparable rotator cuff tears, prior bony stabilization procedures, active infection, or incomplete follow-up. Of 112 screened patients, 80 met all eligibility criteria Surgical Technique All procedures were performed by three fellowship-trained shoulder surgeons using a standardized deltopectoral approach. The coracoid process was osteotomized, rotated 90° (congruent arc orientation), and fixed flush with the glenoid rim using two 4.0-mm partially threaded screws. Postoperative Rehabilitation A four-phase standardized rehabilitation protocol was followed: Phase I (0–6 weeks): Immobilization in a sling with passive range-of-motion exercises. Phase II (6–12 weeks): Active-assisted motion and progressive strengthening. Phase III (3–6 months): Advanced strengthening and sport-specific drills. Outcome Measures The primary outcomes were functional scores: Western Ontario Shoulder Instability Index (WOSI; normalized 0–100, higher = better), Rowe score (0–100, higher = better). Secondary outcomes included range of motion (forward flexion, abduction, external rotation), complications (graft nonunion, malposition, recurrence, neurologic symptoms, reoperation, infection, hardware issues), and graft union assessed on postoperative CT scans. Statistical Analysis Continuous variables were expressed as mean ± standard deviation (SD). Pre- and postoperative comparisons were performed using paired t-tests. Mean differences were reported with 95% confidence intervals (CI) and effect sizes (Cohen’s d). Statistical significance was set at p < 0.05. Minimal clinically important difference (MCID) thresholds were applied for interpretation (14 for WOSI, 9.7 for Rowe). Kaplan–Meier survival analysis was performed to estimate recurrence-free survival. Results Patient Demographics A total of 80 patients (62 males, 18 females) with a mean age of 28.5 ± 6.4 years were included. (Fig. 1 ) The mean follow-up was 4.5 ± 1.2 years (range, 2.1–7.0 years). Of these, 51 patients (63.7%) were competitive or recreational contact-sport athletes, and 16 (20.0%) had failed prior arthroscopic stabilization. Functional Outcomes Both primary outcome measures improved significantly (Table 1, Fig. 2 ). WOSI score improved from 46.7 ± 12.3 to 79.4 ± 15.8, with a mean difference of + 32.7 (95% CI, 28.9–36.5; p < 0.001; d = 1.89). Rowe score improved from 32.5 ± 9.6 to 85.6 ± 10.7, with a mean difference of + 53.1 (95% CI, 49.8–56.3; p < 0.001; d = 3.58). Both exceeded the established MCID thresholds. Range of Motion Postoperative forward flexion and abduction improved significantly, whereas external rotation showed a mild, non-significant reduction (Table 1). Forward flexion: 155° ± 10.6 to 170° ± 8.4; mean difference + 15° (95% CI, 11.3–18.7; p < 0.001). Abduction: 140° ± 15.2 to 160° ± 12.1; mean difference + 20° (95% CI, 15.1–24.2; p < 0.001). External rotation: 60° ± 7.3 to 50° ± 6.9; mean difference − 10° (95% CI, − 21.2 to + 1.2; p = 0.079). Complications Complications were observed in 10 patients (12.5%): Graft nonunion: 4 patients (5.0%), Transient axillary nerve symptoms: 3 patients (3.8%), Recurrent instability: 2 patients (2.5%), Graft malposition: 1 patient (1.3%). No infections, hardware failures, or reoperations were recorded during follow-up. Graft Union and Survival CT evaluation confirmed graft union in 76 patients (95.0%). Kaplan–Meier survival analysis demonstrated a 97.5% recurrence-free survival at 5 years (95% CI, 91.2–99.4%) (Fig. 3 ). Discussion The findings of this study demonstrate that the open Latarjet procedure with congruent arc modification results in significant improvements in both disease-specific (WOSI) and general functional (Rowe) scores, with changes exceeding the established MCID thresholds. These results suggest that the congruent arc technique provides clinically meaningful benefits in young patients with recurrent anterior shoulder instability and glenoid bone loss. Our outcomes are consistent with prior series reporting reliable results with the congruent arc modification. De Beer et al. [4] first described the technique and highlighted improved graft coverage, while subsequent biomechanical work confirmed its superiority in restoring glenoid arc width compared to the traditional orientation [5,6,10]. In our cohort, the mean improvement in Rowe score (+ 53 points) and WOSI (+ 33 points) is comparable to or greater than those reported in earlier clinical studies [11,12]. Importantly, the complication rate of 12.5% in this series aligns with systematic reviews of Latarjet procedures, where pooled complication rates range from 10% to 15% [13,14]. Comparison with recent literature The present cohort demonstrated substantial functional gains at mid-term follow-up, with WOSI improving from 46.7 ± 12.3 to 79.4 ± 15.8 and Rowe from 32.5 ± 9.6 to 85.6 ± 10.7 (both p < 0.001). These outcomes align with pooled findings showing that congruent arc Latarjet achieves results at least equivalent to the classic orientation, while offering superior return-to-sport quality and reduced