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The Modified Bristow Procedure for Anterior Shoulder Instability

26-Year Outcomes in Naval Academy Midshipmen

From the Division of Orthopaedic Shoulder and Knee Surgery, Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California

^* Address correspondence to David T. Schroder, MD, Naval Medical Center San Diego, Department of Orthopaedic Surgery, 34800 Bob Wilson Dr, Ste 112, San Diego, CA 92134-1112 (e-mail: dtschroder{at}nmcsd.med.navy.mil).

Background: Many procedures have been proposed for the correction of anterior shoulder instability. Some of these procedures address the problem anatomically, such as the Bankart procedure, and some prevent instability nonanatomically, such as the Bristow-Latarjet procedure. A modified Bristow procedure was the procedure of choice for anterior shoulder instability among midshipmen at the United States Naval Academy from 1975 to 1979.

Hypothesis: The modified Bristow procedure for anterior shoulder instability provides good shoulder function and stability in the long term.

Study Design: Case series; Level of evidence, 4.

Methods: There were 52 shoulders in 49 patients reviewed at a mean follow-up of 26.4 years. The Rowe score, Single Assessment Numeric Evaluation, and Western Ontario Shoulder Instability Index were used to assess outcomes.

Results: The mean Rowe score was 81.8 (range, 5–100), and the mean Single Assessment Numeric Evaluation score was 82.9 (range, 30–100), with an overall Single Assessment Numeric Evaluation of 71.2% (37 of 52 shoulders) rated as good and excellent. The mean Western Ontario Shoulder Instability Index was 376 of 2100 (range, 0–1560). Overall, recurrent instability occurred in 8 of 52 shoulders (15.4%), with recurrent dislocation in 5 shoulders (9.6%) and recurrent subluxation in 3 shoulders (5.8%). The mean time to recurrent dislocation was 7.0 years.

Conclusion: This study represents the longest follow-up in the literature of the modified Bristow procedure. The authors have shown nearly 70% good and excellent results and recurrent instability comparable with other long-term follow-up studies of open instability procedures.

Key Words: shoulder instability • Bristow-Latarjet • nonanatomical repair • shoulder function indices

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