Latarjet procedure: open with screws or arthroscopic with cortical-buttons? A retrospective cohort comparison of outcomes and complications

Abstract

The original Latarjet-Patte procedure is a reliable procedure to treat traumatic anterior shoulder instability. However, attempts to reduce possible complications have led to the emergence of modified techniques. More prominently are the arthroscopic approach and the use of cortical-buttons for coracoid fixation. To date, limited research is available directly comparing the simultaneous use of these two modifications to the original Latarjet-Patte technique. The purpose of this paper is to compare clinical and radiologic outcomes and complications between open Latarjet with screws and arthroscopic Latarjet with cortical-buttons for traumatic anterior shoulder instability. A multicenter retrospective cohort study of medical records and imaging studies of two groups of patients, with two years of follow-up, who underwent either one of two variations of the Latarjet procedure: open approach with screws (open-screw group) or arthroscopic approach with cortical buttons (scope-button group). Group homogenization was assured by statistical comparison of 14 baseline independent variables as well as multiple regression analysis to assess confounding factors. The primary outcome was the Rowe scale at 24 months after surgery, for which the MCID value of 9.7 was used. Secondary outcomes were recurrence of instability; graft positioning; the Rowe scale at other points in time; and complications. Thirty-eight patients were evaluated in the open-screw group and 44 in the scope-button group, with a 24-month follow-up. All but one patient in each group achieved the MCID from pre- to postoperative Rowe score. The Rowe score did not differ between groups during any of the assessment times. There was no difference regarding graft vertical (p = 0.620) or horizontal (p = 0.280) positioning. There was one recurrence in each group: a dislocation in the open-screw group (p = 0.463) and a subluxation in the scope-button group (p > 0.999). Other complications happened exclusively in the scope-button group: neuropraxis (n = 1; p > 0.999), infection (n = 2; p > 0.999), graft fracture (n = 1; p > 0.999) and graft migration (n = 2; p > 0.999). Multiple regression analysis did not observe influence from any of the potential confounding factors on the final results. At early follow-up, arthroscopic Latarjet with cortical-buttons yielded similarly good clinical and radiologic results as the conventional open Latarjet with screws.