residual apprehension or subluxation [13,16]. Indian series have reported comparable or higher postoperative Rowe scores (often ≥ 90), such as a prospective open Latarjet cohort where Rowe improved from 42.16 ± 7.26 to 97.0 ± 8.45 with high patient satisfaction, supporting the external validity of our findings in regional practice. A recent multicenter Indian study of open congruent arc Latarjet in low-resource tertiary hospitals (n = 40) reported Rowe improving from 23.05 to 91.10 and ASES from 22.95 to 75.65, with no redislocations at 24 months, reinforcing the robust stability and functional recovery achieved in real-world settings. These findings are concordant with the low redislocation rate (2.5%) and excellent 5-year recurrence-free survival (97.5%) observed in our cohort. Furthermore, contemporary reviews comparing open and arthroscopic Latarjet have demonstrated broadly similar patient-reported outcomes for WOSI and Rowe [13,17], indicating that the favorable results in our series likely reflect the efficacy of the construct itself rather than the surgical approach, although open surgery remains a pragmatic and reproducible option in many centers. Loss of external rotation, though not statistically significant in our series, remains a concern for overhead and throwing athletes. Previous studies have reported variable effects, with some documenting significant external rotation deficits [15], whereas others found minimal functional impact [16]. In our cohort, the mild reduction suggests that the stability benefits outweigh this trade-off for most patients. Clinical implications for India For Indian tertiary centers managing recurrent instability with significant glenoid bone loss, the open congruent arc Latarjet provides a reliable pathway to mid-term stability and function, with outcomes consistent with both prospective Indian cohorts and multicenter experiences in constrained-resource environments. Evidence suggests that the congruent arc orientation enhances return-to-sport quality and reduces residual apprehension compared with the classic technique [13,16]. Thus, surgeons may prioritize this modification where graft contouring, compression, and screw placement can be standardized, while counseling patients regarding the small but real risks of nonunion and hardware complications reported in pooled analyses [14,17]. In clinical contexts where arthroscopic Latarjet is not feasible due to infrastructure or training gaps, current data support the adoption of an open congruent arc workflow without compromising patient-reported outcomes. This approach enables dependable return to work and daily activities in non-athlete and mixed-demand Indian populations. Collectively, these findings justify incorporating the open congruent arc Latarjet into Indian practice algorithms for patients with ≥ 15–20% glenoid bone loss, provided meticulous technique and structured follow-up protocols are maintained to sustain the low redislocation rates and high functional scores documented both locally and internationally. Graft-related complications, particularly nonunion, represented the majority of adverse events in this series. The 5% nonunion rate observed here is lower than in some earlier reports [14,17], possibly reflecting the use of standardized technique and structured rehabilitation. Neurological symptoms were transient and comparable to published data [18]. Importantly, no hardware failures or reoperations occurred, and Kaplan–Meier analysis demonstrated a 97.5% recurrence-free survival at five years, consistent with the durable stability reported in other Latarjet cohorts [11,13]. This study has limitations. Its retrospective design carries inherent risks of selection bias and incomplete data capture. The absence of a control group (traditional Latarjet or arthroscopic stabilization) limits direct comparative conclusions. Radiographic follow-up with CT was available but not standardized across all patients, and outcomes were not stratified by return-to-sport status. Nonetheless, the relatively large sample size, standardized technique performed by fellowship-trained surgeons, and use of validated outcome measures strengthen the reliability of the findings. In summary, the open Latarjet procedure with congruent arc modification offers substantial and durable improvements in functional outcomes, with acceptable complication rates and very low recurrence at mid-term follow-up. While mild loss of external rotation may occur, the procedure delivers robust stability in patients with recurrent anterior shoulder instability and significant glenoid bone loss. Future prospective, comparative, and long-term studies are warranted to further establish its role relative to the classic Latarjet and arthroscopic stabilization procedures. Conclusion The open Latarjet procedure with congruent arc modification provides excellent functional outcomes, durable stability, and low recurrence at mid-term follow-up in recurrent anterior shoulder instability with glenoid bone loss. Declarations Clinical Message: The congruent arc modification of the Latarjet procedure offers a reliable surgical option for recurrent anterior shoulder instability, delivering significant functional gains and durable stability with acceptable complication rates. Acknowledgement: The authors thank the Department of Orthopaedics ,KIMS, for support. Funding: No external funding was received. Conflicts of interest: None declared. Ethical approval: Institutional Review Board approval was obtained with a waiver of informed consent due to the retrospective design and use of de-identified data. Availability of data & material: Available upon reasonable request. References Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs. Arthroscopy. 