Patient Preparation

Anesthesia

The choice of anesthesia should be based on the following:

Comorbidities present
Preference of the patient
Preference of the surgeon
Skills of the anesthesiologist

The options for anesthesia include general anesthesia, interscalene block with light sedation, and interscalene block with general anesthesia. Interscalene block has been found to be a viable alternative to general anesthesia for the Bristow procedure. It has been shown that interscalene block results in a shorter hospital stay with significantly less blood loss and presumably imparts the advantages of local anesthesia.^[16]

Positioning

The patient is placed in a supine position on a standard operating table with a bump placed underneath the medial border of the scapula. Alternatively, the patient can be positioned supine in a beach-chair position.

Technique

Phillips BB. Recurrent dislocations. Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia: Elsevier; 2021. Vol 3: 2426-78.
Boileau P, Villalba M, Héry JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am. 2006 Aug. 88 (8):1755-63. [QxMD MEDLINE Link].
Lynch JR, Clinton JM, Dewing CB, Warme WJ, Matsen FA 3rd. Treatment of osseous defects associated with anterior shoulder instability. J Shoulder Elbow Surg. 2009 Mar-Apr. 18 (2):317-28. [QxMD MEDLINE Link].
Sugaya H, Kon Y, Tsuchiya A. Arthroscopic repair of glenoid fractures using suture anchors. Arthroscopy. 2005 May. 21 (5):635. [QxMD MEDLINE Link].
Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB. Arthroscopic stabilization in patients with an inverted pear glenoid: results in patients with bone loss of the anterior glenoid. Am J Sports Med. 2007 Aug. 35 (8):1276-83. [QxMD MEDLINE Link].
Srinivasan S, Pandey R. Current Concepts in the Management of Shoulder Instability. Indian J Orthop. 2017 Sep-Oct. 51 (5):524-528. [QxMD MEDLINE Link]. [Full Text].
Piasecki DP, Verma NN, Romeo AA, Levine WN, Bach BR Jr, Provencher MT. Glenoid bone deficiency in recurrent anterior shoulder instability: diagnosis and management. J Am Acad Orthop Surg. 2009 Aug. 17 (8):482-93. [QxMD MEDLINE Link].
Streubel PN, Krych AJ, Simone JP, Dahm DL, Sperling JW, Steinmann SP, et al. Anterior glenohumeral instability: a pathology-based surgical treatment strategy. J Am Acad Orthop Surg. 2014 May. 22 (5):283-94. [QxMD MEDLINE Link].
Schroder DT, Provencher MT, Mologne TS, Muldoon MP, Cox JS. The modified Bristow procedure for anterior shoulder instability: 26-year outcomes in Naval Academy midshipmen. Am J Sports Med. 2006 May. 34 (5):778-86. [QxMD MEDLINE Link].
Torg JS, Balduini FC, Bonci C, Lehman RC, Gregg JR, Esterhai JL, et al. A modified Bristow-Helfet-May procedure for recurrent dislocation and subluxation of the shoulder. Report of two hundred and twelve cases. J Bone Joint Surg Am. 1987 Jul. 69 (6):904-13. [QxMD MEDLINE Link].
Hovelius L, Körner L, Lundberg B, Akermark C, Herberts P, Wredmark T, et al. The coracoid transfer for recurrent dislocation of the shoulder. Technical aspects of the Bristow-Latarjet procedure. J Bone Joint Surg Am. 1983 Sep. 65 (7):926-34. [QxMD MEDLINE Link].
Hovelius L, Sandström B, Olofsson A, Svensson O, Rahme H. The effect of capsular repair, bone block healing, and position on the results of the Bristow-Latarjet procedure (study III): long-term follow-up in 319 shoulders. J Shoulder Elbow Surg. 2012 May. 21 (5):647-60. [QxMD MEDLINE Link].
