Comparing Bristow and Latarjet Procedures for Anterior Shoulder Instability in Competitive Rugby Players: A Unique Within-Subject Clinical Analysis.

Abstract

Anterior shoulder instability is a significant concern in collision sports like rugby, often requiring surgical intervention. The Bristow and Latarjet procedures are commonly performed coracoid transfer techniques alongside Bankart repair; however, direct comparisons of their clinical outcomes within the same individuals remain unexplored. This study aimed to compare the clinical outcomes of the Bristow and Latarjet procedures in competitive rugby players who underwent both surgeries on contralateral shoulders. We hypothesized that the Bristow procedure would yield superior patient-reported outcomes. Between 2010 and 2022, 503 shoulders underwent coracoid transfer procedures with Bankart repair. Of these, 10 rugby players (20 shoulders) who received the Bristow procedure on one shoulder and the Latarjet procedure on the other were retrospectively investigated. Clinical assessments included postoperative range of motion (ROM), clinical scoring outcomes (ASES, Rowe, WOSI index, satisfaction rate), recurrence rates, residual apprehension, and pain requiring injection treatment more than 2 years postoperatively, which were compared between two procedures. Additionally, postoperative graft healing and resorption were analyzed using CT scan. Both procedures led to significant improvements in clinical scores. However, the WOSI index at final follow-up was significantly better on the Bristow side (96 ± 100 vs. 373 ± 376, p=0.014). Specific WOSI subdomains, particulary those related to physical symptoms and emotional factors, showed superior scores on the Bristow side. Only on the Latarjet side, an earlier return to play was statistically associated with a worse WOSI index. No recurrence was observed on the Bristow side, whereas two cases of subluxation occurred on the Latarjet side. CT evaluation revealed higher coracoid graft resorption rates on the Latarjet side. The Bristow procedure resulted in superior WOSI index scores compared to the Latarjet procedure within the same individuals among competitive rugby players.