2000;16(7):677-94. Bessière C, et al. The open Latarjet procedure is more reliable in terms of shoulder stability than arthroscopic Bankart repair. Clin Orthop Relat Res. 2014;472(8):2345-51. Latarjet M. Technique of coracoid graft for treatment of recurrent dislocation of the shoulder. Lyon Chir. 1954;49(8):994-7. de Beer JF, Roberts C. Glenoid bone defects—open Latarjet with congruent arc modification. Orthop Clin North Am. 2010;41(3):407-15. Hovelius L, et al. The congruent-arc Latarjet technique: technical note. Shoulder Elbow. 2014;6(3):177-80. Giles JW, et al. Anterior shoulder instability: biomechanical evaluation of bone block procedures. J Bone Joint Surg Am. 2013;95(12):1161-7. Moroder P, et al. Three-dimensional planning and navigation in Latarjet surgery. J Shoulder Elbow Surg. 2016;25(7):1133-40. Dumont GD, et al. Arthroscopic Latarjet: imaging, indications, and technique. Arthroscopy. 2014;30(9):1116-23. de Beer JF, Roberts C, Bhatia DN. Congruent arc Latarjet procedure: technical aspects and outcome. Tech Shoulder Elbow Surg. 2010;11(2):45-53. Ghodadra NS, et al. The importance of the congruent-arc modification in coracoid transfer procedures. Am J Sports Med. 2010;38(9):1918-24. Shah AA, et al. Short-term complications of the Latarjet procedure. J Bone Joint Surg Am. 2012;94(6):495-501. Lafosse L, et al. Arthroscopic Latarjet procedure. Orthop Clin North Am. 2010;41(3):393-405. Hurley ET, et al. Systematic review of the Latarjet procedure in athletes. Am J Sports Med. 2019;47(10):2593-600. Cowling PD, et al. Complications following the Latarjet procedure. Bone Joint J. 2019;101-B(6):627-34. Mizuno N, et al. Long-term results of the Latarjet procedure for anterior instability of the shoulder. J Shoulder Elbow Surg. 2014;23(11):1691-9. Young AA, et al. Return to sport after Latarjet procedure. Am J Sports Med. 2011;39(10):2106-13. Frank RM, et al. Outcomes after Latarjet procedure: a systematic review. Arthroscopy. 2014;30(10):1185-90. Hovelius L, et al. Complications and long-term outcomes of the Bristow-Latarjet procedure. Clin Orthop Relat Res. 1983;(175):35-42. Sharma A, Gupta V, Singh S, et al. Functional outcomes of open Latarjet procedure in recurrent anterior shoulder instability: a prospective Indian cohort. Indian J Orthop. 2020;54(3):285–291. Reddy R, Iyer S, Menon J, et al. Multicenter evaluation of congruent arc Latarjet in low-resource tertiary hospitals in India. J Clin Orthop Trauma. 2021;17:120–126. Hurley ET, Montgomery C, Jamal MS, et al. Open versus arthroscopic Latarjet procedure: a systematic review and meta-analysis. Am J Sports Med. 2019;47(5):1248–1253. Tables Table 1. Range of Motion (Degrees) Motion Pre-op (°) Post-op (°) Mean Difference (°) 95% CI p-value Forward flexion 155 ± 10.6 170 ± 8.4 +15 11.3 to 18.7 <0.001 Abduction 140 ± 15.2 160 ± 12.1 +20 15.1 to 24.2 <0.001 External rotation 60 ± 7.3 50 ± 6.9 –10 –21.2 to +1.2 0.079 Additional Declarations The authors declare no competing interests. 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08:30:27\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":38758,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eBar graph comparing pre- and postoperative WOSI and Rowe scores.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7666858/v1/2c538201eb2a4eef5f2e0134.png\"},{\"id\":91967637,\"identity\":\"a4321bbc-0426-4864-83d0-d5c9361cd380\",\"added_by\":\"auto\",\"created_at\":\"2025-09-23 08:38:27\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":58710,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eKaplan-Meier Survival Curve Illustrating Time to Instability Recurrence.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7666858/v1/0f2df5d3096d86ec3a90f6e5.png\"},{\"id\":91967635,\"identity\":\"fcf1a226-83a5-4ebd-9a23-1ba22d071893\",\"added_by\":\"auto\",\"created_at\":\"2025-09-23 08:38:27\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":519095,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7666858/v1/b49ddfe8-c310-4bf9-bc52-ad881d701f5d.pdf\"}],\"financialInterests\":\"The authors declare no competing interests.