Arthroscopic Modified Inlay Bristow (CUIstow) Procedure Can Achieve Similar Graft Healing Rates to Arthroscopic Latarjet Surgery With a Lower Risk of Postoperative Osteoarthritis Progression.

Abstract

To compare shoulder function, recurrence rates, graft healing, and osteoarthritis progression following the arthroscopic Latarjet and modified Inlay Bristow (CUIstow) procedures in patients with anterior shoulder instability. Clinical data from anterior shoulder patients treated with either arthroscopic modified Inlay Bristow procedure or arthroscopic Latarjet procedure at our institution between 2014 and 2019 were collected with at least 2 years of follow-up. Propensity matched by age, sex, degree of the glenoid bone defect (%), and graft fixation method (screw or button) in a 1:1 ratio was conducted to compare postoperative outcomes, including clinical scores, return to sports, complications, and computed tomography assessment findings (position of the transferred coracoid, graft healing, graft absorption, and glenohumeral degenerative osteoarthritis). There were 40 matched pairs in the present study. The study revealed no significant differences between the groups in postoperative shoulder function scores, return to sports, and complications. The Latarjet group exhibited significantly greater restrictions in external rotation compared to the modified Inlay Bristow group, (45% vs 20%, respectively; P = .017). There were significant differences in the vertical positioning of the grafts between the surgical methods (P = .026), with more grafts positioned above the 3 o'clock position in the Latarjet group. Although there was no statistical difference between the 2 groups in graft healing at the final follow-up, the graft healing rate was significantly higher in the Modified Inlay Bristow group (90% vs 70%, respectively; P = .025) at the 3-month follow-up. At the final follow-up, the Latarjet group exhibited significantly more progression of osteoarthritis compared to the Modified Inlay Bristow group, with 20% of Latarjet patients progressing to moderate or severe osteoarthritis, compared with 2.5% in the modified Inlay Bristow group (P = .029). Both arthroscopic modified Inlay Bristow and arthroscopic Latarjet procedures effectively restore shoulder stability and function, but the arthroscopic modified Inlay Bristow procedure offers better external rotation, faster graft healing, and a lower risk of osteoarthritis progression. Level III, retrospective cohort study.