1
|
van der List JP, Waterman BR. Editorial Commentary: Suture-Button Fixation May Have Advantages Over Screw Fixation for Glenoid Bone Grafting Procedures for Shoulder Instability. Arthroscopy 2024; 40:1894-1896. [PMID: 38310503 DOI: 10.1016/j.arthro.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/05/2024]
Abstract
Orthopaedic suture buttons have been increasingly used in a variety of procedures, such as syndesmosis stabilization, coracoclavicular ligament repair, anterior cruciate ligament graft fixation, and Lisfranc injury treatment. In many instances, suture-button fixation constructs have shown equivalent, if not superior, outcomes to screw fixation. More recently, suture buttons have been suggested for osseous fixation of the coracoid during the Latarjet procedure, as well as other anterior (or posterior) bone block reconstruction of the glenoid using distal tibial allograft, tricortical iliac crest, or distal clavicle in cases of complex shoulder instability. Suture buttons offer several unique advantages, including the ability to tension and retension graft fixation, smaller driller paths with bone preservation, less osteolysis, lower risk of hardware removal, and greater ease of hardware revision and/or secondary surgery. However, certain disadvantages also exist, such as higher implant costs, less time-zero implant rigidity, technical difficulty, and, potentially, less mediolateral stability of the bone graft. Time will tell if these suture-button constructs will supplant traditional screw fixation for the Latarjet procedure in terms of clinical and cost-effectiveness.
Collapse
|
2
|
Maguire JA, Dhillon J, Sarna N, Keeter C, Scillia AJ, McCulloch PC, Kraeutler MJ. Screw Fixation for the Latarjet Procedure May Reduce Risk of Recurrent Instability but Increases Reoperation Rate Compared to Suture-Button Fixation: A Systematic Review. Arthroscopy 2024; 40:1882-1893.e1. [PMID: 38040391 DOI: 10.1016/j.arthro.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/02/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE To perform a systematic review to compare clinical outcomes, complications, and reoperation rates of patients undergoing the Latarjet procedure with screw vs suture-button fixation. METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies directly comparing screw vs 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, radiologic outcomes, and patient-reported outcomes. Graft and screw position were assessed via computed tomography. RESULTS Seven 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 = .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. CONCLUSIONS The Latarjet procedure with screw fixation may result in a lower risk of recurrent instability compared to suture-button fixation, although screw fixation may also have a higher reoperation rate due to hardware-related complications. LEVEL OF EVIDENCE Level III, systematic review of Level II to III studies.
Collapse
Affiliation(s)
- James A Maguire
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A..
| | - Jaydeep Dhillon
- Rocky Vista University College of Osteopathic Medicine, Greenwood Village, Colorado, U.S.A
| | - Neil Sarna
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Carson Keeter
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Anthony J Scillia
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Patrick C McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Matthew J Kraeutler
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| |
Collapse
|
3
|
Cozzolino A, de Giovanni R, Malfi P, Bernasconi A, Scarpa S, Smeraglia F, Russo R, Mariconda M. Arthroscopic Latarjet Versus Arthroscopic Free Bone Block Procedures for Anterior Shoulder Instability: A Proportional Meta-analysis Comparing Recurrence, Complication, and Reoperation Rates. Am J Sports Med 2024; 52:1865-1876. [PMID: 38240595 DOI: 10.1177/03635465231188530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND Several arthroscopic glenoid bone augmentation techniques have been introduced to treat patients affected by anterior shoulder instability associated with critical bone loss. The efficacy of the different arthroscopic bony procedures has not been compared yet. PURPOSE To compare the recurrence, complication, and reoperation rates of the arthroscopic Latarjet (AL) and arthroscopic free bone block (ABB) procedures for anterior shoulder instability. STUDY DESIGN Meta-analysis and systematic review; Level of evidence, 4. METHODS A systematic search was