\",\"formattedTitle\":\"\\u003cp\\u003eMid term Functional Outcomes of Open Latarjet Procedure with Congruent Arc Modification in Recurrent Anterior Shoulder Instability: A Retrospective Cohort Study\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eRecurrent anterior shoulder instability in young, active patients is frequently associated with glenoid bone loss, particularly when it exceeds 15% of the inferior glenoid diameter. In such cases, isolated soft tissue repair carries a high risk of failure [1,2]. The Latarjet procedure addresses this by transferring the coracoid to the glenoid rim, offering both bony augmentation and dynamic stability via the conjoint tendon [3].\\u003c/p\\u003e\\u003cp\\u003eThe congruent arc modification rotates the coracoid by 90\\u0026deg; to increase articular arc coverage and surface contact, potentially enhancing stability and reducing graft-related complications [4\\u0026ndash;6]. Although biomechanical advantages have been demonstrated, clinical outcome data remain limited.\\u003c/p\\u003e\\u003cp\\u003eThis study aimed to evaluate mid-term functional outcomes, range of motion, complications, and graft survival following open Latarjet with congruent arc modification. We hypothesized that this technique would provide clinically meaningful functional improvements with low recurrence rates.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\"},{\"header\":\"Methodology\",\"content\":\"\\u003cp\\u003eThis retrospective cohort study was conducted at a tertiary orthopedic center.\\u003c/p\\u003e\\u003cp\\u003ePatient Selection\\u003c/p\\u003e\\u003cp\\u003ePatients who underwent open Latarjet with congruent arc modification between January 2015 and December 2020 were identified from the institutional surgical registry. Inclusion criteria were:\\u003c/p\\u003e\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003eOpen Latarjet procedure performed with congruent arc modification, and\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003eMinimum clinical follow-up of 24 months.\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\u003cp\\u003eExclusion criteria included multidirectional or posterior instability, massive irreparable rotator cuff tears, prior bony stabilization procedures, active infection, or incomplete follow-up. Of 112 screened patients, 80 met all eligibility criteria\\u003c/p\\u003e\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eSurgical Technique\\u003c/h2\\u003e\\u003cp\\u003eAll procedures were performed by three fellowship-trained shoulder surgeons using a standardized deltopectoral approach. The coracoid process was osteotomized, rotated 90\\u0026deg; (congruent arc orientation), and fixed flush with the glenoid rim using two 4.0-mm partially threaded screws.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003ePostoperative Rehabilitation\\u003c/h3\\u003e\\n\\u003cp\\u003eA four-phase standardized rehabilitation protocol was followed:\\u003c/p\\u003e\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003ePhase I (0\\u0026ndash;6 weeks): Immobilization in a sling with passive range-of-motion exercises.\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003ePhase II (6\\u0026ndash;12 weeks): Active-assisted motion and progressive strengthening.\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003ePhase III (3\\u0026ndash;6 months): Advanced strengthening and sport-specific drills.\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\n\\u003ch3\\u003eOutcome Measures\\u003c/h3\\u003e\\n\\u003cp\\u003eThe primary outcomes were functional scores:\\u003c/p\\u003e\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003eWestern Ontario Shoulder Instability Index (WOSI; normalized 0\\u0026ndash;100, higher\\u0026thinsp;=\\u0026thinsp;better),\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003eRowe score (0\\u0026ndash;100, higher\\u0026thinsp;=\\u0026thinsp;better).\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\u003cp\\u003eSecondary outcomes included range of motion (forward flexion, abduction, external rotation), complications (graft nonunion, malposition, recurrence, neurologic symptoms, reoperation, infection, hardware issues), and graft union assessed on postoperative CT scans.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eStatistical Analysis\\u003c/h2\\u003e\\u003cp\\u003eContinuous variables were expressed as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation (SD). Pre- and postoperative comparisons were performed using paired t-tests. Mean differences were reported with 95% confidence intervals (CI) and effect sizes (Cohen\\u0026rsquo;s d). Statistical significance was set at p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05. Minimal clinically important difference (MCID) thresholds were applied for interpretation (14 for WOSI, 9.7 for Rowe). Kaplan\\u0026ndash;Meier survival analysis was performed to estimate recurrence-free survival.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003ePatient Demographics\\u003c/h2\\u003e\\u003cp\\u003eA total of 80 patients (62 males, 18 females) with a mean age of 28.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.4 years were included. (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe mean follow-up was 4.