Clinical Results of Bristow and Latarjet Procedures in Patients With Anterior Shoulder Instability: A Systematic...

Anterior shoulder instability poses a significant challenge, particularly in active populations. The Bristow and Latarjet surgical approaches address this issue; however, their comparative efficacy remains debated. This study conducted a meta-analysis of randomized controlled trials and observational studies to assess the efficacy of the Bristow and Latarjet procedures in patients with anterior shoulder instability. We searched electronic databases, including CENTRAL, MEDLINE, and EMBASE, for both randomized controlled trials and observational studies from inception to May 2023. To ensure the inclusion of recent evidence, we conducted an updated search in March 2025 to identify studies published between May 2023 and March 2025. We included studies that recruited patients with anterior shoulder instability and compared the Bristow and Latarjet procedures. The primary outcomes included redislocation rates, instability symptoms, and the Rowe score. The secondary outcomes included return to sports, bone nonunion, bone resorption, and operative complications. The methodological quality of included studies was assessed using the RoB 2 (Risk of Bias 2) tool for randomized controlled trials and the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool for nonrandomized studies. Meta-analysis using random-effects models was performed to determine the significance of the pooled results. The database search yielded 3,115 records, four of which met the inclusion criteria, comprising a total of 354 patients with 383 shoulders (211 shoulders treated with the Bristow technique and 172 with the Latarjet technique). For the primary outcome of redislocation, all the studies included in this review reported no events in any patient who underwent either the Bristow or Latarjet procedure. In addition, there was no significant difference in instability symptoms between the Bristow and Latarjet procedures (risk ratio (RR), 0.66; 95% confidence interval (CI), 0.16-2.66; P = 0.55). The Rowe score showed a significant difference between the Bristow and Latarjet procedures (mean difference, 1.73; 95% CI, 0.38-3.07; P = 0.01); however, the observed difference did not reach the minimal clinically important difference. Among the secondary outcomes, there were no significant differences between the two procedures in return to sports (RR, 1.00; 95% CI, 0.94-1.07; P = 0.93), bone nonunion (RR, 2.09; 95% CI, 0.94-4.62; P = 0.07), or complications (RR, 1.06; 95% CI, 0.45-2.49; P = 0.90). Three studies used different methods and definitions for evaluating bone resorption; therefore, we did not analyze it. There is currently insufficient evidence to conclude a difference in postoperative outcomes between the Bristow and Latarjet procedures, primarily due to the limited number of included studies, which reduces statistical power and affects the precision of effect estimates. Further high-quality randomized controlled trials focusing on symptoms of instability are needed to inform appropriate procedure selection.