conducted in MEDLINE/PubMed, Web of Science, and Embase to identify clinical studies reporting the outcomes of the AL and ABB procedures. The following search phrases were used: "Arthroscopic" AND "Bone Block" OR "Bone Graft," and "Arthroscopic" AND "Glenoid Augmentation" OR "Glenoid Reconstruction," and "Arthroscopic" AND "Latarjet" OR "Coracoid Graft" OR "Coracoid Transfer." Exclusion criteria were <24 months of minimum follow-up, sample size <10 cases, revision after previous glenoid bone grafting, epilepsy, and multidirectional instability. Data regarding the study design, patient characteristics, surgical technique, and outcomes were extracted and analyzed. A proportional meta-analysis was conducted to compare the complication, recurrence, and reoperation rates between the 2 groups. Multiple subgroup analyses were performed to analyze the incidence of each complication and assess the weight of different fixation methods (in the whole cohort) or different graft types (in the ABB group). The modified Coleman Methodology Score was used to assess the risk of bias. RESULTS Of 5010 potentially relevant studies, 18 studies regarding the AL procedure (908 cases) and 15 studies regarding the ABB procedure (469 cases) were included. The 2 groups were comparable in age (P = .07), sex (P = .14), glenoid bone loss (P = .14), number of preoperative dislocations (P = .62), proportion of primary and revision procedures (P = .95), length of follow-up (P = .81), modified Coleman Methodology Score (P = .21), and level of evidence (P = .49). There was no difference in the recurrence (P = .88), reoperation (P = .79), and complication (P = .08) rates. The subgroup analyses showed a higher rate of hardware-related complications for screw fixation compared with flexible fixation (P = .01). CONCLUSION The AL and ABB procedures had similar recurrence, reoperation, and complication rates. Screw fixation of the bone graft was related to an increased risk of complications compared with flexible fixation. REGISTRATION CRD42022368153 (PROSPERO).
Collapse
Affiliation(s)
- Andrea Cozzolino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Roberto de Giovanni
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Alessio Bernasconi
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Simona Scarpa
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Francesco Smeraglia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Raffaele Russo
- Department of Public Health, University of Naples Federico II, Naples, Italy
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Massimo Mariconda
- Department of Public Health, University of Naples Federico II, Naples, Italy
| |
Collapse
|
4
|
Vuletić F, Bøe B. Current Trends and Outcomes for Open vs. Arthroscopic Latarjet. Curr Rev Musculoskelet Med 2024; 17:136-143. [PMID: 38467987 PMCID: PMC11068718 DOI: 10.1007/s12178-024-09889-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE OF REVIEW This paper aims to analyze and compare the existing research on open and arthroscopic Latarjet procedures for treating anterior shoulder instability. The review will assess different factors such as graft positioning, functional outcomes, complications, and return-to-play rates for both approaches. The study's primary goal is to establish which technique yields superior outcomes. RECENT FINDINGS Recent studies have suggested that arthroscopic Latarjet surgery can produce outcomes similar to open surgery regarding functional scores and patient satisfaction. Some research indicates that arthroscopy may even provide slightly better results. Both techniques have similar complication rates, but arthroscopy requires a longer learning curve and operating time. It is crucial to ensure the proper placement of the graft, and some studies suggest that arthroscopy may be better at achieving accurate positioning. Both open and arthroscopic Latarjet procedures are equally effective in treating shoulder instability. While arthroscopy offers a faster recovery time and causes less soft tissue damage, it requires surgeons to undergo a steeper learning curve. The optimal graft position for both techniques is still debated. More long-term data is needed to establish superiority. Future research should compare approaches in larger cohorts and identify outcome-affecting factors to improve the treatment of shoulder instability. Both techniques are promising, but arthroscopy may be a better option as the procedure evolves into a less invasive reconstruction.