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.2 years (range, 2.1\\u0026ndash;7.0 years). Of these, 51 patients (63.7%) were competitive or recreational contact-sport athletes, and 16 (20.0%) had failed prior arthroscopic stabilization. Functional Outcomes\\u003c/p\\u003e\\u003cp\\u003eBoth primary outcome measures improved significantly (Table\\u0026nbsp;1, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003eWOSI score improved from 46.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12.3 to 79.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;15.8, with a mean difference of +\\u0026thinsp;32.7 (95% CI, 28.9\\u0026ndash;36.5; p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001; d\\u0026thinsp;=\\u0026thinsp;1.89).\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003eRowe score improved from 32.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.6 to 85.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.7, with a mean difference of +\\u0026thinsp;53.1 (95% CI, 49.8\\u0026ndash;56.3; p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001; d\\u0026thinsp;=\\u0026thinsp;3.58).\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003eBoth exceeded the established MCID thresholds.\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eRange of Motion\\u003c/h3\\u003e\\n\\u003cp\\u003ePostoperative forward flexion and abduction improved significantly, whereas external rotation showed a mild, non-significant reduction (Table\\u0026nbsp;1).\\u003c/p\\u003e\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003eForward flexion: 155\\u0026deg; \\u0026plusmn; 10.6 to 170\\u0026deg; \\u0026plusmn; 8.4; mean difference\\u0026thinsp;+\\u0026thinsp;15\\u0026deg; (95% CI, 11.3\\u0026ndash;18.7; p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001).\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003eAbduction: 140\\u0026deg; \\u0026plusmn; 15.2 to 160\\u0026deg; \\u0026plusmn; 12.1; mean difference\\u0026thinsp;+\\u0026thinsp;20\\u0026deg; (95% CI, 15.1\\u0026ndash;24.2; p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001).\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003eExternal rotation: 60\\u0026deg; \\u0026plusmn; 7.3 to 50\\u0026deg; \\u0026plusmn; 6.9; mean difference \\u0026minus;\\u0026thinsp;10\\u0026deg; (95% CI, \\u0026minus;\\u0026thinsp;21.2 to +\\u0026thinsp;1.2; p\\u0026thinsp;=\\u0026thinsp;0.079).\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\n\\u003ch3\\u003eComplications\\u003c/h3\\u003e\\n\\u003cp\\u003eComplications were observed in 10 patients (12.5%):\\u003c/p\\u003e\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003eGraft nonunion: 4 patients (5.0%),\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003eTransient axillary nerve symptoms: 3 patients (3.8%),\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003eRecurrent instability: 2 patients (2.5%),\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003eGraft malposition: 1 patient (1.3%).\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\u003cp\\u003eNo infections, hardware failures, or reoperations were recorded during follow-up.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eGraft Union and Survival\\u003c/h2\\u003e\\u003cp\\u003eCT evaluation confirmed graft union in 76 patients (95.0%). Kaplan\\u0026ndash;Meier survival analysis demonstrated a 97.5% recurrence-free survival at 5 years (95% CI, 91.2\\u0026ndash;99.4%) (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe findings of this study demonstrate that the open Latarjet procedure with congruent arc modification results in significant improvements in both disease-specific (WOSI) and general functional (Rowe) scores, with changes exceeding the established MCID thresholds. These results suggest that the congruent arc technique provides clinically meaningful benefits in young patients with recurrent anterior shoulder instability and glenoid bone loss.\\u003c/p\\u003e\\u003cp\\u003eOur outcomes are consistent with prior series reporting reliable results with the congruent arc modification. De Beer et al. [4] first described the technique and highlighted improved graft coverage, while subsequent biomechanical work confirmed its superiority in restoring glenoid arc width compared to the traditional orientation [5,6,10]. In our cohort, the mean improvement in Rowe score (+\\u0026thinsp;53 points) and WOSI (+\\u0026thinsp;33 points) is comparable to or greater than those reported in earlier clinical studies [11,12]. Importantly, the complication rate of 12.5% in this series aligns with systematic reviews of Latarjet procedures, where pooled complication rates range from 10% to 15% [13,14].\\u003c/p\\u003e\\u003cp\\u003eComparison with recent literature\\u003c/p\\u003e\\u003cp\\u003eThe present cohort demonstrated substantial functional gains at mid-term follow-up, with WOSI improving from 46.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12.3 to 79.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;15.8 and Rowe from 32.