The Pros and Cons of Bristow vs Latarjet for Rugby Athletes

There are advantages and disadvantages to both the Latarjet and Bristow procedure for rugby players, new research shows.

The study, “Open Bristow Versus Open Latarjet for Anterior Shoulder Instability in Rugby Players: Radiological and Clinical Outcomes,” was published online on May 12, 2022, in Orthopaedic Journal of Sports Medicine.

“Coracoid transfer is a reliable method for managing anterior shoulder instability in athletes who play contact sports; however, differences between the Bristow and Latarjet procedures are unclear,” the researchers wrote.

For their study, they compared clinical outcomes and rates of bone union and bone resorption of the coracoid process between the two procedures in rugby players. Sixty-six shoulders underwent open Bristow procedure and 35 underwent open Latarjet procedure. All of them were reviewed retrospectively for anterior shoulder instability.

The researchers evaluated graft union and resorption using computed tomography at 3 months to 1 year postoperative. Patient-reported outcome measures, including American Shoulder and Elbow Surgeons score, Rowe score, and satisfaction rate were also obtained. The mean follow-up was 74 months (range, 45-160 months) for Bristow and 64 months (range, 50-76 months) for Latarjet.

Recurrence and the rate of return to play, frequency of pain after return to play and retirement rate after return to play were all evaluated.

In 97.1% of the Latarjet procedure cases, bone union of the coracoid was achieved at 3 months postoperatively; however, bone union was achieved in only 72.7% of the Bristow procedure cases at 6 months postoperative.

Bone resorption of the coracoid process occurred in 6.1% of shoulder after the Bristow procedure, whereas 100% of shoulders showed bone resorption after the Latarjet procedure.

Overall, there were no statistical differences in outcome scores between the two procedures. Subluxation and persistent pain after returning to sports were identified at a significantly higher rate in the Latarjet group (5 shoulders and 9 shoulders, respectively, than in the Bristow group (2 shoulders and 2 shoulders, p = .001, respectively).

“The Latarjet procedure had an advantage in the early and high rate of bone union but was at a disadvantage in bone resorption compared with the Bristow procedure. Subluxation and pain after returning to sports were more frequent in patients who underwent the open Latarjet procedure than in those who underwent the open Bristow procedure,” the researchers wrote.

The study authors included Makoto Tanaka, M.D., Ph.D., of Daini Osaka Police Hospital in Japan, Hiroto Hanai, M.D., of Osaka University Graduate School of Medicine, Japan, Yuki Kotani, M.D., also of Osaka University Graduate School of Medicine, Kosuke Kuratani, M.D., of Japan Community Healthcare Organization Osaka Hospital, Hidekazu Nakai, M.D. and Shuma Kinoshita, M.D., of Daini Osaka Police Hospital in Japan, Takehito Hirose, M.D., of Osaka University Graduate School of Medicine and Kenji Hayashida, M.D., Ph.D., of Daini Osaka Police Hospital in Japan.