Open Latarjet with Metal-Free Cerclage Fixation

Hachem, Abdul-ilah; Lin, Jerry Chun‐Wei; Ixtacuy, Luis Rojas; Molina-Creixell, Andrés; Campagnoli, Alex; Ríus, Xavier

doi:10.1016/j.eats.2022.11.030

Cited by 6 publications

(5 citation statements)

References 40 publications

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“…The development of this tensioning protocol reduces the peak stresses (80-30 lbf) to prevent cerclage cutting through the grafts, which may be a concern with poor bone quality. 22,23 Removal of initial slack and creep can provide a more uniform load distribution and create a synergetic effect of the interconnected cerclage sutures, resulting in a higher overall fixation strength. Conversely, individual tightening of separate button-suspended suture pairs leads to variable grades of tension, resulting in an unbalanced stabilization with greater rotational or translational migrations of the bone block.…”

Section: Discussionmentioning

confidence: 99%

“…Final graft compression was then achieved by tensioning of the hitching suture of both suture sets again to 134 N (Figure 3F). 23 Three alternating half-hitch knots were added to both suture sets to lock the construct (4 alternating knots in total).…”

Section: Methodsmentioning

confidence: 99%

“…Suture slack was removed by initial tensioning of each cerclage to 134 N (loading to 30 lbf) using a tensioner (FiberTape Cerclage Tensioner; Arthrex Inc) (Figure 3D). 23 After cutting and separating the cerclage strands, we tied an initial half hitch to provisionally secure the construct (Figure 3E). Final graft compression was then achieved by tensioning of the hitching suture of both suture sets again to 134 N (Figure 3F).…”

Section: Primary Fixationmentioning

confidence: 99%

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

Ritter,

Hachem,

Scheibel

et al. 2023

Am J Sports Med

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Background: Reconstruction techniques for anterior glenoid bone loss have seen a trend from screws to suture-based fixations. However, comparative biomechanical data, including primary fixation and glenoid-graft contact pressure mapping, are limited. Hypothesis: Suture-based bone block cerclage (BBC) and suspensory suture button (SB) techniques provide similar primary fixation and cyclic stability to double-screw fixation but with higher contact loading at the bony interface. Study Design: Controlled laboratory study. Methods: In total, 60 cadaveric scapulae were prepared to simulate anterior glenoid bone loss with coracoid autograft reconstruction. Graft fixation was performed with 3 different techniques: (1) an interconnected all-suture BBC, (2) 2 SB suspensions, and (3) 2 screws. Initial compression was analyzed during primary fixation. Cyclic peak loading with 50 N and 100 N over 250 cycles at 1 Hz was performed with a constant valley load of 25 N. Optical recording and pressure foils allowed for spatial bone block tracking and contact pressure mapping at the glenoid-graft interface. Load-to-failure testing was performed at a rate of 1.5 mm/s with ultimate load and stiffness measured. Results: Initial graft compression was higher with screw fixation (141 ± 5 N) compared with suture-based fixations ( P < .001), with BBC fixation providing significantly higher compression than SB fixation (116 ± 7 N vs. 91 ± 5 N; P < .001). Spatial bone block migration and ultimate failure load were similar between the BBC and screw groups. The SB group showed significantly increased bone block translation (3.1 ± 1.0 mm; P≤ .014) and rotation (2.5°± 1.4°; P≤ .025) and significantly lower ultimate failure load (180 ± 53 N) compared with the BBC ( P = .046) and screw ( P = .002) groups. Both suture-based fixations provided significantly increased graft-glenoid contact loading with higher pressure amplitudes ( P≤ .032) and contact pressure after cyclic loading (+13%; SB: P = .007; BBC: P = .004) compared with screw fixation. Conclusion: Both SB and interconnected cerclage fixation improved dynamic contact loading compared with screw fixation in a biomechanical glenoid bone loss model. Cerclage fixation was biomechanically comparable with screw fixation but with a greater variability. SB fixation showed significantly lower primary fixation strength and greater bone block rotation and migration. Clinical Relevance: Suture-based bone block fixations improved graft-glenoid contact loading, but the overall clinical consequence on healing remains unclear.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Primary Fixationmentioning

confidence: 99%

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

Ritter,

Hachem,

Scheibel

et al. 2023

Am J Sports Med

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“…The Latarjet procedure is the gold standard treatment for recurrent shoulder instability associated with bone loss [25]. Despite excellent reported outcomes, it is a technically and biomechanically complex operation with an intensive postoperative rehabilitation protocol.…”

Section: Discussionmentioning

confidence: 99%

“…Despite excellent reported outcomes, it is a technically and biomechanically complex operation with an intensive postoperative rehabilitation protocol. Non-compliance with postoperative instructions carries a high risk of complications [25]. Thus, patients require access to easily comprehensible information to make informed decisions.…”

Section: Discussionmentioning

confidence: 99%

Readability of Online Information on the Latarjet Procedure

Ahmed,

Jassim,

Karkuri

2023

Cureus

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IntroductionA common complication of first-time or recurrent shoulder dislocations is bone loss at the humeral head and glenoid. Recurrent shoulder instability is often a result of bony defects in the glenoid following shoulder dislocations. In the setting of glenoid bone loss, surgical interventions are generally required to restore stability. The Latarjet procedure is a challenging operation and, due to its complexity, may be associated with operative complications. It can be difficult to explain the procedure to patients in a manner that is easily comprehensible, which may lead to confusion or being overwhelmed with information. Hence, it is important that the information available to patients is easily accessible and perceivable to allow for adequate health literacy. Health literacy is defined as the ability to make health decisions in the context of everyday life. MethodsThe search engines Google and Bing were accessed on a single day in the month of July 2023, searching the terms "Latarjet surgery" and "Latarjet procedure." For each term on both search engines, the first three pages were evaluated, resulting in a total of 114 websites for review. Out of these, 25 websites met the inclusion criteria and underwent further in-depth analysis through the online readability software, WEB FX. This software generated a Flesch Reading Ease Score (FRES) and a Reading Grade Level (RGL) for each website. ResultsIn our study, the mean FRES was 50.3 (SD ±12.5), categorizing the data as 'fairly difficult to read.' The mean RGL score was 8.12 (SD ±2.35), which exceeds the recommended target. ConclusionIn conclusion, the results of this study have demonstrated that the material available on the Internet about the Latarjet procedure is above the recommended readability levels for the majority of the population. Our findings align with similar studies assessing the readability of online patient information. Based on these findings, physicians should provide patients with vetted information to facilitate a better understanding of the procedure, thereby enabling patients to make more informed decisions regarding their health.

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