Collapse
Affiliation(s)
- Filip Vuletić
- Department for Orthopaedic and Trauma Surgery, University Hospital "Sveti Duh", Sveti Duh 64, 10000, Zagreb, Croatia
- Faculty of Kinesiology, University of Zagreb, Horvaćanski zavoj 15, 10000, Zagreb, Croatia
| | - Berte Bøe
- Division of Orthopaedic Surgery, Oslo University Hospital, Trondheimsveien 235, 0586, Aker, Oslo, Norway.
| |
Collapse
|
5
|
Nolte AK, Bayer T, Jäger S, Raiss P, Wegmann K, Kretzer JP, Bülhoff M, Renkawitz T, Panzram B. Primary bone graft stability after Latarjet surgery: biomechanical evaluation of a fixation technique with metal-free all-suture cerclage vs. cortical screws. J Shoulder Elbow Surg 2024; 33:e175-e184. [PMID: 37652214 DOI: 10.1016/j.jse.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND To reduce hardware-related complications in coracoid graft fixation to the anterior aspect of the glenoid, a metal-free Latarjet technique was recently introduced. The aim of this study was to compare the primary stability of a classic Latarjet procedure with 2 metal screws to a novel metal-free, all-suture cerclage method. It is hypothesized that fixation of the coracoid graft with 2 malleolar screws will provide higher primary stability compared with an all-suture cerclage technique. METHODS This biomechanical in vitro study was conducted on 12 fresh-frozen cadaveric shoulders (6 matched pairs) with a mean donor age of 80 years (range, 67-89 years). Coracoid graft fixation was performed using a recently introduced all-suture cerclage technique (group A) or a classic Latarjet technique with two 4.5-mm malleolar screws (group B). The conjoint tendon was loaded with a static force of 10 N to simulate the sling effect. Graft loading with a probe head consisted of 6 ascending load levels (10-50 N, 10-100 N, 10-150 N, 10-200 N, 10-250 N, and 10-300 N) with 100 cycles each at 1 Hz. Relative motion of the bone graft to the glenoid was measured using an optic 3-dimensional system. RESULTS While loading the conjoint tendon with 10 N, no difference in mean displacement of the bone-graft was found between both groups (P = .144). During cyclic loading, a significant difference in relative displacement for both groups was already detected in load level 1 (group A: 2398.8 μm vs. group B: 125.7 μm; P = .024), and this trend continued with the following load levels (P < .05). DISCUSSION AND CONCLUSION The study demonstrated that the innovative metal-free, all-suture cerclage fixation technique results in higher micromotion than the classic coracoid graft fixation with 2 malleolar screws. According to the present biomechanical investigation, shoulders treated with a metal-free all-suture cerclage technique might need adapted rehabilitation protocols to protect the construct and allow for graft healing.
Collapse
Affiliation(s)
- Anna-Katharina Nolte
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany.
| | - Tobias Bayer
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jäger
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany; Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Patric Raiss
- Orthopädische Chirurgie München, Munich, Germany
| | | | - J Philippe Kretzer
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany; Laboratory of Biomechanics and Implant Research, Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Bülhoff
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Panzram
- Department of Orthopaedics, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
6
|
Gutiérrez-Zúñiga D, Largacha M. Arthroscopic Posterior Glenoid Reconstruction With Distal Clavicle Bone-Block. Arthrosc Tech 2024; 13:102885. [PMID: 38584640 PMCID: PMC10995699 DOI: 10.1016/j.eats.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/02/2023] [Indexed: 04/09/2024] Open
Abstract
Posterior glenoid bone loss is a potential cause for failure in arthroscopic capsulolabral repair. Although multiple techniques have been described to reconstruct posterior bone defects, they do not reliably yield improved patient outcomes and have high complication rates. We present a technique to reconstruct posterior glenoid bone loss using a distal clavicle autologous bone graft harvested by a mini-open approach and secured arthroscopically with suture buttons. The graft is positioned extra-articularly by repairing the posterior labral complex with a knotless fixation using labral tape.