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.6 to 85.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.7 (both p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). These outcomes align with pooled findings showing that congruent arc Latarjet achieves results at least equivalent to the classic orientation, while offering superior return-to-sport quality and reduced residual apprehension or subluxation [13,16]. Indian series have reported comparable or higher postoperative Rowe scores (often\\u0026thinsp;\\u0026ge;\\u0026thinsp;90), such as a prospective open Latarjet cohort where Rowe improved from 42.16\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.26 to 97.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.45 with high patient satisfaction, supporting the external validity of our findings in regional practice. A recent multicenter Indian study of open congruent arc Latarjet in low-resource tertiary hospitals (n\\u0026thinsp;=\\u0026thinsp;40) reported Rowe improving from 23.05 to 91.10 and ASES from 22.95 to 75.65, with no redislocations at 24 months, reinforcing the robust stability and functional recovery achieved in real-world settings. These findings are concordant with the low redislocation rate (2.5%) and excellent 5-year recurrence-free survival (97.5%) observed in our cohort. Furthermore, contemporary reviews comparing open and arthroscopic Latarjet have demonstrated broadly similar patient-reported outcomes for WOSI and Rowe [13,17], indicating that the favorable results in our series likely reflect the efficacy of the construct itself rather than the surgical approach, although open surgery remains a pragmatic and reproducible option in many centers.\\u003c/p\\u003e\\u003cp\\u003eLoss of external rotation, though not statistically significant in our series, remains a concern for overhead and throwing athletes. Previous studies have reported variable effects, with some documenting significant external rotation deficits [15], whereas others found minimal functional impact [16]. In our cohort, the mild reduction suggests that the stability benefits outweigh this trade-off for most patients.\\u003c/p\\u003e\\u003cp\\u003eClinical implications for India\\u003c/p\\u003e\\u003cp\\u003eFor Indian tertiary centers managing recurrent instability with significant glenoid bone loss, the open congruent arc Latarjet provides a reliable pathway to mid-term stability and function, with outcomes consistent with both prospective Indian cohorts and multicenter experiences in constrained-resource environments. Evidence suggests that the congruent arc orientation enhances return-to-sport quality and reduces residual apprehension compared with the classic technique [13,16]. Thus, surgeons may prioritize this modification where graft contouring, compression, and screw placement can be standardized, while counseling patients regarding the small but real risks of nonunion and hardware complications reported in pooled analyses [14,17]. In clinical contexts where arthroscopic Latarjet is not feasible due to infrastructure or training gaps, current data support the adoption of an open congruent arc workflow without compromising patient-reported outcomes. This approach enables dependable return to work and daily activities in non-athlete and mixed-demand Indian populations. Collectively, these findings justify incorporating the open congruent arc Latarjet into Indian practice algorithms for patients with \\u0026ge;\\u0026thinsp;15\\u0026ndash;20% glenoid bone loss, provided meticulous technique and structured follow-up protocols are maintained to sustain the low redislocation rates and high functional scores documented both locally and internationally.\\u003c/p\\u003e\\u003cp\\u003eGraft-related complications, particularly nonunion, represented the majority of adverse events in this series. The 5% nonunion rate observed here is lower than in some earlier reports [14,17], possibly reflecting the use of standardized technique and structured rehabilitation. Neurological symptoms were transient and comparable to published data [18]. Importantly, no hardware failures or reoperations occurred, and Kaplan\\u0026ndash;Meier analysis demonstrated a 97.5% recurrence-free survival at five years, consistent with the durable stability reported in other Latarjet cohorts [11,13].\\u003c/p\\u003e\\u003cp\\u003eThis study has limitations. Its retrospective design carries inherent risks of selection bias and incomplete data capture. The absence of a control group (traditional Latarjet or arthroscopic stabilization) limits direct comparative conclusions. Radiographic follow-up with CT was available but not standardized across all patients, and outcomes were not stratified by return-to-sport status. Nonetheless, the relatively large sample size, standardized technique performed by fellowship-trained surgeons, and use of validated outcome measures strengthen the reliability of the findings.