A guided surgical approach and novel fixation method for arthroscopic Latarjet

• Published in: Journal of shoulder and elbow surgery Vol. 25; no. 1; pp. 78 - 89
• Main Authors: Boileau, Pascal, MD, Gendre, Patrick, MD, Baba, Mohammed, MD, Thélu, Charles-Édouard, MD, Baring, Toby, FRCS, Gonzalez, Jean-François, MD, PhD, Trojani, Christophe, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2016
• Subjects: Adolescent; Adult; arthroscopic Latarjet; Arthroscopy - adverse effects; Arthroscopy - methods; Bone Screws; Bone Transplantation - adverse effects; Bone Transplantation - methods; cortical button; Female; Follow-Up Studies; glenoid bone loss; Humans; Joint Instability - surgery; Latarjet procedure; Male; Middle Aged; Orthopedics; Scapula - surgery; shoulder instability; Shoulder Joint - diagnostic imaging; Shoulder Joint - surgery; Suture Techniques; Tomography, X-Ray Computed; Wound Healing; Young Adult; Treatment Study; Level IV; Case Series; Latarjet procedure; cortical button; arthroscopic Latarjet; glenoid bone loss; shoulder instability
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2015.06.001

Background Most of the complications of the Latarjet procedure are related to the bone block positioning and use of screws. The purpose of this study was to evaluate if an arthroscopic Latarjet guiding system improves accuracy of bone block positioning and if suture button fixation could be an alternative to screw fixation in allowing bone block healing and avoiding complications. Materials and methods Seventy-six patients (mean age, 27 years) underwent an arthroscopic Latarjet procedure with a guided surgical approach and suture button fixation. Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging. Clinical examinations were performed at each visit. Results At a mean of 14 months (range, 6-24 months) postoperatively, 75 of 76 patients had a stable shoulder. No neurologic complications were observed; no patients have required further surgery. The coracoid graft was positioned strictly tangential to the glenoid surface in 96% of the cases and below the equator in 93%. The coracoid graft healed in 69 patients (91%). Conclusions A guided surgical approach optimizes graft positioning accuracy. Suture button fixation can be an alternative to screw fixation, obtaining an excellent rate of bone union. Neurologic and hardware complications, classically reported with screw fixation, have not been observed with this guided technique and novel fixation method.