Collapse
Affiliation(s)
| | - Mauricio Largacha
- Clínica del Country, Bogotá, Colombia
- Pontificia Universidad Javeriana, Bogotá, Colombia
| |
Collapse
|
7
|
Bonnevialle N, Baltassat A, Martinel V, Barret H, Mansat P. Arthroscopic Distal Clavicle Bone Bock Combined With Hill-Sachs Remplissage for Primary Anterior Shoulder Instability Treatment. Arthrosc Tech 2024; 13:102882. [PMID: 38584634 PMCID: PMC10995697 DOI: 10.1016/j.eats.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/02/2023] [Indexed: 04/09/2024] Open
Abstract
Arthroscopic distal clavicle transfer is an effective option to treat anterior shoulder instability with glenoid bone loss. The use of this free bone graft in an all-inside procedure, with a cortical button fixation makes the construct simpler to perform and allows to be combined with a Hill-Sachs Remplissage to address humeral bone defect. The morbidity of the donor site is low and provide the biologic capacity of an autograft. We report a step-by-step procedure, and the rationale are discussed.
Collapse
Affiliation(s)
- Nicolas Bonnevialle
- Service de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, France
- Clinique Universitaire du Sport, Toulouse, France
- Clinique Pyrénées-Ormeau, Groupe Elsan, Tarbes, France
| | - Antoine Baltassat
- Service de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, France
- Clinique Universitaire du Sport, Toulouse, France
| | | | - Hugo Barret
- Service de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, France
- Clinique Universitaire du Sport, Toulouse, France
| | - Pierre Mansat
- Service de Chirurgie Orthopédique et Traumatologique, CHU de Toulouse, France
- Clinique Universitaire du Sport, Toulouse, France
- Clinique Pyrénées-Ormeau, Groupe Elsan, Tarbes, France
| |
Collapse
|
8
|
Jackson GR, Brusalis CM, Schundler SF, Sachdev D, Obioha OA, McCormick JR, Mameri ES, Kaplan DJ, Knapik DM, Chahla J, Verma NN. Isolated Primary Latarjet Procedures for Anterior Shoulder Instability Results in High Rates of Graft Resorption and Glenohumeral Degenerative Changes With Low Rates of Failure at a Minimum 2-Year Follow-Up: A Systematic Review. Arthroscopy 2024; 40:581-591.e1. [PMID: 37270111 DOI: 10.1016/j.arthro.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To evaluate the incidence of postoperative complications after an isolated primary Latarjet procedure for anterior shoulder instability at a minimum 2-year follow-up. METHODS A systematic review was performed in accordance with 2020 PRISMA guidelines. EMBASE, Scopus, and PubMed databases were queried from database inception through September 2022. The literature search was limited to human clinical studies reporting on postoperative complications and adverse events after a primary Latarjet procedure with a minimum 2-year follow-up. Risk of bias was measured using the Newcastle-Ottawa Scale. RESULTS Twenty-two studies, consisting of 1,797 patients (n = 1,816 shoulders), with a mean age of 24 years were identified. The overall postoperative complication rate ranged from 0% to 25.7%, with the most common complication being persistent shoulder pain (range: 0%-25.7%). Radiological changes included graft resorption (range: 7.5%-100%) and glenohumeral degenerative changes (range: 0%-52.5%). Recurrent instability following surgery was documented in 0% to 35% of shoulders, while the incidence of bone block fractures ranged from 0% to 6% of cases. Postoperative nonunion, infection, and hematomas had a reported incidence rate ranging from 0% to 16.7%, 0% to 2.6%, and 0% to 4.4%, respectively. Overall, 0% to 7.5% of surgeries were reported failures, and 0% to 11.1% of shoulders required reoperation, with a revision rate ranging from 0% to 7.7%. CONCLUSIONS The incidence of complications following the primary Latarjet procedure for shoulder instability was variable, ranging from 0% to 25.7%. High rates of graft resorption, degenerative changes, and nonunion were present while failure and revision rates remained low at a minimum 2-year follow-up. LEVEL OF EVIDENCE Level III, systematic review of Level I-III studies.
