Comparison of Bristow procedure and Bankart arthroscopic method as the treatment of recurrent shoulder instability


1 Department of Orthopedics, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Orthopedic Surgeon, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Orthopedics, Yazd University of Medical Sciences, Yazd, Iran

4 School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Anterior shoulder dislocation is the most common major joint dislocation. In patients with recurrent shoulder dislocation, surgical intervention is necessary. In this study, two methods of treatment, Bankart arthroscopic method and open Bristow procedure, were compared.
Materials and Methods: This clinical trial survey had been done in the orthopedic department of Alzahra and Kashani hospitals of Isfahan during 2008-2011. Patients with recurrent anterior shoulder dislocation who were candidates for surgical treatment were randomly divided into two groups, one treated by Bankart arthroscopic technique and the other treated by Bristow method. All the patients were assessed after the surgery using the criteria of ROWE, CONSTANT, UCLA, and ASES. Data were analyzed by SPSS software.
Results: Six patients (16.22%) had inappropriate condition with ROWE score (score less than 75); of them, one had been treated with Bristow and five with Bankart (5.26 vs. 27.78). Nine patients (24.32%) had appropriate condition, which included six from Bristow group and three treated by Bankart technique (31.58 vs. 16.67). Finally, 22 patients (59.46%) showed great improvement with this score, which included 12 from Bristow and 10 from Bankart groups (63.16 vs. 55.56). According to Fisher's exact test, there were no significant differences between the two groups (P = 0.15).
Conclusion: The two mentioned techniques did not differ significantly, although some parameters such as level of performance, pain intensity, use of analgesics, and range of internal rotation showed more improvement in Bristow procedure. Therefore, if there is no contraindication for Bristow procedure, it is preferred to use this method.


