Recurrent anterior dislocation of the shoulder joint is a common disorder of the shoulder
joint. Patients with recurrent anterior dislocation of the shoulder severely affect movement
and quality of life, and severe cases can lead to severe dysfunction of the shoulder joint.
Nowadays, arthroscopic Bankart surgery is routinely used to treat such patients. However, the
recurrence rate of shoulder dislocation with conventional arthroscopic Bankart repair is high
in professional athletes with very high levels of athleticism and in complex patients with
large glenoid bone defects. For this population, coracoid transfer surgery (Bristow-Latarjet
procedure) is currently considered to have better efficacy.
The Latarjet procedure is now relatively well established internationally; however, this
technique has a large osteotomy block and uses two hollow screws to fix the bone block. This
is very traumatic and cannot be used in patients with small coracoid, and there is a high
incidence of postoperative bone resorption of the bone block, and in the event of severe bone
resorption, the screws left behind are more damaging to the subscapularis tendon. In
contrast, the Bristow procedure is relatively less invasive, but the early healing rate of
the grafted bone block is lower than that of the Latarjet procedure. In response to this
problem, the group improved the Bristow procedure in a previous clinical study by using an
embedded technique to fix the bone block, which is the first of its kind in the world, and
the investigators named it the Chinese Unique Inlay Bristow (Cuistow) procedure. The
description and clinical results of this procedure have been accepted by the American Journal
of Sports Medicine, and the technique is now a routine procedure in our department.
There is still some debate as to whether the classical coracoid procedure should be performed
arthroscopically or open. Open surgery is more traumatic, but relatively easy to perform,
with a shorter operative time and a shorter learning curve to master the technique;
arthroscopic surgery is less traumatic, with faster recovery, but relatively more expensive
and requires higher surgical skills. Some studies have concluded that there is no significant
difference between the two in terms of long-term postoperative outcomes and complications. In
our previous study, the investigators found that the use of our first " Mortise and Tenon
structure " bone displacement fixation resulted in better early postoperative stability and
higher postoperative bone healing rates than the traditional coracoid transfer procedure.
However, it is unknown whether there is a difference in clinical outcomes and postoperative
bone healing rates using open surgery compared to arthroscopic surgery.
In this study, a prospective observational study was conducted in which the advantages and
disadvantages of arthroscopic and open surgery for Cuistow procedure were explained to the
patient before surgery, and then the patient chose one of the surgical approaches according
to his or her own wishes. The functional recovery and bone resorption of the two groups were
compared, and the two surgical approaches were evaluated to determine whether there were
significant differences in postoperative bone healing rates and clinical outcomes between the
two surgical approaches.
In conclusion, the aim of this study was to evaluate the advantages and disadvantages of the
two surgical approaches through a comparative study. The investigators wish to provide a
complete systematic solution for the treatment of difficult and complex recurrent anterior
shoulder dislocations, and to provide an effective remedy for cases of recurrence after
Bankart surgery.