Summary

We developed an arthroscopic “Button-Socket” Bristow technique base on the “Mortise-Tenon” structure concept using mini-TightRope® fixation, in order to improve the fixation and fusion of the graft, and the results showed that it can provide satisfactory fusion rate and graft positioning with a low complication rate.

Abstract

Background

The arthroscopic Bristow-Latarjet procedure is recently becoming an increasingly popular technique for treatment of recurrent anterior shoulder instability. Nevertheless, the position, fixation and fusion of the coracoid graft are still the main factors which influencing the outcomes, so also most concerned by surgeons. We developed an arthroscopic “Button-Socket” Bristow technique base on the “Mortise-Tenon” structure concept using mini-TightRope® fixation, in order to improve the fixation and fusion of the graft. The purpose of this study was to assess the positioning of the coracoid graft and the fusion rate on CT scan in the arthroscopic “Button-Socket” Bristow procedure.

Methods

The study design was a prospective series of 56 shoulders in 55 consecutive patients who received arthroscopic “Button-Socket” Bristow procedure in authors’ department. Radiological assessment on CT scan performed immediately, 3 months and 6 months post-operatively included an analysis of the fusion and the position of the coracoid bone graft using a validated method. 4:00 was considered an ideal positioning (middle point of the grafts) in the sagittal view. In the axial view, the positioning was considered as ?ush, congruent, medial, too medial, or lateral.

Results

The median age of patients was 26.8 (±9.6) years. Mean operative time was of 146.0±28.5 min. The fusion rate was of 100 % at 3 months and 98.2% at 6 months. Coracoid grafts (middle point) were positioned 04:04 h (123.8° ± 12.3°). In the axial view, 50 % of the grafts positioning were considered as ?ush, 12.5 % as congruent, 37.5 % as medial. Neither lateral nor too medial position were noted. One osteolysis occurred at 6 months follow-up and received revision surgery later, this patient suffered from epilepsy and had long term medication of carbamazepine, which may cause the abnormal bone metabolism.

Conclusion

The “Button-Socket” Bristow technique base on the “Mortise-Tenon” structure concept using mini-TightRope® fixation provides satisfactory fusion rate and graft positioning with a low complication rate. The “Mortise-Tenon” structure makes the grafts much more stable. Using mini-TightRope® fixation instead of screw can reduce the bone loss as much as possible, and also can performs a stable fixation together with “Mortise-Tenon” structure.
Level of evidence IV