Arthroscopic Bristow-Latarjet Procedure (SS-05)

Abstract

Anterior shoulder instability is well known as a common pathology and many surgeons have chosen the arthroscopic Bankart procedure or other soft tissue procedures for its treatment. However using these techniques may result in unsatisfactory outcomes when an anterior glenoid fracture or bone loss is associated. These patients may achieve better and safer results by using a bony block procedures as the Bristow-Latarjet procedure. The intention of the study is to present the full arthroscopic Bristow-Latarjet procedure of the author and its implications in 21 patients. We performed 21 arthroscopic bristow-latarjet procedures in patients presenting HAGL, soft tissue procedures failures, gross shoulder instability and anterior glenoid bone loss following the senior author's technique. Patients were evaluated by UCLA score and comparative difference of external rotation, before and 6-month after surgeries. Twenty one arthroscopic Bristow-Latarjet procedures have been performed, one lost the surgery because the breakage of the graft, 4 have less than 6 months post surgery. The remaining 16 were evaluated. In the 6-month postoperative evaluation, the UCLA score changed from 24,37 (before surgery) to 33,1. The average loss of external rotation was 12,5 degrees, compared with the normal shoulder. The only real failure was the breaking of the coracoid in 1 patient. In this case the author used successfully the arthroscopic conjoined tendon tenodesis (using anchors) in the anterior glenoid rim. The coracoid and conjoined tendon transfer procedure is one of the most useful treatments for shoulder instability. Using this procedure many other shoulder surgeons have derived good and safe results. This procedure is strongly recommended for anterior glenoid bony loss, in contact athletes, gross anterior shoulder instability and failure of previous soft tissue procedures; however special attention is necessary to avoid limitation in external rotation. To improve surgical access and to make it easier to scope, the surgeon may use different portals to have a wide view and be able to work better. Compared with the open procedure, it is shown to be superior because of limited exposure, especially in young athletes with significant musculature. The arthroscopic technique is also advantageous in those cases in which the preoperative assessment fails to reveal a Humeral Avulsion of the Glenohumeral Ligament lesion or a large bony avulsion from the anterior glenoid rim. It also allows the surgeon to modify his plan intraoperatively. As to the graft placement and fixation, the arthroscopic technique provides better visualization for positioning the coracoid. This should minimize the risk of anterior overhang of the bone block and then, reduce the risk of osteoarthritis of the humeral head, a well-recognized complication of open procedures. There is also the advantage of the graft-shaving possibility. The absence of special devices was our challenge in creating this technique. The coracoid is horizontally positioned exposing the bone marrow and leading to a biological healing. Even with the advantages mentioned in the above, at this time, it does not seem evident that in long term the arthroscopic technique produces better results than the open surgery.