Graft osteolysis and recurrent instability after the Latarjet procedure performed with bioabsorbable screw fixation

Abstract

The Latarjet procedure is a reliable treatment of recurrent anterior shoulder instability. The coracoid process is usually fixed with metallic screws; however, these can lead to irritation and the necessity for hardware removal and also can produce artifacts on imaging studies. The use of resorbable screws could avoid these complications. The purpose of this study was to assess the clinical results of the Latarjet procedure performed with bioabsorbable screws in addition to healing of the graft and resorption of the screws. In 2009, we performed a prospective study (case series, IV) of 11 patients (12 shoulders) who underwent a Latarjet procedure fixed with resorbable screws. Each patient was observed clinically and had a computed tomography scan at 3 months and 2 years of follow-up. Every graft healed at 3-month follow-up. At 2-year follow-up, 4 patients had at least one instability episode, and one underwent a revision surgery. Three of these 4 patients were unhappy or disappointed. The Walch-Duplay score was excellent or good for 7 shoulders and medium or poor for 5. Screw resorption appeared complete in every case. No drill hole enlargement was observed. Every drill hole was partially filled with bone. Of 12 shoulders, 8 (66.67%) were associated with a severe osteolysis and an almost complete disappearance of the graft. Coracoid graft osteolysis, previously reported after the Latarjet procedure, appears to be exacerbated with a risk of complete disappearance of the graft when the procedure is performed with the bioabsorbable screws used in this study.