Early Follow‐Up of Arthroscopic Latarjet Procedure with Screw or Suture‐Button Fixation for Recurrent Anterior Shoulder Instability

Abstract

Objective To evaluate the early clinical and radiographic results of arthroscopic Latarjet procedure using screw or suture‐button fixation in patients with recurrent anterior shoulder dislocation. Methods Twelve patients who underwent arthroscopic Latarjet procedure between January 2015 and December 2018 at our institution were retrospectively studied. Data of the patients' history, including age, gender, side of affected arm, body mass index (BMI), and the number of dislocations since fist dislocation were collected. Preoperative and postoperative clinical follow‐up data were evaluated using Walch–Duplay score, American Shoulder and Elbow Society (ASES) score, and modified Rowe score. Active external rotation and active internal rotation at 90° of abduction as well as active elevation were evaluated preoperatively and postoperatively. The position and healing condition of the transferred coracoid bony graft were also assessed using computed tomography (CT) and Mimics 19.0 software. Results Mean follow‐up was 24.9 months (range, 13 to 53 months) of all patients. At final follow‐up, the average ASES score (preoperative vs postoperative values) had improved from 68.9 ± 7.9 to 91.1 ± 6.1 in screw fixation group and 68.9 ± 8.9 to 87.5 ± 6.7 in suture‐button fixation group; the average Rowe score (preoperative vs postoperative values) had improved from 25.0 ± 8.4 to 92.5 ± 4.2 in screw fixation group and 21.7 ± 13.7 to 93.3 ± 4.1 in suture‐button fixation group; the average of Walch–Duplay score (preoperative vs postoperative values) had improved from 12.5 ± 15.1 to 91.7 ± 4.1 in screw fixation group and 18.3 ± 20.7 to 88.3 ± 7.5 in button fixation group. The forward flexion was 175.0° ± 8.4° preoperatively and 178.3° ± 4.1° postoperatively in screw fixation group while 174.8° ± 10.2° preoperatively and 175.0° ± 5.5° postoperatively in suture‐button fixation group. The active external rotation was 77.5° ± 5.2° preoperatively and 71.7° ± 4.1° postoperatively in screw fixation group while 72.5° ± 6.9° preoperatively and 68.3° ± 7.5° postoperatively in suture‐button fixation group. The average of active internal rotation was 66.7° ± 6.1° preoperatively and 67.5° ± 6.1° postoperatively in screw fixation group while 68.3° ± 11.3° preoperatively and 66.7° ± 7.5° postoperatively in suture‐button fixation group. In postoperative CT scan, 91.7% grafts midline center were located at or under the equator in the en face view; 75% of the bone blocks were flush to the glenoid face in the axial view, with only two grafts exhibiting slight medial placement in screw fixation group (33.3%) and one graft exhibiting slight lateral placement in suture‐button fixation group (16.7%). All grafts achieved bone union. Graft absorption mostly occurred outside of the “best‐fit” circle. The average bony absorption rates of the coracoid grafts were 25.2% and 10.18% in screw fixation group and suture‐button fixation group, respectively, at 6 months postoperative follow‐up. Conclusion Both suture‐button fixation and screw fixation techniques in arth...

Pediatric Shoulder Arthroscopy is Effective and Most Commonly Indicated for Instability, Obstetric Brachial Plexus Palsy, and Partial Rotator Cuff Tears

“…Although ASES and pain scores of pediatric patients undergoing arthroscopy for instability significantly improved after surgery, ROM remained relatively consistent before and after arthroscopy, similar to outcomes reported for adult patients. 36 , 37 , 38 , 39 The majority of instability patients in this study returned to sport after surgery, at a similar rate to that previously reported of all patients undergoing arthroscopic procedures for instability. 39 , 40 Clinical outcomes for surgical repair of rotator cuff tears in pediatric patients have been reported to be excellent, but these studies have not independently reported outcomes for open and arthroscopic repair.…”

Arthroscopic Latarjet yields better union and prevention of instability compared to arthroscopic bony Bankart repair in shoulders with recurrent anterior instability: a systematic review

“…A further 87 studies were excluded after full‐text review. This left 29 eligible studies [1, 7, 8, 11, 14, 16–18, 23, 24, 29–32, 38, 40–45, 47, 48, 53, 55–59] of which 16 assessed arthroscopic bony Bankart repair, 13 assessed arthroscopic Latarjet (Tables 1 and 2). All studies reported preoperative glenoid bone loss: 21 reported mean preoperative glenoid bone loss, of which 4 created subgroups of glenoid bone loss and reported the mean loss of each subgroup, while 8 used a threshold of glenoid bone loss as a part of their inclusion criteria.…”

Primary Stability and Bone Contact Loading Evaluation of Suture and Screw based Coracoid Graft Fixation for Anterior Glenoid Bone Loss

“…Thus, the increased COF shift and bone block motion of more elastic suture-based fixation may actually provide an ability for a lateralized graft to self-correct over time and become flush with the glenoid rim. 12,52,56 Additionally, biological remodeling of the reconstructed glenoid can lead to bone resorption 26,55 as the bony structure readapts toward the native glenoid shape (Wolff law). 22,52,55,58 Whereas screw fixation in these cases results in hardware prominence of the screw heads, causing shoulder pain due to humeral head and subscapular impingement, 11,27,59 the dynamic suture-based techniques have the potential to maintain impingement-free glenohumeral articulation.…”