Short-Term Bone Fusion With Arthroscopic Double-Button Latarjet Versus Open-Screw Latarjet

Abstract

Background: Recently, arthroscopic double-button Latarjet (AL) has provided an alternative to conventional open Latarjet (OL) in the treatment of anterior shoulder instability with glenoid bone loss. Therefore, theoretically, the faster fusion is obtained, the sooner return to sports under safe conditions can occur. The emerging flexible fixation of the bone block has clearly offered a new approach to achieve bone fusion. However, the period required to achieve this goal remains controversial. Purpose/Hypothesis: The purpose was to compare computed tomography (CT) scan results of AL and OL in the early postoperative period. It was hypothesized that the bone block fusion with AL would require a longer time than that with OL. Study Design: Cohort study; Level of evidence, 3. Methods: In a retrospective 1-year study, the authors compared 17 primary double-button AL to 22 primary 2-screw OL procedures indicated for anterior shoulder instability in patients with an Index Severity Instability Score >3 points. These patients were reviewed with a CT scan at 1 day, 3 months, and 6 months postoperatively. The characteristics for the 2 groups were comparable. CT scans aimed to analyze graft position, bone contact area with the scapula, and fusion at 3 and 6 months. Clinical assessment was based on the Walch-Duplay and Rowe scores. Results: The mean preoperative Index Severity Instability Score was 5.3 ± 1.9 points, with a mean anterior glenoid bone loss of 9.1% ± 4.6%. At 3 months, the rates of fusion were 41% and 100% for the AL and OL groups, respectively ( P < .001). This rate increased to 70% in the AL group at 6 months ( P = .006). In the axial and sagittal planes, there was no difference in graft position between the AL group and the OL group. The bone block was longer and there was a more extensive bone contact area in the OL group (AL, 131 mm2 vs OL, 223 mm2; P < .001). At 6 months of follow-up, no significant difference in clinical scores was noted between the groups: Walch-Duplay score, 93.0 ± 10.9 points versus 91.8 ± 12.5 points ( P = .867); and Rowe score, 99.0 ± 2.2 points versus 95.0 ± 8.4 points ( P = .307) for the AL and OL groups, respectively. Conclusion: AL required more time to achieve bone block fusion than OL. This finding should be taken into account when considering this procedure for patients in a hurry to return to sports involving the shoulder.

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

“…Therefore, the time required for bone fusion to allow return to sports under secure conditions is critical after a Latarjet procedure. Bonnevialle et al 8 found the rates of fusion were 41% and 100% for the screw fixation and suture button fixation groups at 3 months postoperatively, respectively. In our study, we found that the rate of bone healing with screw fixation was not significantly different at 3 months postoperatively (87.3% vs 83.3%).…”

“…Internal rotation was determined as the highest spine level that the patient’s thumb could reach behind the back: above T7 (10 points), T7 to T12 (8 points), T12 to L3 (6 points), L3 to sacrum (4 points); sacrum to greater trochanter (2 points); and below the greater trochanter (0 points), as performed for the Constant score. 8 …”

“…Internal rotation was determined as the highest spine level that the patient's thumb could reach behind the back: above T7 (10 points), T7 to T12 (8 points), T12 to L3 (6 points), L3 to sacrum (4 points); sacrum to greater trochanter (2 points); and below the greater trochanter (0 points), as performed for the Constant score. 8 Preoperative and postoperative clinical results were assessed using the visual analog scale (VAS) for pain and instability, Rowe score, and American Shoulder and Elbow Surgeons (ASES) score. In addition, the Subjective Shoulder Value (SSV) score was used at the final follow-up, expressed as a percentage of a healthy shoulder (100%).…”

Use of Cannulated Screws for Primary Latarjet Procedures

“…Specifically, some studies have found comparable load to failure 31 and functional results 28 to screw fixation without complications related to hardware removal, 6 , 9 , 16 , 28 while others have indicated delayed graft fusion with greater graft mobilization. 2 , 8 …”

Arthroscopic “Double-Inlay” Eden-Hybinette Procedure with Modified Suture Button Fixation for the Revision of Failed Bristow-Latarjet

“…5 Although several studies have shown the advantages of using suture button fixation in the Bristow-Latarjet or Eden-Hybinette procedure, [13][14][15] the potential inferior biomechanical strength of suture button fixation is still in concern. 16,17 This Technical Note introduced an arthroscopic "doubleinlay" Eden-Hybinette procedure with modified suture button fixation for the revision of failed Bristow-Latarjet. This technique has two "Mortise-Tenon" structures.…”