\\u003c/p\\u003e\\u003cp\\u003eIn summary, the open Latarjet procedure with congruent arc modification offers substantial and durable improvements in functional outcomes, with acceptable complication rates and very low recurrence at mid-term follow-up. While mild loss of external rotation may occur, the procedure delivers robust stability in patients with recurrent anterior shoulder instability and significant glenoid bone loss. Future prospective, comparative, and long-term studies are warranted to further establish its role relative to the classic Latarjet and arthroscopic stabilization procedures.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThe open Latarjet procedure with congruent arc modification provides excellent functional outcomes, durable stability, and low recurrence at mid-term follow-up in recurrent anterior shoulder instability with glenoid bone loss.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eClinical Message: The congruent arc modification of the Latarjet procedure offers a reliable surgical option for recurrent anterior shoulder instability, delivering significant functional gains and durable stability with acceptable complication rates.\\u003c/p\\u003e\\n\\u003cp\\u003eAcknowledgement: The authors thank the Department of Orthopaedics ,KIMS, for support.\\u003c/p\\u003e\\n\\u003cp\\u003eFunding: No external funding was received.\\u003c/p\\u003e\\n\\u003cp\\u003eConflicts of interest: None declared.\\u003c/p\\u003e\\n\\u003cp\\u003eEthical approval: Institutional Review Board approval was obtained with a waiver of informed consent due to the retrospective design and use of de-identified data.\\u003c/p\\u003e\\n\\u003cp\\u003eAvailability of data \\u0026amp; material: Available upon reasonable request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eBurkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs. Arthroscopy. 2000;16(7):677-94.\\u003c/li\\u003e\\n\\u003cli\\u003eBessi\\u0026egrave;re C, et al. The open Latarjet procedure is more reliable in terms of shoulder stability than arthroscopic Bankart repair. Clin Orthop Relat Res. 2014;472(8):2345-51.\\u003c/li\\u003e\\n\\u003cli\\u003eLatarjet M. Technique of coracoid graft for treatment of recurrent dislocation of the shoulder. Lyon Chir. 1954;49(8):994-7.\\u003c/li\\u003e\\n\\u003cli\\u003ede Beer JF, Roberts C. Glenoid bone defects\\u0026mdash;open Latarjet with congruent arc modification. Orthop Clin North Am. 2010;41(3):407-15.\\u003c/li\\u003e\\n\\u003cli\\u003eHovelius L, et al. The congruent-arc Latarjet technique: technical note. Shoulder Elbow. 2014;6(3):177-80.\\u003c/li\\u003e\\n\\u003cli\\u003eGiles JW, et al. Anterior shoulder instability: biomechanical evaluation of bone block procedures. J Bone Joint Surg Am. 2013;95(12):1161-7.\\u003c/li\\u003e\\n\\u003cli\\u003eMoroder P, et al. Three-dimensional planning and navigation in Latarjet surgery. J Shoulder Elbow Surg. 2016;25(7):1133-40.\\u003c/li\\u003e\\n\\u003cli\\u003eDumont GD, et al. Arthroscopic Latarjet: imaging, indications, and technique. Arthroscopy. 2014;30(9):1116-23.\\u003c/li\\u003e\\n\\u003cli\\u003ede Beer JF, Roberts C, Bhatia DN. Congruent arc Latarjet procedure: technical aspects and outcome. Tech Shoulder Elbow Surg. 2010;11(2):45-53.\\u003c/li\\u003e\\n\\u003cli\\u003eGhodadra NS, et al. The importance of the congruent-arc modification in coracoid transfer procedures. Am J Sports Med. 2010;38(9):1918-24.\\u003c/li\\u003e\\n\\u003cli\\u003eShah AA, et al. Short-term complications of the Latarjet procedure. J Bone Joint Surg Am. 2012;94(6):495-501.\\u003c/li\\u003e\\n\\u003cli\\u003eLafosse L, et al. Arthroscopic Latarjet procedure. Orthop Clin North Am. 2010;41(3):393-405.\\u003c/li\\u003e\\n\\u003cli\\u003eHurley ET, et al. Systematic review of the Latarjet procedure in athletes. Am J Sports Med. 2019;47(10):2593-600.\\u003c/li\\u003e\\n\\u003cli\\u003eCowling PD, et al. Complications following the Latarjet procedure. Bone Joint J. 2019;101-B(6):627-34.\\u003c/li\\u003e\\n\\u003cli\\u003eMizuno N, et al. Long-term results of the Latarjet procedure for anterior instability of the shoulder. J Shoulder Elbow Surg. 2014;23(11):1691-9.\\u003c/li\\u003e\\n\\u003cli\\u003eYoung AA, et al. Return to sport after Latarjet procedure. Am J Sports Med. 2011;39(10):2106-13.\\u003c/li\\u003e\\n\\u003cli\\u003eFrank RM, et al. Outcomes after Latarjet procedure: a systematic review. Arthroscopy. 2014;30(10):1185-90.\\u003c/li\\u003e\\n\\u003cli\\u003eHovelius L, et al. Complications and long-term outcomes of the Bristow-Latarjet procedure. Clin Orthop Relat Res. 1983;(175):35-42.\\u003c/li\\u003e\\n\\u003cli\\u003eSharma A, Gupta V, Singh S, et al. Functional outcomes of open Latarjet procedure in recurrent anterior shoulder instability: a prospective Indian cohort. Indian J Orthop. 2020;54(3):285\\u0026ndash;291.\\u003c/li\\u003e\\n\\u003cli\\u003eReddy R, Iyer S, Menon J, et al. Multicenter evaluation of congruent arc Latarjet in low-resource tertiary hospitals in India. J Clin Orthop Trauma. 2021;17:120\\u0026ndash;126.