Improvement of coracoid process union rates: a comparative study of conventional open and arthroscopic-assisted Bristow procedures for treating anterior shoulder instability in rugby players.

Autor: Tanaka M; Centre for Sports Medicine, Osaka International Medical & Science Center, Osaka, Japan; Department of Orthopaedic Surgery, Osaka International Medical & Science Center, Osaka, Japan. Electronic address: makoto.tanaka@mac.com., Hirose T; Department of Orthopaedic Surgery, Osaka International Medical & Science Center, Osaka, Japan., Hanai H; Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan., Kotani Y; Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan., Kuratani K; Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan., Nakai H; Department of Orthopaedic Surgery, Osaka International Medical & Science Center, Osaka, Japan., Hayashida K; Department of Orthopaedic Surgery, Osaka Central Hospital, Osaka, Japan.
Jazyk: angličtina
Zdroj: Journal of shoulder and elbow surgery [J Shoulder Elbow Surg] 2024 Nov; Vol. 33 (11), pp. 2368-2376. Date of Electronic Publication: 2024 Apr 10.
DOI: 10.1016/j.jse.2024.02.041
Abstrakt: Background: The Bristow coracoid transfer procedure is a reliable technique for treating anterior shoulder instability in patients with large glenoid bone loss or those involved in collision sports. However, its success is marred by its inferior bone union rate of the coracoid process as compared to the Latarjet procedure. This study aimed to evaluate whether arthroscopic confirmation of the secured coracoid fixation during the Bristow procedure improves the bone union rate and clinical outcomes as compared to the open procedure.
Methods: We retrospectively reviewed 104 rugby players (n = 111 shoulders) who underwent an open (n = 66 shoulders) or arthroscopy (AS)-assisted (n = 45 shoulders) Bristow procedure at our center from 2007 to April 2019. In the AS-assisted group, the screw fixation and coracoid stability and contact were confirmed under arthroscopic visualization. Graft union was evaluated through computed tomography at 3 months, 6 months, and 1 year postoperatively. Patient-reported outcome measures were assessed based on the American Shoulder and Elbow Surgeons score, Rowe score, and satisfaction rate. Recurrence, the rate of return to play (RTP), and the frequency of pain after RTP were also assessed.
Results: The mean follow-up period was 73.5 (range: 45-160) months for the open group and 32.3 (range: 24-56) months for the AS-assisted group. In the former, the rates of bone union were 50%, 72.7%, and 88.9% at 3 months, 6 months, and 1 year, respectively. In contrast, the AS-assisted group had significantly greater bone union rates-88.9%, 93.3%, and 95.6% at 3 months, 6 months, and 1 year, respectively. Both groups showed significant improvement in the American Shoulder and Elbow Surgeons and Rowe scores compared to preoperative values as well as high satisfaction rates (open: 92%; AS-assisted: 95.7%). There were no statistically significant differences in the recurrence and RTP rates as well as the frequency of pain after RTP between the 2 groups.
Conclusion: The AS-assisted procedure allows early and high bone healing without compromising the clinical outcomes.
(Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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