Collapse
Affiliation(s)
- Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Christopher M Brusalis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Sabrina F Schundler
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Divesh Sachdev
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Obianuju A Obioha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Johnathon R McCormick
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Instituto Brasil de Tecnologia da Saúde, Rio de Janeiro, Brazil; Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Daniel J Kaplan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, Missouri, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| |
Collapse
|
9
|
Lawhorn KW. Editorial Commentary: Both Bristow and Latarjet Procedures Result in Low Rates of Recurrent Shoulder Instability Despite Potential for Bone Resorption and Lack of Graft Healing. Arthroscopy 2023; 39:2434-2437. [PMID: 37981386 DOI: 10.1016/j.arthro.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 11/21/2023]
Abstract
Anterior shoulder instability surgery has evolved over the decades, including both anatomic and nonanatomic repairs and reconstructions. Surgeons are continually advancing their skills and performing more of these procedures using arthroscopic as opposed to open techniques in patients with and without glenoid bone loss. However, there is a steep learning curve and increased technical demands when performing these procedures arthroscopically. Despite high success rates, bone graft resorption or lack of healing after Latarjet and Bristow procedures is well documented, and it is possible that patients develop enough scarring that their shoulders remain stable. Osteoarthritis after these nonanatomic procedures can occur making shoulder arthroplasty and reconstruction technically more challenging because of scarring and the altered anatomy. It remains to be seen whether these arthroscopic techniques as opposed to open surgery lessen the scarring and thus the technical demands of shoulder reconstruction in the small subset of patients who unfortunately develop symptomatic shoulder osteoarthritis. Therefore, in my practice, these techniques are carefully chosen for select patients. My indications for use of the Bristow procedure as a primary procedure for anterior shoulder instability are in patients who perform mixed martial arts fighting and high-level wrestlers without significant glenoid or humeral bone loss. My indications for the Latarjet procedure are in patients with chronic anterior instability and associated anterior glenoid bone loss 15% to 30%, off-track Hill-Sachs lesions, and revision surgery, particularly in high-demand contact and collision athletes. These 2 arthroscopic procedures, despite being nonanatomic, provide surgeons with excellent treatment options for those difficult patients with anterior shoulder instability. Despite high success rates with these arthroscopic procedures, patients should be counseled on the risks of graft resorption, graft nonunion, and possible shoulder osteoarthritis. The appropriate indications for these arthroscopic procedures can enhance the successful outcomes for high-risk patients with shoulder instability while also considering the possible long-term impacts of altering shoulder anatomy and scarring in the rare patient who develops shoulder osteoarthritis.
Collapse
|
10
|
Ritter D, Hachem AI, Scheibel M, Raiss P, Denard PJ, Campagnoli A, Wijdicks CA, Bachmaier S. Primary Stability and Bone Contact Loading Evaluation of Suture and Screw based Coracoid Graft Fixation for Anterior Glenoid Bone Loss. Am J Sports Med 2023; 51:2858-2868. [PMID: 37656204 DOI: 10.1177/03635465231188976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Reconstruction techniques for anterior glenoid bone loss have seen a trend from screws to suture-based fixations. However, comparative biomechanical data, including primary fixation and glenoid-graft contact pressure mapping, are limited. HYPOTHESIS Suture-based bone block cerclage (BBC) and suspensory suture button (SB) techniques provide similar primary fixation and cyclic stability to double-screw fixation but with higher contact loading at the bony interface. STUDY DESIGN Controlled laboratory study. METHODS In total, 60 cadaveric scapulae were prepared to simulate anterior glenoid bone loss with coracoid autograft reconstruction. Graft fixation was performed with 3 different techniques: (1) an interconnected all-suture BBC, (2) 2 SB suspensions, and (3) 2 screws. Initial compression was analyzed during primary fixation. Cyclic peak loading with 50 N and 100 N over 250 cycles at 1 Hz was performed with a constant valley load of 25 N. Optical recording and pressure foils allowed for spatial bone block tracking and contact pressure mapping at the glenoid-graft interface. Load-to-failure testing was performed at a rate of 1.5 mm/s with ultimate load and stiffness measured. RESULTS Initial graft compression was higher with screw fixation (141 ± 5 N) compared with suture-based fixations (P < .001), with BBC fixation providing significantly higher compression than SB fixation (116 ± 7 N vs. 91 ± 5 N; P < .001). Spatial bone block migration and ultimate failure load were similar between the BBC and screw groups. The SB group showed significantly increased bone block translation (3.1 ± 1.0 mm; P≤ .014) and rotation (2.5°± 1.4°; P≤ .025) and significantly lower ultimate failure load (180 ± 53 N) compared with the BBC (P = .046) and screw (P = .002) groups. Both suture-based fixations provided significantly increased graft-glenoid contact loading with higher pressure amplitudes (P≤ .032) and contact pressure after cyclic loading (+13%; SB: P = .007; BBC: P = .004) compared with screw fixation. CONCLUSION Both SB and interconnected cerclage fixation improved dynamic contact loading compared with screw fixation in a biomechanical glenoid bone loss model. Cerclage fixation was biomechanically comparable with screw fixation but with a greater variability. SB fixation showed significantly lower primary fixation strength and greater bone block rotation and migration. CLINICAL RELEVANCE Suture-based bone block fixations improved graft-glenoid contact loading, but the overall clinical consequence on healing remains unclear.
