Results of Modified Mini-Open Arthroscopically Assisted Bristow - Latarjet - Bankart Procedure

The aim of the study — to evaluate clinical outcomes, complications, bone-block healing, positioning and subscapularis muscle insufficiency after modified mini-open arthroscopically assisted Bristow - Latarjet - Bankart procedure. Materials and Methods. The study included 133 patients who underwent modified mini-open arthroscopically assisted Bristow - Latarjet - Bankart procedure, assessed the functional outcome using the Rowe and Walch-Duplay scales, the range of motion and stability of the joint, and the function of the subscapularis muscle. All patients underwent CT, 82 patients were assessed for MR-signs of subscapularis muscle atrophy. Results. All patients were satisfied with the treatment results. The mean value on the Rowe scale increased from 35.7 [31,2; 41,0] to 91.3 [82,1; 96,8] (38 to 100 Me 90) (p<0.001) and on the Walch-Duplay scale from 41.5 [34,2; 44,5] to 88.9 [80,4; 97,2] (32 to 100, Me 88) (p<0.001). In 2 (1.5%) patients, shoulder dislocation recurred, in 9 (6.8%) patients, a positive test of premonition of dislocation or periodic feelings of instability were observed. There were no persistent contractures. In 6 (4.5%) cases, the graft was located medially and in 3 (2.3%) cases — laterally. The average α-angle was 14° [5°; 24°] (2° to 39°, Me 15). The proportion of the graft area lost due to resorbtion was 19% [9%; 30%] (from 6 to 58%, Me 20). Nonunion of the graft was observed in 4 (3.0%) patients, 2 (1.5%) of whom had a fracture and bone block migration. A significant (p = 0.021) decrease in the intensity of the MR-signal of the subscapularis muscle was observed, most pronounced in the lower portion. In 9 patients with a positive test of anticipation of dislocation or sensations of instability, the degree of bone block resorption (p = 0.038) and MR-signs of atrophy of the upper and lower portions of the subscapularis muscle were significantly higher (p = 0.031 and p<0.001), and the results of stress testing significantly worse (p<0.001) than in 122 patients without signs of instability. Conclusion. The results of this study show the efficacy of the modified arthroscopically-assisted Bristow - Latarjet - Bankart procedure in patients with large bone defects, when the soft tissue technique is not a reasonable option.