Introduction: Screw entry point and trajectory (the alpha angle) are essential to ensure appropriate graft position in the Bristow Latarjet procedure. A high alpha angle may occur in patients with a large soft tissue envelope, where adequate medial positioning of the drill and guide can be challenging. This study investigated the effect of using a longer drill bit and soft tissue guide during the procedure to improve the starting position and drill trajectory and whether this can result in improved postoperative screw alpha angle.Material and methods: 66 consecutive Latarjet procedures between January 2013 and August 2017 were separated into two groups. In group one (Standard drill) the screw holes were created using the standard length 3.2 mm AO large fragment drill bit and 3.2/4.5 mm double drill sleeve (Synthes, Paoli, PA, USA). For the patients in group two (Long drill) the 3.2 mm percutaneous drill bit (300 mm) with a longer 4.3 mm drill sleeve (Synthes, Paoli, PA, USA) was utilised. The postoperative Bernageau radiographs were assessed independently by two observers to record each screw alpha angle.Results: There was a significant difference in average screw angle between both groups studied (5.8 ± 1.7 versus 2.1 ± 0.8, P = 0.037). There was excellent reliability (all correlations > 0.93) for both intra-observer and inter-observer measurements of screw angles.Discussion: The use of a longer drill bit and guide allowed optimal positioning of the drill during screw hole preparation in the Latarjet procedure. This simple technique modification is cheap and easy to add to any surgeons practice and may offer benefit to patients.
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