2017 ISAKOS Biennial Congress ePoster #2022

 

Arthroscopic Socket Bristow: A Novel Surgical Procedure for Treatment of Recurrent Anterior Shoulder Instability

Lin Lin, MD, PhD, Beijing CHINA
Guoqing Cui, MD, Beijing CHINA

Institute of Sports Medicine, Peking University 3rd Hospital, Beijing, Beijing, CHINA

FDA Status Not Applicable

Summary

Arthroscopic Socket Bristow for treatment of recurrent anterior shoulder instability

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Abstract

Background

Recently, arthroscopic Latarjet in the treatment of anterior shoulder instability is getting popular. However, the prevalence of non-union and osteolysis remains high up to 10-20%. There has been no previous description of the Bristow procedure being performed arthroscopically. We present the first report of a new surgical technique, the arthroscopic socket Bristow procedure. The purpose of this study is to introduce a novel arthroscopic coracoid process transfer procedure to facilitate bone block healing.

Materials And Methods

From May 2015 to May 2016, 30 patients (mean age, 27.5 years) underwent arthroscopic socket Bristow combined with Bankart repair. A specific designed instrument was developed to accomplish this procedure. The most important feature of this technique is that a coracoid process was placed into a socket (about 10mm deep) in the glenoid neck, which significantly increase the bony contact area of block and glenoid neck. A screw was used to fix the bone block to the glenoid neck. Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging. Clinical examinations were performed at each follow-up visit.

Results

No neurologic complications were observed and no patients required further surgery. All patients had a stable shoulder. Postoperative CT scan showed that the position of transferred bone block was below the equator in 97% (29/30) with 4:10 (from 3:50 to 5:00). The coracoid graft was positioned strictly tangential to the glenoid surface in 97% (29/30) of the cases with average 0.68mm below the surface. The coracoid graft healed in 69 patients (91%). At 3-month follow-up, one case (1/30) showed osteolysis and one case (1/30) showed partial union. At 6-month follow-up, 76.9% of cases (10/13) completely healed and 3 cases partially healed. No union was found at follow up thus far.

Conclusion

Arthroscopic socket Bristow procedure optimized graft positioning accuracy and improved graft healing at short term follow-up in this study. Because the duration of follow-up is short, we can not evaluate the recurrent rate in this study. Long term follow-up is guaranteed to confirm the effects of this new procedure. But our early results showed significant graft healing rate and position accuracy, which might predict good results of this technique.