Editorial Commentary: Both Bristow and Latarjet Procedures Result in Low Rates of Recurrent Shoulder Instability Despite Potential for Bone Resorption and Lack of Graft Healing

Abstract

Anterior shoulder instability surgery has evolved over the decades, including both anatomic and nonanatomic repairs and reconstructions. Surgeons are continually advancing their skills and performing more of these procedures using arthroscopic as opposed to open techniques in patients with and without glenoid bone loss. However, there is a steep learning curve and increased technical demands when performing these procedures arthroscopically. Despite high success rates, bone graft resorption or lack of healing after Latarjet and Bristow procedures is well documented, and it is possible that patients develop enough scarring that their shoulders remain stable. Osteoarthritis after these nonanatomic procedures can occur making shoulder arthroplasty and reconstruction technically more challenging because of scarring and the altered anatomy. It remains to be seen whether these arthroscopic techniques as opposed to open surgery lessen the scarring and thus the technical demands of shoulder reconstruction in the small subset of patients who unfortunately develop symptomatic shoulder osteoarthritis. Therefore, in my practice, these techniques are carefully chosen for select patients. My indications for use of the Bristow procedure as a primary procedure for anterior shoulder instability are in patients who perform mixed martial arts fighting and high-level wrestlers without significant glenoid or humeral bone loss. My indications for the Latarjet procedure are in patients with chronic anterior instability and associated anterior glenoid bone loss 15% to 30%, off-track Hill-Sachs lesions, and revision surgery, particularly in high-demand contact and collision athletes. These 2 arthroscopic procedures, despite being nonanatomic, provide surgeons with excellent treatment options for those difficult patients with anterior shoulder instability. Despite high success rates with these arthroscopic procedures, patients should be counseled on the risks of graft resorption, graft nonunion, and possible shoulder osteoarthritis. The appropriate indications for these arthroscopic procedures can enhance the successful outcomes for high-risk patients with shoulder instability while also considering the possible long-term impacts of altering shoulder anatomy and scarring in the rare patient who develops shoulder osteoarthritis.