Elsevier

Journal of Shoulder and Elbow Surgery

Volume 13, Issue 5, September–October 2004, Pages 509-516
Journal of Shoulder and Elbow Surgery

Original article
One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: Study I—clinical results

https://doi.org/10.1016/j.jse.2004.02.013Get rights and content

Abstract

In this prospective study on the Bristow-Latarjet repair, which started in 1980 and ended in 2001, we report the outcome in 118 shoulders where the patients have been followed up for 15 years (mean, 15.2 years; range, 14.3-20.8 years). The study was based on a physical examination, scoring with the system of Rowe et al, and the patients' subjective assessment of the operative result. After 2 years, 1 of 118 shoulders had redislocated and 98% of patients were satisfied with the operative repair. At 15 years' follow-up, 1 patient had undergone revision surgery as a result of recurrence of instability. One patient had had one redislocation during the follow-up period, and one patient reported three recurrences 3 years postoperatively. This patient has had no redislocations during the last 12 years. Furthermore, one more patient had had two recurrences 9 and 12 years after surgery but was very satisfied at follow-up. Subluxations occurred once in 4 patients and several times in 7 patients. These patients were, however, satisfied with the procedures at follow-up. One patient reported posterior subluxations at follow-up. Apprehension was significantly more common in patients with bilateral instability (P = .04) and was found in 19 of 109 shoulders. Of the patients, 90 (76%) were very satisfied with the operative result, 26 were satisfied (22%), and 1 did not know. The patient with revision surgery was considered to be dissatisfied. The incidence of bilateral shoulder instability increased from 22 of 118 (19%) at the time of surgery to 41 of 117 (35%) at 15 years after surgery. We conclude that the overall clinical results, with a satisfaction rate of 98% 15 years after the Bristow-Latarjet repair, were as good as the results reported after any operative method for recurrent anterior shoulder dislocation. However, until the radiologic part of this study is completed, we recommend the procedure only for shoulders with revision because of failed previous surgery and to surgeons familiar with the method.

Section snippets

Materials and methods

During 1980 to 1985, we performed 124 Bristow-Latarjet procedures at the Orthopaedic Department, Gävle Hospital, Gävle, Sweden. Six patients died after the 2-year follow-up. There were 113 patients (118 shoulders) who underwent follow-up at 15 years (5 patients had bilateral problems). Mean and median age at surgery was 27 years and 25.0 years, respectively (SD, 8.0; range, 15-57 years). Table I shows the age when the primary dislocation occurred, the time between the initial dislocation and

Two-year results

The 2-year follow-up was undertaken in 116 of 118 shoulders that also had the 15-year follow-up. Table IV, Table V, Table VI demonstrate the results after 2 years with respect to bilateral involvement, stability, subjective and objective assessment, and loss of movement. Of 54 patients with surgery on the dominant shoulder, 27 (50%) said they had fully recovered with respect to throwing ability.

Of 6 patients who had died by the 15-year follow-up, 5 were very satisfied and 1 was satisfied after

Discussion

In this study the rate of recurrence 15 years after a Bristow procedure was just 3.4% and was 13.4% if subluxations were included. The rate of significant recurrence of instability with the need for further surgery was lower than 1% (1/118 cases). Of the patients, 98% were very satisfied or satisfied at follow-up. These figures were better than in our previous report with a shorter follow-up (2-5 years), in which we found a recurrence rate of 6% and further surgery as a result of remaining

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