Clinical and Radiographic Outcomes After Arthroscopic Inlay Bristow Surgery With Screw Versus Suture Button Fixation: A Comparative Study of 117 Patients With 3.3-Year Follow-up

Abstract

Background: Some studies have advocated the use of suture button fixation during Bristow-Latarjet surgery to reduce complications associated with screw fixation. However, data comparing these fixation methods are relatively incomplete. Purpose: To investigate the efficacy of modified arthroscopic Bristow-Latarjet surgery and compare the clinical and radiographic outcomes using screw versus suture button fixation. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 136 patients with traumatic anterior shoulder instability who underwent the modified arthroscopic Bristow-Latarjet surgery between June 2015 and February 2018. Of these patients, 117 who met the inclusion criteria were enrolled at a mean follow-up of 3.3 ± 0.7 years. Shoulders were separated into 2 groups based on fixation technique: screw fixation (group A; n = 63) or suture button fixation (group B; n = 54). Computed tomography imaging findings and clinical results were assessed preoperatively; immediately after operation; and postoperatively at 3 months, 6 months, 1 year, and final follow-up. Results: There were no significant differences between the groups in terms of postoperative clinical scores, the level of return to sports, range of motion, graft position, or reoperation rates. Bone healing was observed in 97.4% of the cases overall (114/117), with 98.4% bone union in group A and 96.3% in group B at final follow-up. Bone absorption was more common in group A (n = 30; 47.6%) compared with group B (n = 10; 18.5%) ( P = .003). There were no hardware-related complications in group B, compared with 7.9% of patients in group A ( P = .034). One patient in group B had a recurrent dislocation due to an unexpected event, and there were no recurrent dislocations in group A. Conclusion: After the modified arthroscopic Bristow-Latarjet procedure, both suture button and screw fixation methods demonstrated high bony healing rates and low risk of recurrence. Less coracoid graft resorption and no hardware-related complications were seen with suture button fixation.

Previously failed Bankart repair and the duration from first dislocation to surgery were the risk factors associated with the level of return to sports after coracoid transfer

“…Third, we included two different fixation techniques (screw and button) in the same analysis and there was no subgroup analysis regarding this factor. However, previous studies have shown that fixation methods are not associated with RTS [26]. Finally, another limitation was that the proposed classification of RTS is still not validated in other studies.…”

“…The evaluation consisted of the following: the graft placement was evaluated using CT scans obtained immediately following surgery. The bone graft was considered lateral if it went beyond the glenoid rim by more than 2 mm, and it was judged to be medial if it was medial to the rim by more than 2 mm [26]. The α angle was defined as the angle between the axis of the screw (or the bone tunnel, button fixation) and the glenoid rim.…”

“…Generally, patients underwent modified arthroscopic Bristow (with screw or suture‐button fixation) procedure as described in the previous studies [19, 25]. After surgery, the patients were given a uniform set of standardised rehabilitation guidelines [26].…”

Radiological and Histological Analyses of Nonrigid Versus Rigid Fixation for Free Bone Block Procedures in a Rabbit Model of Glenoid Defects

“…These histological findings may explain the excellent radiological outcomes reported in clinical scenarios, consistent with our study. 15,26,30,37,39,50 However, concerns have been increasingly raised regarding the high rate of hardware-related complications, such as screw protrusion or pullout, risk of neurological injuries, and graft osteolysis. 8,16,50 Secondary to some of these concerns, some novel surgical techniques, which use a nonrigid fixation approach for graft positioning via suture anchors or suture suspensory systems, have been comprehensively described.…”