Arthroscopic Bristow-Latarjet Combined With Bankart Repair (2B3 Procedure): Tips and Tricks

Abstract

Arthroscopic capsulolabral repair alone results in high rates of recurrent instability in patients with glenoid or humeral bone loss and capsular laxity, especially in young patients and those who participate in competitive contact sports. The arthroscopic Bristow-Latarjet-Bankart is a procedure that combines the theoretical advantages of both the Bristow-Latarjet procedure and the arthroscopic Bankart repair, while mitigating the potential disadvantages of each. The coracoid bone block is passed through a subscapularis split and fixed on the glenoid neck, after which an arthroscopic Bankart repair is performed using suture anchors. The fixation of the bone block can be done by means of a screw or a double-button with sutures. The combined procedure provides a so-called triple-blocking effect: (1) the transferred coracoid bone block compensates for anterior glenoid bone loss and conforms to the glenoid concavity (bony effect); (2) the transferred conjoint tendon creates a dynamic reinforcement of the inferior part of the capsule, both by itself and by lowering the inferior part of the subscapularis, particularly when the arm is abducted and externally rotated (belt or sling effect); and (3) the capsulolabral repair recreates the anterior bumper, protecting the humeral head from direct contact with the coracoid bone graft, and keeping proprioception (bumper effect).