AJSM Webinar Series: Management of Anterior Shoulder Instability: A Highlight of the Top 4 Articles in AJSM (2024 to 2025) - Recording-Boileau - The Arthroscopically Guided Bristow-Latarjet Procedure with Cortical Button Fixation

Boileau - The Arthroscopically Guided Bristow-Latarjet Procedure with Cortical Button Fixation

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This study evaluates the long-term outcomes (minimum 10 years) of the arthroscopically guided Bristow-Latarjet procedure using posterior guided drilling and suture button fixation for recurrent anterior shoulder instability. Conducted at the Institut Universitaire Locomoteur et du Sport in Nice, France, it involved 65 patients (68 shoulders) treated between 2011 and 2013, with an average follow-up of 135 months. The procedure aimed to improve accuracy and safety over traditional methods that use freehand drilling and screws, which are associated with complications such as hardware failure, nerve injury, and osteoarthritis (OA).<br /><br />Key findings include a 94% rate of no recurrent instability, with all recurrences being traumatic and treated successfully by revision surgery. Complications such as coracoid fractures, hardware failure, or neurological injuries were absent. Most patients (94%) returned to sports, with 68% at their previous or higher level. Range of motion showed minimal restrictions in external rotation (<10° on average). Radiographically, 81% of coracoid bone grafts were properly positioned and 81% healed completely, with fibrous union or nonunion in some but without adverse clinical impact.<br /><br />OA developed or progressed in only 23% of shoulders, which is considerably lower than traditional Latarjet reports (up to 71%), and no cases showed complete joint space loss. Previous failed Bankart repairs and competitive sports participation were associated with an increased risk of OA. Patients with OA had lower subjective shoulder scores and more restricted external rotation. <br /><br />The authors conclude that using posterior-guided drilling and suture button fixation improves graft placement accuracy and safety, reduces complications related to screws, and yields durable shoulder stability with minimal motion loss and lower OA rates over a decade. This technique represents a significant advancement over traditional open or arthroscopic Latarjet procedures that employ freehand drilling and screw fixation. Limitations include the retrospective design and lack of a control group. Overall, the arthroscopically guided Bristow-Latarjet with cortical buttons is a safe, reliable, and effective long-term solution for recurrent anterior shoulder instability.

Keywords

arthroscopically guided Bristow-Latarjet procedure

posterior guided drilling

suture button fixation

recurrent anterior shoulder instability

long-term outcomes

coracoid bone graft positioning

osteoarthritis progression

shoulder stability

range of motion

complications reduction