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Bristow Versus Latarjet In High-Demand Athletes With Anterior Shoulder Instability: A Prospective Randomized Comparison


Paulo Henrique Schmidt Lara, MD
BRAZIL

Bristow Versus Latarjet In High-Demand Athletes With Anterior Shoulder Instability: A Prospective Randomized Comparison

Paulo S. Belangero, MD, PhD, BRAZIL Paulo Henrique Schmidt Lara, MD, BRAZIL Leandro MASINI Ribeiro, BRAZIL Eduardo A. Figueiredo, MD, BRAZIL Carlos V. Andreoli, PhD, BRAZIL Alberto C. Pochini, MD, PhD, BRAZIL Benno Ejnisman, MD, BRAZIL Ricardo Luiz Smith, Prof., BRAZIL

Center of Sports Medicine of the Paulista School of Medicine of the Federal University of São Paulo, São Paulo, São Paulo, BRAZIL

2021 Congress   Abstract Presentation   5 minutes   Not yet rated

 

Anatomic Location

Shoulder Glenohumeral

Anatomic Structure

Bones Labrum

Diagnosis / Condition

Instability Dislocation

Treatment / Technique

Autograft

Patient Populations

Female Athletes Professional Athletes / Olympians Sport Specific Population

Diagnosis Method

X-ray CT-Scan

Sports Medicine

Sport Specific Injuries

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Summary: Bristow x Latarjet in high-demand athletes

Background

Traumatic anterior shoulder instability is a common disease, especially in young athletes. The Latarjet and Bristow techniques are non-anatomical surgeries that involve the transfer of the coracoid process to the anterior border of the glenoid and are indicated in cases at a high risk for recurrence and in the presence of associated bone lesions. Studies have evaluated the recurrence and complications associated with these techniques, but they have important differences, and should not be considered synonymous. The objective of this study was to prospectively compare the Bristow and Latarjet techniques in high-demand athletes. Hypothesis: Bristow and Latarjet techniques lead to similar results. Patients and methods: Thirty-seven athletes (41 shoulders; three athletes underwent bilateral surgery) with anterior recurrent dislocation of the shoulder that were surgically treated using the Bristow or Latarjet technique were prospectively analyzed according to range of motion, functional scores, sports return rate and complications. The inclusion criteria for this study were anterior shoulder instability, no history of a shoulder procedure, high demand sports participation (more than 7 hours/week), 10-20% glenoid bone erosion in computed tomography scans and at least 60 months of follow-up. The follow-up time was 5 years. The mean age was 26.4 years (range: 16-46 years). Results: Elevation and lateral rotation (passive and active) achieved values in the final follow-up similar to those found in the preoperative period. The mean postoperative scores after five years were as follows: ASES, 79,1 (range: 66–95); ASORS, 77,8 (range: 60–100); WOSI, 52,6 (range: 18–77); and VAS, 1,88 (range: 0–6). All of the results presented statistical significance. We did not have any case of redislocation. However, seven (17%) patients presented positive apprehension test (Three (16%) patients in the Bristow and four (18%) in the Latarjet group). Our results showed two cases of graft reabsorption that needed surgery to screw removal (one in each group). Two cases of screw malpositioning (with the graft being intra articular). Both cases were in the Bristow group and were surgically revised in two weeks from initial surgery. Comparing both procedures we found no statistically significant difference in active external rotation and active elevation. We found a statistically significant difference in passive external rotation in favor of the Latarjet technique four weeks after surgery (Latarjet average: 29,1 degrees; Bristow average: 20,53 degrees; p=0,01). We also found a statistically significant difference in passive elevation in favor of the Latarjet technique eight weeks after the surgery (Latarjet average: 132,73 degrees; Bristow average: 120,21 degrees; p=0,04). We found no statistically significant difference between both techniques regarding the functional scores (ASES, ASORS and WOSI). Comparing both procedures regarding sports return and complications there was no statistically significant difference. Conclusion: The Bristow and Latarjet techniques showed significant improvement in functional scores, a low complication rate, an absence of recurrence, a good return to sports rate, and preservation of the shoulder range of motion. The Latarjet technique showed better results in the initial range of motion, but in the last follow-up, both procedures yielded similar ranges of motion.

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