Arthroscopic Latarjet Procedure Combined With Bankart Repair: A Technique Using 2 Cortical Buttons and Specific Glenoid and Coracoid Guides

Abstract

The arthroscopic Latarjet procedure is challenging because it can be difficult to place 2 screws parallel to the glenoid surface and a medial portal (dangerous for the brachial plexus) is mandatory. In addition, precise positioning of the coracoid bone block flush with the joint line and in a subequatorial position as recommended is troublesome without the use of a guiding system because of the arthroscopic lens distortion. To improve the reproducibility of the arthroscopic Latarjet procedure and to minimize the risk of nerve complications, we developed a guiding system to optimize the positioning of the coracoid bone block and 2 cortical buttons to facilitate its fixation. Four portals are used: a posterior standard portal and 3 anterior portals, all lateral to the conjoint tendon. The anterior rim of the glenoid and the coracoid process are prepared. Two holes are drilled in the glenoid and in the coracoid process with 2 specific guides. The subscapularis is then split, and 2 cortical buttons are passed from posterior to anterior through the tunnels with a shuttle relay. The coracoid process undergoes osteotomy and is guided through the split in the subscapularis to the anteroinferior rim of the glenoid by pulling on the cortical buttons.

Latarjet with cortical button fixation is associated with an increase of the risk of recurrent dislocation compared to screw fixation

“…Several types of fixation have been proposed to secure the coracoid process to the glenoid. These include one [17] or two metallic screws [1], bioabsorbable screws [4], metallic plates [14] and more recently one [7] or two cortical buttons [32]. Most studies report the results of one or two metallic screws, as this is how the technique was originally described [22].…”

Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: a prospective randomized trial

“…44,64 Although several modifications exist including arthroscopic execution, options for bone graft fixation, alternative bone harvesting sites, or use of allografts, both described procedures maintain their distinctive character. 3,4,8,17,26,34,35,41,47,52,[56][57][58][59][60][61][62]66 Although several articles on the clinical outcomes of both procedure types have been published and the superiority of one technique over the other has been a common topic at several shoulder conferences, no randomized comparative trials with a high level of evidence are currently available. 2,40 The goal of this study was to perform a prospective randomized trial comparing both competing techniques to provide more reliable data for discussion.…”

Arthroscopic Latarjet Procedure: A Technique Using Double Round ENDOBUTTONs and Specific Glenoid and Coracoid Guides

“…13 The failure mechanisms were unique to each fixation technique: specimens fixated with screws underwent graft fracture through the drill holes, and specimens fixated with ENDOBUTTONs underwent failure due to glenoid bone fractures. An advantage of the current suture-button fixation technique is the smaller diameter of the 2 holes drilled in the glenoid in comparison to those previously described by Valenti et al 5 (i.e., 2.8 mm vs. 3.5 mm).…”

“…Lafosse et al 2 used 7 portals to perform the first full arthroscopic procedure, including a medial portal for the subscapularis split and introduction of the cannula for coracoid handling and fixation. Boileau reduced the number of portals required to perform the procedure to 6 4 , and Valenti et al 5 described an arthroscopic technique performed with only 4 portals, all lateral to the conjoint tendon. The current technique involves 6 portals that are all lateral to the conjoined tendon.…”

“…1 Notwithstanding the satisfactory postoperative outcomes reported by Boileau et al, the use of only one cortical button has been recently hypothesized to expose the graft to rotation around the button, thus compromising the graft-healing process. In lieu of this, Valenti et al 5 developed a guiding system to position the coracoid process with 2 cortical buttons to provide stable and secure fixation on the bone block without the risk of hardware complications related to screws. This Technical Note describes our fully arthroscopic Latarjet technique procedure using 2 pairs of round buttons and specific glenoid and coracoid guides (Fig 1).…”