Influence of screw type and length on fixation of anterior glenoid bone grafts

Willemot, Laurent; Wodicka, Ross; Bosworth, Adrian; Castagna, Alessandro; Burns, Joseph P.; Verborgt, Olivier

doi:10.1177/1758573217704817

Cited by 26 publications

(30 citation statements)

References 46 publications

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“…These threaded malleolar stainlesssteel screws have relatively large heads. Since 2016, we have used partially threaded cannulated titanium screws, which are placed with a guide and have a smaller head diameter but a coarser pitch and a larger thread rise, 38 as well as Outlier observed in 1 patient, who had recurrence of instability after screw removal in the ipsilateral shoulder, as well as episodes of instability in the contralateral shoulder, for which he subsequently underwent OLP. loads to failure equivalent to other screw designs.…”

Section: Discussionmentioning

confidence: 99%

Screw Removal Can Resolve Unexplained Anterior Pain Without Recurrence of Shoulder Instability After Open Latarjet Procedures

et al. 2020

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Background: Anterior shoulder instability can be successfully treated using Latarjet procedures, although a small proportion of patients report unexplained pain. Purpose/Hypothesis: The purpose was to report the prevalence and characteristics of patients with unexplained pain without recurrent instability after open Latarjet procedures and to determine whether screw removal can alleviate pain. The hypothesis was that unexplained pain without recurrent instability might be due to soft tissue impingements against the screw heads and that the removal of screws would alleviate or reduce pain. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed the clinical and radiographic records of 461 consecutive shoulders treated by open Latarjet procedures for anterior instability between 2002 and 2014. Unexplained anterior pain was present in 21 shoulders (4.6%) and treated by screw removal at 29 ± 37 months (mean ± SD). Postoperative assessment at >12 months after screw removal included complications, visual analog scale for pain (pVAS), subjective shoulder value, Rowe score, Walch-Duplay score, and ranges of motion. The study cohort comprised the shoulders of 20 patients (9 women, 11 men) aged 25 ± 6 years (median, 25 years; range, 16-34 years) at screw removal and involved the dominant arm in 13 (62%) shoulders. Results: Screw removal alleviated pain completely in 14 shoulders (67%; pVAS improvement, 6.4 ± 1.8; median, 6; range, 3-8) and reduced pain in the remaining 7 (33%; pVAS improvement, 2.4 ± 1.4; median, 2; range, 1-5). At 38 ± 23 months after screw removal, 2 recurrences of instability unrelated to screw removal occurred. The subjective shoulder value was 79% ± 22% (median, 90%; range, 0%-95%); Rowe score, 85 ± 20 (median, 95; range, 30-100); and Walch-Duplay score, 82 ± 19 (median, 85; range, 25-100). Mobility improved in active forward elevation (171°± 14°), external rotation with the elbow at the side (61°± 12°), and external rotation with the arm at 90° of abduction (67°± 13°) and especially in internal rotation, with only 2 shoulders (10%) limited to T12 spine segment. Conclusion: The present findings confirm that unexplained anterior pain after Latarjet procedures can be related to the screws used to fix bone blocks, which can safely be alleviated or reduced by screw removal.

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Section: Discussionmentioning

confidence: 99%

Screw Removal Can Resolve Unexplained Anterior Pain Without Recurrence of Shoulder Instability After Open Latarjet Procedures

et al. 2020

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“…The shoulders of each pair were randomly assigned to 1 of 2 groups: (1) fixation using two 3.75-mm cannulated, fully threaded metal screws or (2) fixation using a double suture button construct. Two 3.75-mm bicortical cannulated (Arthrex), 3.5-mm cannulated (Mitek), and 4.5-mm solid screws (Synthes) have recently been reported to have comparable maximal displacement in a biomechanical study 31 ; therefore, 3.75-mm screws were chosen for this study.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical Comparison of Screw Fixation Versus a Cortical Button and Self-tensioning Suture for the Latarjet Procedure