Simon RR, Sherman SC, Koenigsknecht SJ. Emergency orthopedics: The Extremities. 5 th ed. New York: McGraw-Hill; 2006.  Back to cited text no. 1
Schaider J, Simon RR. Shoulder Injuries. Clinical Practice of Emergency Medicine. In: Wolfson, AB, Hendey, GW, Hendry, PL. editors, Philadelphia: Lippincott, Williams and Wilkins; 2005. p. 1033.  Back to cited text no. 2
Sineff SS, Reichman EF. Shoulder joint dislocation reduction. In: Emergency medicine procedures. In: Reichman EF, Simon RR, editors. New York: McGraw-Hill; 2004. p. 593.  Back to cited text no. 3
Simonet WT, Melton LJ 3 rd , Cofield RH, Ilstrup DM. Incidence of anterior shoulder dislocation in Olmsted County, Minnesota. Clin Orthop Relat Res 1984;186:186-91.  Back to cited text no. 4
Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am 2010;92:542-9.  Back to cited text no. 5
Pulavarti RS, Symes TH, Rangan A. Surgical interventions for anterior shoulder instability in adults. Cochrane Database Syst Rev 2009;7:CD005077.  Back to cited text no. 6
Riebel GD, McCabe JB. Anterior shoulder dislocation: A review of reduction techniques. Am J Emerg Med 1991;9:180-8.  Back to cited text no. 7
Stayner LR, Cummings J, Andersen J, Jobe CM. Shoulder dislocations in patients older than 40 years of age. Orthop Clin North Am 2000;31:231-9.  Back to cited text no. 8
Pollock RG, Bigliani LU. Glenohumeral instability: Evaluation and treatment. J Am Acad Orthop Surg 1993;1:24.  Back to cited text no. 9
Chalidis B, Sachinis N, Dimitriou C, Papadopoulos P, Samoladas E, Pournaras J. Has the management of shoulder dislocation changed over time?. Int Orthop 2007;31:385-9.  Back to cited text no. 10
Te Slaa Rl, Wijffels Mp, Brand R, Marti RK. The Prognosis Following Acute Primary Glenohumeral Dislocation. J Bone Joint Surg Br 2004;86:58.  Back to cited text no. 11
Ee GW, Mohamed S, Tan AH. Long term results of arthroscopic bankart repair for traumatic anterior shoulder instability. J Orthop Surg Res 2011;6:28.  Back to cited text no. 12
Wang RY, Arciero RA, Mazzocca AD. The recognition and treatment of first-time shoulder dislocation in active individuals. J Orthop Sports Phys Ther 2009;39:118-23.  Back to cited text no. 13
Brady WJ, Knuth CJ, Pirrallo RG. Bilateral inferior glenohumeral dislocation: Luxatio erecta, an unusual presentation of a rare disorder. J Emerg Med 1995;13:37-42.  Back to cited text no. 14
Paterson WH, Throckmorton TW, Koester M, Azar FM, Kuhn JE. Position and duration of immobilization after primary anterior shoulder dislocation: A systematic review and meta-analysis of the literature. J Bone Joint Surg Am 2010;92:2924-33.  Back to cited text no. 15
Mahirogullari M, Kuskucu M, Solakoglu C, Akmaz I, Pehlivan O, Kiral A, Kaplan H. Comparison of outcomes of two diVerent surgeries in regarding to complications for chronic anterior shoulder instability. Arch Orthop Trauma Surg 2006;126:674-9.  Back to cited text no. 16
Millett PJ, Clavert P, Warner JJ. Open operative treatment for anterior shoulder instability: When and why? J Bone Joint Surg Am 2005;87:419-32.  Back to cited text no. 17
Hutchinson JW, Neumann L, Wallace W. Angus bone buttress operation for recurrent anterior shoulder dislocation in epilepsy. J Bone Joint Surg Br 1995;77:928-32.  Back to cited text no. 18
Kronberg M, Brostrom LA. Rotation osteotomy of the proximal humerus to stabilise the shoulder: Five years' experience. J Bone Joint Surg Br 1995;77:924-7.  Back to cited text no. 19
Bach BR, O'brien SJ, Warren RF, Leighton M. An unusual neurological complication of the Bristow Procedure. J Bone Joint Surg Am 1988;70:458-60.  Back to cited text no. 20
Hovelius L, Thorling GJ, Fredin H. Recurrent anterior dislocation of the shoulder. J Bone Joint Surg 1979;61:566-9.  Back to cited text no. 21
Weaver JK, Derkash RS. Don't forget the Bristow-Latarjet Procedure. Clin Orthop Relat Res 1994;308:102-10.  Back to cited text no. 22
Young DC, Rockwood CA Jr. Complications of a failed Bristow Procedure and their management. J Bone Joint Surg 1991;73:969-81.  Back to cited text no. 23
Omidi-Kashani F, Sadri-Mahvelati E, Mazlumi SM, Makhmalbaf H. Is Bristow-Latarjet operation effective for every recurrent anterior shoulder dislocation?. Arch Iran Med 2008;11:270-3.  Back to cited text no. 24
Pulavarti RS, Symes TH, Rangan A. Surgical interventions for anterior shoulder instability in adults. Cochrane Database Syst Rev 2009;4:CD005077.  Back to cited text no. 25
Abdolhossein M, Seyyedali M, Naser S. Recurrent shoulder dislocation. Iran J Orthop Surg 2006;1;11-6.  Back to cited text no. 26
Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 1994;3:347-52.  Back to cited text no. 27
Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am 1986;68:1136-44.  Back to cited text no. 28
Hovelius LK, Sandström BC, Rösmark DL, Saebö M, Sundgren KH, Malmqvist BG. Long-term results with the Bankart and Bristow-Latarjet procedures: Recurrent shoulder instability and arthropathy. J Shoulder Elbow Surg 2001;10:445-52.  Back to cited text no. 29
Jobe FW, Giangarra CE, Kvitne RS, Glousman RE. Anterior capsulolabral recon- struction of the shoulder in athletes in overhand sports. Am J Sports Med 1919;5:428-34.  Back to cited text no. 30