Collapse
Affiliation(s)
- Daniel Ritter
- Arthrex Department of Orthopedic Research, Munich, Germany
| | - Abdul-Ilah Hachem
- Department of Orthopedic and Traumatology Surgery, Hospital Universitari Bellvitge & Centro Médico Teknon, University of Barcelona, Barcelona, Spain
| | - Markus Scheibel
- Schulthess Clinic, Zurich, Switzerland
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | |
Collapse
|
11
|
Lacouture-Suarez JD, Azar M, Brusalis CM, Ranieri R, Brotat-Rodriguez M, Boileau P. Screw-Related Complications May Occur at a Greater Rate After Arthroscopic Versus Open Latarjet Procedure: A Systematic Review. Arthrosc Sports Med Rehabil 2023; 5:100726. [PMID: 37645398 PMCID: PMC10461157 DOI: 10.1016/j.asmr.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/18/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To determine the rate of complications attributable to the use of screw fixation during the Latarjet procedure and to delineate screw-related complications for open and arthroscopic Latarjet surgery. Methods A systematic review of the literature was performed by querying MEDLINE and EMBASE computerized databases for relevant articles that reported clinical outcomes associated with the Latarjet procedure. Clinical studies of open and/or arthroscopic Latarjet surgery that employed screw fixation of the coracoid were included in our analysis. Results From 692 articles identified initially, 32 studies met eligibility criteria. The study cohort comprised 2,758 shoulders, with a mean age of patients ranged from 17 to 62 years, and the mean duration of follow-up ranged from 0.3 to 25.6 years. Twenty-two studies reported outcomes of an open Latarjet technique whereas 10 studies reported on an arthroscopic Latarjet technique. Across all studies, the overall complication rate ranged from 1.4% to 36%. The rate of screw-related complications ranged from 0% to16%, and the rate of screw removal ranged from 0% to 18%. Among the subset of studies that reported specific indications for screw removal, the most common indications were pain and screw loosening. Reported rates of screw-removal among arthroscopic Latarjet procedures range from 0% to 18% and among open procedures range from 0% to 7.3%. Conclusions (1) Up to one-third of the overall surgical complications associated with the Latarjet procedure may be related to the use of screw fixation, (2) arthroscopic Latarjet procedure did not decrease the rate of screw related complications. The reported rate of screw-removal may be higher after the arthroscopic Latarjet procedures (up to 18%) than after open procedures (up to 7,3%), and is mainly indicated for persistent shoulder pain and/or screw loosening. Level of Evidence Level IV, systematic review of Level III-IV studies.
