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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (5): 896-901. doi: 10.19723/j.issn.1671-167X.2021.05.014

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An arthroscopic “inlay” Bristow procedure with suture button fixation: Surgical technique and radiology evaluation

SHAO Zhen-xing1,SONG Qing-fa1,ZHAO Yu-qing2,CUI Guo-qing1,△()   

  1. 1. Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
    2. Department of Radiology, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-02-18 Online:2021-10-18 Published:2021-10-11
  • Contact: Guo-qing CUI E-mail:drcuiguoqing1964@126.com

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Abstract:

Objective: To introduce an arthroscopic “inlay” Bristow procedure based on the Mortise-Tenon joint structure concept using suture button fixation, and to evaluate its clinical and radiology results postoperatively with a minimal 3-year follow-up. Methods: A total of 56 patients who received arthroscopic “inlay” Bristow procedure with suture button fixation between June 2015 to June 2016 were eventually enrolled in this study. Radiological assessment on the 3D CT scan was performed preoperatively, immediately after operation, and postoperatively at the end of 3 months, 6 months and the final follow-up. Complications postoperatively were also recorded. Results: A total of 56 patients were finally included in this study. The mean follow-up time was (36.1±3.7) months. Coracoid grafts (middle point) were positioned at about 4 o’clock (123.8°±12.3°) in the En-face view. In the axial view, 95% (53/56) of the grafts positioning were measured as flush, 5% (3/56) as medial. Bone union rate was 96.4% at the final follow-up. At the end of 3 months, 6 months, and the final follow-up, the length of the coracoid graft was 96.9%±4.9%, 91.9%±6.2%, and 91.6%±6.6% of the immediate postoperative length, respectively. Compared with the immediate postoperative length, the length measured at the end of 3 months shortened not significantly (t=2.12, P>0.05). The coracoid graft shortened more pronouncedly 6 months postoperatively (t=4.98, P<0.05) and then remained almost constant over time (t=-0.75, P>0.05), with all grafted coracoid graft retaining more than 90% of their initial length by the 3-year follow-up. And new bone formation at the junction between the coracoid graft and glenoid neck in the axial view were obviously noted in 25 cases. The quantitative evaluation showed that the glenoid area in En-face view was significantly increased at the final follow-up than that immediately after surgery [(9.72±1.22) cm2 vs. (9.42±1.11) cm2]. No degenerative changes were noted on CT images in all the patients at the final follow-up. Conclusion: This study reported a series of “inlay” Bristow procedure with suture button fixation for recurrent shoulder dislocation, providing satisfactory union rate and excellent graft positioning. And using suture button fixation instead of screw can reduce osteolysis and complications related to hardware implantation. Moreover, the bone remodeling between the coracoid process and glenoid could be beneficial to restoring the anterior stability of shoulder joint in a long term follow-up.

Key words: Joint instability, Shoulder dislocation, Arthroscopy, Suture button, Three dimensional CT imaging

CLC Number: 

  • R684.73

Figure 1

Coracoid bone graft healing process in graft-union case A-D, bone graft healing at immediately, 3 months, 6 months and final follow-up postoperatively in 3D En-Face view respectively; E-H, bone graft healing at immediately, 3 months, 6 months and final follow-up postoperatively in 2D axial view respectively. New bone formation could be noted since 3 months postoperatively as white arrow showed."

Figure 2

Osteolysis in the graft-nonunion case A-D, 3D En-Face view at immediately, 3 months, 6 months, 1 year and final follow-up postoperatively respectively; E-H, 2D axial view at imme-diately, 3 months, 6 months and final follow-up postoperatively respectively. The coracoid graft stayed nonunion at 3 months postoperatively and gradually absorbed in the following follow-up."

Figure 3

Coracoid length variation CT images were reconstructed along the long axis of the coracoid graft and the central level was selected to measure the maximum distance from the tip of the coracoid graft to the coracoid-scapular junction. A-D, coracoid measurement at immediately, 3 months, 6 months and final follow-up postoperatively in 2D axial view respectively; E, coracoid length variation."

Figure 4

Postoperative bone remodeling between the coracoid graft and the glenoid The glenoid was adjusted to En-face position in the scapular VR image, and the outermost border of the bony articular glenoid and the outermost border of the coracoid graft were outlined and their areas were measured. A, glenoid area preoperative; B, glenoid area immediately postoperative; C, glenoid area at final follow-up (glenoid area plus coracoid graft area); D, glenoid area variation."

Table 1

Occurrence of complications postoperatively (n=56)"

Complications n (%)
Hematoma 0
Neurologic injury 0
Infection 0
Hardware-related complication 0
Bone graft nonunion 2 (3.6)
Recurrent dislocation 0
Recurrent subluxation* 1 (1.8)
Glenohumeral joint arthropathy 0
Revision surgery 0
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