Don't forget the Bristow-Latarjet procedure

The authors have been disturbed by a number of reports appearing in the past 5 years condemning the Bristow procedure because of difficulties with screw failure and misplacement, nerve damage, and tethering of the subscapularis. A retrospective study was performed comparing the Bankart and Bristow procedures as performed by the authors during a 10-year period. Complications, rate of recurrence, presence of subluxation, range of motion, return to activity, strength, pain, and overall satisfaction were evaluated. There were 85 patients in the study, of which 61 had the Bristow operation and 24 were treated with the Bankart procedure. The minimum followup was 2 years. Very little difference was found between the 2 operations in any of the parameters studied, and in the authors' opinion, the Bristow procedure remains a reasonable alternative to the Bankart operation. The range of abduction, external rotation, and strength compared favorably with the Bankart group. The authors have encountered instances wherein capsular deficiency rendered the accomplishment of the Bankart procedure difficult or unreliable. Four such cases are reported. Under these circumstances, the Bristow served as a reliable alternative. Technical recommendations for avoiding the difficulties that have led to the condemnation of the Bristow procedure are described in detail.