The bristow and latarjet procedures: Why these techniques should not be considered synonymous
Journal of Bone and Joint Surgery - American Volume
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Copyright © 2014 by the Journal of Bone and Joint Surgery, Incorporated. Background: Recurrent shoulder instability is commonly associated with glenoid bone defects. Coracoid transfer procedures, such as the Bristow and Latarjet procedures, are frequently used to address these bone deficiencies. Despite the frequent synonymous labeling of these transfers as the "Bristow-Latarjet" procedure, their true equivalence has not been demonstrated. Therefore, our purpose was to compare the biomechanical effects of these two procedures. Methods: Eight cadaveric specimens were tested on a custom shoulder simulator capable of loading nine muscle groups and of accurately orienting the joint throughout shoulder motion. The specimens were tested in the intact state, following Bristow and Latarjet reconstructions of a capsulolabral injury (0% glenoid defect), and following each procedure after creation of 15% and 30% glenoid bone defects. The reconstruction order was randomized. In each condition, joint stiffness (anterior stability) and occurrence of dislocation were assessed in shoulder adduction and abduction with neutral and external rotation. Results: No significant differences (p < 0.05) in joint stiffness or stability were found between the Bristow and Latarjet reconstructions for the 0% glenoid defect in any joint position. However, substantially greater joint stiffness occurred following the Latarjet procedure, as compared with the Bristow procedure, for the 15% and 30% glenoid bone-loss conditions in adduction with neutral rotation, adduction with external rotation, and abduction with external rotation (average across the three joint positions: 8.6 ± 4.4 N/mm versus 3.9 ± 1.26.7 N/mm [p = 0.034] with 15% bone loss and 7.5 ± 4.4 N/mm versus 3.4 ± 1.5 N/mm [p = 0.045] with 30% bone loss). The Latarjet reconstruction restored the stiffness that had been measured in the intact state in eleven of the twelve tested conditions, whereas the Bristow procedure was successful in only four of the twelve conditions. In addition, during instability testing, threemore specimens dislocated following the Bristow reconstruction, compared with the Latarjet procedure, in the 15% defect condition and five more dislocated in the 30% defect condition. Conclusions: The Bristow and Latarjet procedures are not equivalent in terms of their effects on glenohumeral joint stiffness and stability in cases of glenoid osseous deficiency.