Arthroscopic Bristow - Latarjet Procedure: Results and Technique after nine-year experience

Introduction: Anterior shoulder instability is one of the most common pathologies of the shoulder [8]. Among the many surgical techniques available to treat anterior shoulder instability, one of the most effective and well known techniques is the transfer of the coracoid and conjoined tendon to the anterior glenoid rim [2]. This procedure was suspected to be originally performed by Walter Rowley Bristow for the surgical treatment of recurrent anterior shoulder instability before 1929 [18]; however, no details on the surgical technique were reported until the Helfet report in 1958 over the technique he learnt in 1939 from Bristow [11]. In 1954, Michel Latarjet established the modern concept of this surgery using one screw to fix the coracoid and splitting the subscapularis in the horizontal direction [15]. Didier Patte et al. disseminated this technique throughout Europe in the 1980s and used two 4.5 mm screws to fix the graft [19]. This procedure involving the transfer of the coracoid and conjoined tendon to the anterior glenoid rim has been modified several times, but these modifications have always respected the principles established by Bristow and Latarjet [14]. Many of these modifications have resulted in successful results with some common complications. The most common complications include loss of external rotation, osteoarthritis, pain, musculocutaneous nerve lesions and nonunions [10]. These complications have led many surgeons to avoid this procedure and prefer capsular plication with labral reconstruction. Recently, minimally invasive arthroscopic techniques have been developed to perform Latarjet surgery [14 ].Through an intraarticular view, the surgeon is able to better position the graft and avoid some of the possible complications related to positioning, such as recurrence of dislocation and osteoarthritis. The intraarticular view of the insertion site also ensures the presence of bone marrow at the contact area, which allows for a more reliable osteosynthesis [1,14,17]. However, this new approach to the established procedure requires new instruments and increased surgical costs. In 2009, a surgical technique was created to allow the Bristow procedure to be performed with a minimally invasive procedure that uses regular arthroscopic devices and one screw [8]. In this study, we have modified this technique and present the results of 33 patients who underwent the arthroscopic Bristow procedure to treat anterior shoulder instability. Hypothesis: This new modification of the arthroscopic Bristow procedure, which utilizes regular arthroscopic devices, is an effective procedure to treat patients with anterior shoulder instability. Purpose: To assess the effectiveness and safety of the modified arthroscopic Bristow Introduction: The Bristow procedure is an established and effective method to treat anterior shoulder instability. Following the current trend towards minimally invasive procedures, we performed the Bristow technique arthroscopically and assessed the results. Materials and Methods: This study enrolled 33 patients with more than 2 years of follow-up. We assessed the UCLA score before and after surgery and completed post-surgical assessments of the Rowe score, Simple Shoulder Test (SST) score, and differences in external rotation (DER) at follow-up approximately 2 years or more post-surgery. Results: At the 2-year follow-up, the average UCLA score increased from 25.48±0.64 (SD 3.67) pre-surgery to 33.03±0.57 (SD 3.26) (p<0.0001). In addition, the mean Rowe score was 93.33±2.00 (SD 10.93; compared with the cutoff score of 75, p<0.0001), the mean SST score was 11.20±0.28 (SD 1.52), and the mean DER was 11.50±1.65 (SD 9.02). No recurrences of instability or musculocutaneous nerve lesions occurred in the patients. Conclusion: Together, the UCLA score, SST score, DER, Rowe score and the recurrence rate suggest that the arthroscopic Bristow procedure was effective in treating anterior shoulder instability with short-term follow-up. However, although these results are encouraging, this procedure is not free of complications. Additional data and prospective trials are important to better understand the possible advantages and disadvantages of this procedure.