Arthroscopic Screw Removal After Arthroscopic Latarjet Procedure

Abstract

Arthroscopic Latarjet procedure is an efficient and reliable approach for the treatment of shoulder instability. Nevertheless, the screws fixing the bone block may sometimes be responsible for pain and uncomfortable snapping in the shoulder that is triggered during active external rotation. We propose an all-arthroscopic technique for screw removal in cases of complications involving the screws from a Latarjet procedure. The all-arthroscopic screw removal is reliable and efficient. This procedure is indicated in more cases than thought because of the bone block resorption. It permits a revision of the glenohumeral joint in case of persisting pain.

Latarjet Cerclage: The Metal-Free Fixation

“…4,6 Other reported screw-related complications include capsular and subscapular muscle irritation or iatrogenic nerve injurydinvolving the suprascapular, musculocutaneous, or cubital nerves. 9,[22][23][24][25] Even though clinically relevant neurologic injury is not common, fixation with screws also may lead to graft osteolysis, cut out, and symptomatic hardware, as previously mentioned. 26 These problems may require the removal of the screws by an open or arthroscopic approach.…”

“…26 These problems may require the removal of the screws by an open or arthroscopic approach. 23 In addition, failure of screw fixation may result from fractures through one or both drill holes, overtightening of the screws at the coracoid bone block or even from screw breakage in bone graft resorption or pseudarthrosis. 9,19,27,28 Apart from the most widely used metal screws, other devices have been used in coracoid process fixation such as metallic buttress plates, bioabsorbable screws, and cortical buttons.…”

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

“…The screws used for fixing the bone block may be responsible for pain and uncomfortable snapping in the shoulder that is triggered during active external rotation 11 and may require screw removal. 12 The round buttons are smaller than screws and lie flush with the coracoid, avoiding soft-tissue irritation. A further advantage of using buttons compared with using screws is represented by the smaller holes that need to be drilled in the coracoid process (Table 1).…”

Editorial Commentary: Arthroscopic Latarjet Shoulder Stabilization: Where Are We? Where Are We Going?

“…Some groups already began to publish how to manage complications of the arthroscopic Latarjet (ie, screw removal). 24 The author of the present commentary believes that clinical and surgical observations must continue to spur further research. It is crucial that we state the obvious, so we can analyze and understand the causes of failure to find solutions to every single difficulty, and to try to answer the simple but basic questions.…”