The outcome of the Latarjet procedure was also assessed with the use of the glenoid concept. Mook et al. reported that failure after the Latarjet procedure occurred in 50% (4/8) of those whose Hill-Sachs lesion was located more medially than the grafted coracoid process (off-track lesion), but only in 16% (4/25) of those with an on-track lesion [69]. The patients with an off-track lesion after the Latarjet procedure were 4.0 times more likely to experience postoperative instability than those without. They concluded that the glenoid track concept may be predictive of stability after the Latarjet procedure.

One thing we need to consider is the fragment type of glenoid bony defect. It is more frequently observed than erosion-type lesions [2, 4, 5]. Sugaya et al. performed bony Bankart repair in patients with an average bone loss of 24.8% (range: 11.4–38.6%) and an average fragment size of 9.2% (range, 2.1–20.9%) of the glenoid fossa [69]. All the fragments were in the capsulolabral complex and were fixed back to the glenoid with the use of suture anchors. With an average 34-month follow-up, 39/42 (93%) were rated good or excellent. Two patients (5%) had recurrent dislocations due to reinjury during sports. They concluded that arthroscopic bony Bankart repair yielded a successful outcome even in shoulders with a large bony defect >25%.

The fragment may be absorbed gradually if you leave it alone [4]. Nakagawa et al. reported that all the fragments underwent absorption to some extent: <50% in 32 shoulders, >50% in 45, and 100% in 15. Most fragments showed absorption during the first year after the primary dislocation. Thus, by the time the fragment is fixed to the glenoid by means of osseous Bankart repair, there is a significant discrepancy between the size of the glenoid defect and the size of the fragment as shown in the previous study [70]. This discrepancy could be a concern when performing bony fragment fixation. After the midterm to long-term follow-up, however, the original glenoid defect was well remodeled, and the gap between the fragment and the glenoid became much smaller with new bone formation [71]. On the other hand, Nakagawa et al. reported that the bone union was not always observed and the outcome was affected by bone union [72]. On the contrary, Jiang et al. reported that the size of the reconstructed glenoid, not the bone union, affected the outcome [73]. The indication and efficacy of bony fragment fixation are still controversial and need to be determined by clarifying the outcomes and factors affecting the outcomes.