Screw Fixation for the Latarjet Procedure May Reduce Risk of Recurrent Instability but Increases Reoperation Rate Compared to Suture-Button Fixation: A Systematic Review

Abstract

PurposeTo perform a systematic review to compare clinical outcomes, complications, and reoperation rates of patients undergoing the Latarjet procedure with screw versus suture-button fixation. MethodsA systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies directly comparing screw versus suture-button fixation for the Latarjet procedure. The search terms used were: shoulder screw suture button. Patients were evaluated based on reoperation rate, complication rate, recurrent instability, radiological outcomes, and patient-reported outcomes. Graft and screw position were assessed via computed tomography. ResultsSeven studies (1 level II, 6 level III) met inclusion criteria, with 845 patients undergoing the Latarjet procedure with screw fixation (Screw Group) and 279 patients with suture-button fixation (Suture-Button Group). Mean patient age ranged from 21.2 to 29.6 years. Mean follow-up time ranged from 6.0 to 40.8 months. The recurrent instability rate ranged from 0% to 2.5% in the Screw Group and 0% to 8.3% in the Suture-Button Group. The reoperation rate ranged from 0% to 7.7% in the Screw Group compared to 0% to 1.9% in the Suture-Button Group. One study reported significantly lower Visual Analog Scale pain scores in the Suture-Button Group compared with the Screw Group (1.5 vs 1.2, p = 0.003). No other studies reported significant differences in any patient-reported outcomes. There was no significant difference in horizontal or vertical graft position, graft union rate, or complication rate between groups in any study. ConclusionThe Latarjet procedure with screw fixation may result in a lower risk of recurrent instability compared to suture-button fixation, though screw fixation may also have a higher reoperation rate due to hardware-related complications. Level of EvidenceIII, systematic review of level II-III studies