Provencher

Aman

LaPrade

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Metal screws are traditionally used to fix the coracoid process to the glenoid. Despite stable fixation, metal screws have been associated with hardware complications. Therefore, some studies have advocated for suture button fixation during the Latarjet procedure to reduce the complications associated with screw fixation.Purpose:To biomechanically evaluate the ultimate failure load of a cortical button and self-tensioning suture versus metal screws for coracoid graft fixation during the Latarjet procedure.Study Design:Controlled laboratory study.Methods:Eight matched pairs of fresh-frozen, male cadaveric shoulders (N = 16) underwent the Latarjet procedure. The shoulders of each pair were randomly assigned to 1 of 2 groups: fixation using two 3.75-mm cannulated, fully threaded metal screws or fixation using a double suture button construct. Specimens were secured in a dynamic testing machine and cyclically preconditioned from 2 to 10 N at 0.1 Hz for 10 cycles. After preconditioning, specimens were pulled to failure at a normalized displacement rate of 400% of the measured gauge length per minute. The ultimate failure load and mechanism of failure were recorded for each specimen.Results:The mean ultimate load to failure for screw fixation (226 ± 114 N; 95% CI, 147-305 N) was not significantly different from that for suture button fixation (266 ± 73 N; 95% CI, 216-317 N) (P = .257). The mean strain at failure for screw fixation (63% ± 21%; 95% CI, 48%-77%) was not significantly different from that for suture button fixation (86% ± 26%; 95% CI, 69%-104%) (P = .060). The most common mechanism of failure for the screw fixation method was at the bone block drill holes, while an intramuscular rupture at the clamp-muscle interface occurred for the suture button construct.Conclusion:The screw and suture button fixation techniques exhibited comparable biomechanical strength for coracoid bone block fixation of the Latarjet procedure.Clinical Relevance:Metal screws have been reported to be a large contributor to intraoperative and postoperative complications. Therefore, given the results of the current study, a suture button construct may be an alternative to metal screw fixation during the Latarjet procedure. However, further clinical studies are warranted.

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“…9,13,21,47,[55][56][57] Reinsertion of screws for fixation of the new bone graft may be difficult and can be a source of intraoperative and postoperative complications. 16,31,39,54,55,57 On the one hand, leaving broken screws in situ may compromise new hardware trajectory and ultimately jeopardize graft positioning, whereas, on the other hand, attempting to extract broken hardware can compound the existing glenoid bone loss. 31,46,55,56 In a previous publication, a series of patients with recurrent anterior shoulder instability who underwent an arthroscopic Latarjet procedure using a guided surgical approach and suture-button fixation system have been reported.…”

mentioning

confidence: 99%

All-arthroscopic, guided Eden-Hybbinette procedure using suture-button fixation for revision of failed Latarjet

Boileau

Duysens

Saliken

et al. 2019

Journal of Shoulder and Elbow Surgery

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Purpose: To report the results of a guided arthroscopic Eden-Hybbinette procedure, using suture button for iliac crest bone graft fixation, in a series of patients with a prior failed Latarjet and persistent glenoid bone loss. Methods: Seven consecutive patients (5 males, 2 females, mean age: 30.7 years [range, 17-47 years]) with recurrent anterior dislocations and glenoid deficiency greater than 20% underwent the all-arthroscopic revision procedure. The iliac crest bone graft and suture-button device (Bone-Link) were shuttled through the rotator interval. Specific drill guides were used and a suture tensioning device allowed bone graft compression. Previous broken screw shafts (3 patients) were left in situ. Graft placement and healing was assessed postoperatively with computed tomography imaging. Results: No neurologic injury or hardware problems occurred, and no patient required further surgery. On computed tomography scan, optimal positioning (flush and under the equator) and healing of the bone graft was observed in all patients. At a mean follow-up of 21 months (range, 12-39 months), all but one patient were satisfied and had a stable shoulder; 5 returned to sports. The Constant score increased from 32 to 81 points, and the subjective shoulder value from 31% to 87% (P < .001). The Walch-Duplay and Rowe scores averaged 85.7 (range, 65-100) points and 86.4 (range, 70-100) points, respectively. Conclusion: Recurrence of anterior shoulder instability after a failed Latarjet procedure can be successfully treated by an all-arthroscopic Eden-Hybbinette procedure. Suture-button fixation is reliable and permits optimal positioning and predictable healing of the new bone graft; in addition, it is an appropriate fixation option in the setting of retained broken hardware. This study was performed according to the medical ethical guidelines of Institut Universitaire Locomoteur et du Sport (Approval Ref: Study 2017-05), and a written, informed consent was obtained for all patients. A video of the technique is available upon request to the corresponding author.

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Influence of screw type and length on fixation of anterior glenoid bone grafts

Cited by 26 publications

References 46 publications

Screw Removal Can Resolve Unexplained Anterior Pain Without Recurrence of Shoulder Instability After Open Latarjet Procedures

Screw Removal Can Resolve Unexplained Anterior Pain Without Recurrence of Shoulder Instability After Open Latarjet Procedures

Biomechanical Comparison of Screw Fixation Versus a Cortical Button and Self-tensioning Suture for the Latarjet Procedure

All-arthroscopic, guided Eden-Hybbinette procedure using suture-button fixation for revision of failed Latarjet

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