AJSM Webinar Series: Management of Anterior Shoulder Instability: A Highlight of the Top 4 Articles in AJSM (2024 to 2025)-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 presents a minimum 10-year follow-up evaluation of the arthroscopically guided Bristow-Latarjet procedure for recurrent anterior shoulder instability using cortical button fixation and a posterior guided drilling technique. Conducted at the Institut Universitaire Locomoteur et du Sport, Nice, France, it analyzed 65 patients (68 shoulders) treated between 2011 and 2013.<br /><br />Key findings include a 94% rate of no recurrent instability at a mean follow-up of 135 months, with all recurrences being traumatic and treated successfully with revision surgery. There were no hardware failures, coracoid fractures, or neurological complications observed. Range of motion showed minor, non-significant deficits in external rotation compared to the contralateral side. Importantly, 94% of patients remained active in sports, with 68% returning at the same or higher level. Patient-reported outcomes, including the Walch-Duplay, Rowe, and Constant-Murley scores, significantly improved postoperatively.<br /><br />CT imaging revealed precise positioning of the coracoid bone graft in 97% of cases, with 81% demonstrating bone graft healing and 9% fibrous union, none of which affected clinical outcomes. Glenohumeral osteoarthritis (OA) appeared in 26% of shoulders at follow-up, mostly mild to moderate, with no cases of complete joint space loss (Samilson-Prieto stage 4). Previous failed Bankart repairs and competitive sports participation were associated with increased OA risk. OA presence correlated with lower subjective shoulder scores and reduced external rotation.<br /><br />The study highlights advantages over traditional screw fixation methods, which are associated with higher complication and reoperation rates, shoulder pain, and hardware-related issues. The guided posterior glenoid drilling improves accuracy and safety by avoiding neurovascular injury, while suture button fixation minimizes hardware complications and facilitates bone graft healing.<br /><br />Limitations include its retrospective design, lack of a control group, and 30% loss to follow-up. Nonetheless, this procedure offers a safe, reproducible, and durable solution for anterior shoulder instability, enabling high rates of sports return, minimal motion restrictions, and low long-term OA incidence. It represents a significant advancement in surgical technique by enhancing fixation reliability and reducing complications inherent in freehand screw-based Latarjet procedures.

Keywords

Bristow-Latarjet procedure

anterior shoulder instability

cortical button fixation

posterior guided drilling

long-term follow-up

shoulder range of motion

bone graft healing

glenohumeral osteoarthritis

sports return rate

surgical complications