Tasaki A, Morita W, Yamakawa A, Nozaki T, Kuroda E, Hoshikawa Y, et al. Combined Arthroscopic Bankart Repair and Coracoid Process Transfer to Anterior Glenoid for Shoulder Dislocation in Rugby Players: Evaluation Based on Ability to Perform Sport-Specific Movements Effectively. Arthroscopy. 2015 Sep. 31 (9):1693-701. [QxMD MEDLINE Link].
Clowez G, Gendre P, Boileau P. The Bristow-Latarjet procedure for revision of failed arthroscopic Bankart: a retrospective case series of 59 consecutive patients. J Shoulder Elbow Surg. 2021 Dec. 30 (12):e724-e731. [QxMD MEDLINE Link].
Schmidt RC, O'Neill CN, Gowd AK, Satalich JR, O'Connell RS, Waterman BR, et al. Significant Increase in Early Reoperation After Latarjet-Bristow Procedure Versus Arthroscopic Bankart Repair for Anterior Shoulder Instability: A Propensity Score Matched Analysis. Arthroscopy. 2023 Jul 31. [QxMD MEDLINE Link].
Mitchell EI, Murphy FL, Wyche MQ, Torg JS. Interscalene brachial plexus block anesthesia for the modified Bristow procedure. Am J Sports Med. 1982 Mar-Apr. 10 (2):79-82. [QxMD MEDLINE Link].
Ranalletta M, Rossi LA, Bertona A, Tanoira I, Hidalgo IA, Maignon GD, et al. Modified Latarjet Without Capsulolabral Repair in Rugby Players With Recurrent Anterior Glenohumeral Instability and Significant Glenoid Bone Loss. Am J Sports Med. 2018 Mar. 46 (4):795-800. [QxMD MEDLINE Link].
Yang JS, Mazzocca AD, Cote MP, Edgar CM, Arciero RA. Recurrent Anterior Shoulder Instability With Combined Bone Loss: Treatment and Results With the Modified Latarjet Procedure. Am J Sports Med. 2016 Apr. 44 (4):922-32. [QxMD MEDLINE Link].
Garcia JC. Arthroscopic Bristow: Assessments of Safety and Effectiveness, 12 Years of Experience. Rev Bras Ortop (Sao Paulo). 2021 Apr. 56 (2):205-212. [QxMD MEDLINE Link]. [Full Text].
Lin L, Zhang M, Song Q, Cheng X, Shao Z, Yan H, et al. Cuistow: Chinese Unique Inlay Bristow: A Novel Arthroscopic Surgical Procedure for Treatment of Recurrent Anterior Shoulder Instability with a Minimum 3-Year Follow-Up. J Bone Joint Surg Am. 2021 Jan 6. 103 (1):15-22. [QxMD MEDLINE Link].
Dai L, Wang J, Yan H. Modified Arthroscopic Bristow Procedure: Screw Fixation Without Subscapularis Split. Arthrosc Tech. 2023 Aug. 12 (8):e1249-e1257. [QxMD MEDLINE Link]. [Full Text].
Song Q, Gao A, Bai J, Shao Z, Cui G. The Arthroscopic Bristow Procedure Is Superior to the Arthroscopic Latarjet Procedure in Return to Sports but Inferior in Graft Healing: A Comparative Study With 3.4-Year Follow-Up. Arthroscopy. 2023 Dec. 39 (12):2423-2433. [QxMD MEDLINE Link].
Young DC, Rockwood CA Jr. Complications of a failed Bristow procedure and their management. J Bone Joint Surg Am. 1991 Aug. 73 (7):969-81. [QxMD MEDLINE Link].
Griesser MJ, Harris JD, McCoy BW, Hussain WM, Jones MH, Bishop JY, et al. Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review. J Shoulder Elbow Surg. 2013 Feb. 22 (2):286-92. [QxMD MEDLINE Link].

Media Gallery

The coracoid process (C) and the conjoined tendon (CT) after osteotomy.
The glenoid (G), humeral head (H), and the scapular neck (N) after division of the subscapularis and capsule.
The musculocutaneous nerve (M) is identified near the conjoined tendon (CT) in order to ensure it is not under undue tension.
The coracoid tip has been secured to the scapular neck, and the capsule and subscapularis have been repaired.

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Bristow Procedure Periprocedural Care

Patient Preparation

Anesthesia

Positioning

References

Tables

Contributor Information and Disclosures

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