Collapse
Affiliation(s)
- Juan David Lacouture-Suarez
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| | - Michel Azar
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| | | | - Riccardo Ranieri
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| | - Maria Brotat-Rodriguez
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| | - Pascal Boileau
- ICR-Institut de Chirurgie Réparatrice - Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
| |
Collapse
|
12
|
Boileau P, Jettoo P, Lacouture JD. Arthroscopic Remnant Coracoid Autograft for Revision of the Failed Latarjet Procedure With Persistent Glenoid Bone Loss. Arthrosc Tech 2023; 12:e923-e930. [PMID: 37424657 PMCID: PMC10323830 DOI: 10.1016/j.eats.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/12/2023] [Indexed: 07/11/2023] Open
Abstract
Recurrence of anterior instability after a Latarjet procedure with persistent glenoid bone loss can be related to coracoid bone block resorption, migration, or malposition. Multiple options are available to address anterior glenoid bone loss, including autograft bone transfers (such as iliac crest graft, distal clavicle autograft) or allografts (distal tibia allograft). Here, we present the use of the remnant coracoid process as an option for consideration in the treatment of glenoid bone loss after failed Latarjet procedure with persistent glenoid bone loss. The remnant coracoid autograft is harvested and transferred inside the glenohumeral joint, through the rotator interval, and fixed using cortical buttons. This arthroscopic procedure includes using 1) glenoid and coracoid drilling guides to optimize graft positioning and making the procedure more reproducible and safer and 2) a suture tensioning device to provide intraoperative graft compression and ensure bone graft healing.
Collapse
Affiliation(s)
- Pascal Boileau
- Address correspondence to Pascal Boileau, M.D., Ph.D., ICR - Institut de Chirurgie Réparatrice Locomoteur & Sport, Groupe Kantys, Nice, France.
| | | | | |
Collapse
|
13
|
Kim D, Lee DW, Lee J, Jang Y. Latarjet procedure without capsular repair produces favorable clinical results and avoids limitation in external rotation. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07393-0. [PMID: 36951982 DOI: 10.1007/s00167-023-07393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE This study aimed at analyzing the range of motion (ROM) and other clinical outcomes in patients with > 20% glenoid bone loss who underwent the Latarjet procedure with or without anterior capsule repair. METHODS This retrospective study included 47 patients with > 20% glenoid bone loss who underwent the classic Latarjet procedure from 2016 to 2021. Of these, 25 did not undergo capsular repair (no-capsular-repair group; group I) whereas 22 patients did (capsular-repair group; group II). The Rowe score, American Shoulder and Elbow Surgeons score, Visual Analogue Scale, ROM, recurrence, and complications were evaluated before and 3, 6, and 12 months after the surgery. A goniometer was used to measure the forward flexion and external rotation (arm adducted, 90° abducted) of both shoulders. The ROM deficit was measured as the difference from the contralateral healthy shoulder. RESULTS The external rotation in arm adduction at 3 and 6 months after surgery showed significantly better results in group I than group II(p = 0.002 at 3 months; p = 0.005 at 6 months). The deficit in external rotation with arm adduction was also significantly lower in group I at 3 months (p = 0.001) and 6 months (p = 0.001) after surgery. However, external rotation with arm adduction at 12 months after surgery did not significantly differ between the groups. Moreover, the ROM in external rotation with 90° arm abduction was significantly better in group I than that in group II at 3, 6, and 12 months postoperatively (p = 0.002, p = 0.001, and p = 0.005, respectively). The deficit in external rotation with 90° arm abduction gradually decreased with time after surgery and differed significantly between the groups. However, the difference in deficit between the two groups at 12 months after surgery did not exceed the measurement error. All clinical scores significantly improved after surgery compared to before surgery; however, the improvement did not significantly differ between the two groups. CONCLUSION The Latarjet procedure without capsular repair showed good laxity restoration and clinical results with less early postoperative external rotation limitation than that achieved by the same procedure with capsular repair. However, external rotation deficit at 1 year after surgery did not show a clinically relevant difference difference between the two groups. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- DooSup Kim
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, 20 Ilsan-Ro, Wonju, 26426, Republic of Korea
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Korea
| | - Dong-Woo Lee
- Department of and Orthopedics, Hanil General Hospital, Seoul, Republic of Korea
| | - JaeMin Lee
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, 20 Ilsan-Ro, Wonju, 26426, Republic of Korea
| | - YoungHwan Jang
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, 20 Ilsan-Ro, Wonju, 26426, Republic of Korea.
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Korea.
| |
Collapse
|