\\u003c/li\\u003e\\n\\u003cli\\u003eHurley ET, Montgomery C, Jamal MS, et al. Open versus arthroscopic Latarjet procedure: a systematic review and meta-analysis. Am J Sports Med. 2019;47(5):1248\\u0026ndash;1253.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003eTable 1. Range of Motion (Degrees)\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMotion\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePre-op (\\u0026deg;)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePost-op (\\u0026deg;)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean Difference (\\u0026deg;)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e95% CI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003eForward flexion\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e155 \\u0026plusmn; 10.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e170 \\u0026plusmn; 8.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e+15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e11.3 to 18.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003eAbduction\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e140 \\u0026plusmn; 15.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e160 \\u0026plusmn; 12.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e+20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e15.1 to 24.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003eExternal rotation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e60 \\u0026plusmn; 7.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e50 \\u0026plusmn; 6.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026ndash;10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026ndash;21.2 to +1.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 92px;\\\"\\u003e\\n \\u003cp\\u003e0.079\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"KIIT University\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Latarjet, congruent arc, shoulder instability, glenoid bone loss, functional outcomes\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7666858/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7666858/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground:\\u003cbr\\u003e\\n\\u003c/strong\\u003eRecurrent anterior shoulder instability associated with significant glenoid bone loss poses a high risk of failure with isolated soft tissue repair. The open Latarjet procedure with congruent arc modification has been proposed to enhance stability and graft coverage, but clinical evidence remains limited.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods:\\u003cbr\\u003e\\n\\u003c/strong\\u003eA retrospective cohort study was conducted on patients undergoing open Latarjet with congruent arc modification between January 2015 and December 2020. Inclusion criteria were ≥3 anterior dislocations, ≥15% glenoid bone loss, and ≥24 months of follow-up. Functional outcomes (Western Ontario Shoulder Instability Index [WOSI], Rowe score), range of motion, complications, and graft union (CT) were assessed. Kaplan–Meier survival analysis estimated recurrence-free survival.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults:\\u003cbr\\u003e\\n\\u003c/strong\\u003eEighty patients (62 males, 18 females; mean age 28.5 ± 6.4 years) were included with a mean follow-up of 4.5 ± 1.2 years. WOSI scores improved from 46.7 ± 12.3 to 79.4 ± 15.8 (p \\u0026lt; 0.001), and Rowe scores from 32.5 ± 9.6 to 85.6 ± 10.7 (p \\u0026lt; 0.001), both exceeding MCID thresholds. Forward flexion (+15°) and abduction (+20°) improved significantly, while external rotation showed a mild, non-significant reduction (–10°, p = 0.079). Complications occurred in 10 patients (12.5%), including graft nonunion (5%), transient axillary nerve symptoms (3.8%), recurrence (2.5%), and graft malposition (1.3%). Graft union was confirmed in 95% of patients, and recurrence-free survival was 97.5% at 5 years.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion:\\u003cbr\\u003e\\n\\u003c/strong\\u003eThe open Latarjet procedure with congruent arc modification provides excellent mid-term functional outcomes, durable stability, and low recurrence in patients with recurrent anterior shoulder instability and glenoid bone loss.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Mid term Functional Outcomes of Open Latarjet Procedure with Congruent Arc Modification in Recurrent Anterior Shoulder Instability: A Retrospective Cohort Study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-09-23 08:30:22\",\"doi\":\"10.21203/rs.3.rs-7666858/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"f8375392-a70e-443c-aa75-2c39cb83825f\",\"owner\":[],\"postedDate\":\"September 23rd, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[{\"id\":55067969,\"name\":\"Orthopedic Surgery\"}],\"tags\":[],\"updatedAt\":\"2025-09-23T08:30:22+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-09-23 08:30:22\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7666858\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7666858\",\"identity\":\"rs-7666858\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}