Abstract
PurposeThe purpose of this study was to compare the clinical results of the Latarjet procedure using two cortical buttons vs two screws. It was hypothesized that cortical button would result in similar rates of recurrent dislocations, but a lower rate of reoperation compared to screw fixation.MethodsA retrospective comparative case-cohort analysis was performed for all patients undergoing a Latarjet procedure for recurrent anterior glenohumeral instability. Patient demographics, number of dislocations prior surgery, arm dominance, shoulder hyperlaxity, level of sport, type of sport and ISIS score were collected. Shoulders were separated into two groups based on surgical fixation (screws vs cortical button). Postoperatively, shoulders were evaluated for recurrent dislocation, revision surgery, post-operative Walch–Duplay score, and the Simple shoulder test (SST). Two hundred and thirty-six patients were included in the screw fixation group (group A) and 72 in button fixation group (group B) and were evaluated at a mean follow-up of 3.4 ± 0.8 years. Demographics of the two groups were similar with the exception of operative side hand dominance, which was more common in group B [50 (69.4%) vs 128 (54.2%), p = 0.02].ResultsRecurrent dislocation was significantly lower in Group A: 6 (2.5%) vs 6(8.3%) (p = 0.02). Reoperation was more common in group A [14 (5.9%) vs 0 (0%)]. At follow-up, Walch–Duplay scores and simple shoulder tests were similar in both groups.ConclusionButton fixation for Latarjet showed higher rates of recurrent dislocation compared to screw fixation. However, the increased stability afforded by screw fixation needs to be weighed against the increased risk of reoperation for hardware prominence.Level of evidenceIII.
Highlights
The Latarjet procedure is a commonly used procedure for chronic anterior shoulder instability associated with critical glenoid bone loss (> 15%) or in patients with a high risk of
Two hundred and thirty-six patients were included in the screw fixation group and 72 in the button fixation group
Demographics of the two groups were similar with the exception of operative side hand dominance which was more common in group B [50 (69.4%) vs 128 (54.2%), p = 0.02]
Summary
The Latarjet procedure is a commonly used procedure for chronic anterior shoulder instability associated with critical glenoid bone loss (> 15%) or in patients with a high risk ofParé, Boulogne‐Billancourt, France 5 Hopital Ambroise Paré, Boulogne‐Billancourt, FranceKnee Surgery, Sports Traumatology, Arthroscopy (2020) 28:2354–2360 recurrence [28]. The transferred coracoid is used to reconstruct the missing anterior glenoid while the conjoined tendon adds a sling effect that is especially effective in abduction-external rotation [1, 26]. This procedure can be performed either open or arthroscopically with similar functional outcomes [19]. Several types of fixation have been proposed to secure the coracoid process to the glenoid These include one [17] or two metallic screws [1], bioabsorbable screws [4], metallic plates [14] and more recently one [7] or two cortical buttons [32]. Hardware complications include intra- and post-operative fracture of the coracoid bone block secondary to overtightening of the screw(s) (1.1–1.5%), avulsion, twisting or breakage of the screw, and mechanical impingement between the screws and the humeral head or subscapularis (11–12%) [10, 16]
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