A modification of Bristow Latarjet procedure and results at 2 years follow-up
Author(s): Dr. Raja Shekhar K, Dr. Kopuri Ravi Kiran and Dr. Lenin Chinnusamy
Abstract:Background: Recurrent instability and deficits of shoulder function are common after a primary traumatic anterior shoulder dislocation. The possibility of recurrent dislocation decreases with increasing age at primary dislocation. Open surgeries have been traditionally used for treatment of anterior glenohumeral instability of which coracoid bone transfer have stood the test of time ever since. Though Bristow-Latarjet procedure is a time tested and well-practiced procedure, it is not free of complications.
Aims: To describe the surgical technique performed by us and highlight on the advantages with the modifications in the standard Bristow Latarjet procedure.
Methods: A prospective study was performed on 24 patients suffering from recurrent anterior shoulder instability with anteroinferior glenoid loss, who were treated with the technique described by us over a three year period. A modified Bristow Latarjet procedure was used to treat our patients. The modifications included using congruent arc coracoid bone block, and addition of supero-inferior capsular plication with reattachment of coraco-acromial ligament to superomedial capsule. Balg and Boileau index was used for selecting our patient group. All patients were followed for a minimum of 24 months and had a regular radiological evaluation. Results – there were 20 male and 4 female patients with all patients having the dominant extremity involved. The average number of pre-operative dislocations was 5 (range 3 to 10). No patient had recurrent instability after the procedure. Walch-Duplay scores at last follow-ups are as follows; excellent 75%, good 25%. 4 patients had mildly reduced external rotation at 90° abduction (average 5°).
Conclusion: Recurrent instability due to bone loss is a difficult problem that is not amenable to traditional soft tissue stabilization procedures. The modifications described by us in the traditional Bristow Latarjet procedure give excellent stability without compromising the range of movements and may theoretically, prevent delayed osteoarthritis. However, further clinical trials involving larger case group followed over a greater time period is necessary to confirm these preliminary results.