title: Arthroscopic Bristow procedure for anterior instability in shoulders with a stretched or deficient capsule: the "belt-and-suspenders" operative technique and preliminary results.
abstract: OBJECTIVE
  We report the results of a new technique consisting of a combined arthroscopic Bankart repair associated with a transfer of the coraco-biceps tendon to reinforce the deficient anterior capsule by lowering the subscapularis.
  
  
  METHODS
  The procedure combines 2 parts: an arthroscopic Bankart repair, which recreates the glenoid concavity and retensions the inferior glenohumeral ligament (i.e., "the belt," or intra-articular ligamentoplasty), and an arthroscopic transfer of the conjoined tendon with a coracoid fragment, to reinforce the stretched or torn inferior glenohumeral ligament (i.e., "the suspenders," or extra-articular ligamentoplasty). The coracoid fragment is exteriorized, shaped, and calibrated, and a tenodesis of the coraco-biceps tendon is performed above the subscapularis tendon by fixing the coracoid fragment with a bioabsorbable interference screw in a glenoid socket in the scapular neck. Thirty-six patients were available for clinical and radiographic review with a minimum 1-year follow-up.
  
  
  RESULTS
  Of the patients, 28 (78%) were very satisfied, 5 (14%) were satisfied, and 3 (8%) were disappointed. In comparison to the contralateral shoulder, postoperative mobility revealed no loss of active anterior elevation, a mean deficit of 9 degrees in external rotation with the arm at the side, a mean deficit of 15 degrees in external rotation in abduction, and no loss of internal rotation. The mean Walch-Duplay score was 87 points. Failures occurred in 3 patients (8%) who presented with recurrent instability.
  
  
  CONCLUSIONS
  This new intra- and extra-articular combined technique constitutes an alternative in the treatment of anterior shoulder instability in patients with deficient or stretched anterior capsule. It combines the theoretic advantages of the Bristow bone-block procedure and the arthroscopic Bankart repair while eliminating the potential disadvantages of each.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, University of Nice, Nice, France. boileau.p@chu-nice.fr
authors.forename: Pascal
authors.initials: P
authors.lastname: Boileau
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Bicknell
authors.forename: A Benchikh
authors.initials: AB
authors.lastname: El Fegoun
authors.forename: Christopher
authors.initials: C
authors.lastname: Chuinard
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D001265:Athletic Injuries / Q000601:surgery; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000601:surgery; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012783:Shoulder Dislocation / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*; D013709:Tendon Transfer; D016896:Treatment Outcome