A biodegradable expansion plug for fixation of the coracoid bone block in the Bristow-Latarjet operation

Abstract

In a prospective study, 33 patients with recurrent anterior dislocation of the shoulder were treated by a modified Bristow-Latarjet operation using a biodegradable poly-L-lactide expansion plug to fix the transferred coracoid bone block. The mean follow up was 12 months. No redislocations occurred. To assess incorporation of the bone block, serial CT scans were obtained in 18 randomly selected patients and 15 showed solid fusion. The shape of the implant was not affected by degradation during the first 18 months and there were no signs of inflammatory foreign body reaction. This type of plug avoids the complications which have necessitated the removal of metal devices and is a promising new method of fixing the transferred coracoid.

Complications associated with open coracoid transfer procedures for shoulder instability

“…Metallic screw fixation was used in 29 studies, 1,[4][5][6]9,12,13,[15][16][17]19,22,24,29,[31][32][33]36,[42][43][44][45][46][47][49][50][51][52][53] and bioabsorbable screws and plugs were used in 1 study. 39 Repeat surgery was documented in 81 cases (4.9 AE 1.0%), including for hardware problems in 50 and recurrent instability in 20. Other reasons included infection in 5, hematoma in 3, graft migration into the joint in 1, aseptic graft necrosis with a cutaneous fistula in 1, and a permanent axillary nerve palsy treated with a sural nerve graft in 1.…”

“…Three percent of cases (20 of 636) from 14 studies 1,5,6,9,13,[15][16][17]19,22,24,32,41,45 were revision procedures. Sixteen studies 4,12,29,31,33,36,39,[43][44][45]47,[49][50][51][52][53] (1058 cases) made no comment regarding whether the procedures were primary or revision cases. Metallic screw fixation was used in 29 studies, 1,[4][5][6]9,12,13,[15][16][17]19,22,24,29,[31][32][33]36,[42][43][44]…”

“…1,[4][5][6]9,12,[15][16][17]19,22,24,29,31,32,36,39,[42][43][44][45][46][47][49][50][51]53 Nerve palsy Taking those 19 studies 1,4,5,9,12,13,[15][16][17]19,24,29,32,36,39,44,47,52,53 that discuss general intraoperative and perioperative complications, the rate of nerve injury identified would be 0.7% (8 of 1069 cases). These included 1 permanent axillary nerve injury treated with a sural nerve graft and 7 transient nerve palsies (1 axillary, 3 musculocutaneous, 2 ulnar and, 1 radial nerve).…”

“…Since these early descriptions of coracoid transfer procedures for shoulder instability, significant interest has been maintained, with numerous modifications to the approach (including arthroscopic techniques) and method of fixation described, although the basic concept has remained the same. 5,7,8,9,12,13,16,22,24,26,39 Understanding the complications associated with these procedures can minimize their occurrence and is important for surgical training and in providing informed consent for patients in whom the operation is planned. The purpose of this study was to conduct a systematic review of the complications of open coracoid transfer procedures to characterize the safety profile for this method of the treatment of anterior shoulder instability.…”

Graft osteolysis and recurrent instability after the Latarjet procedure performed with bioabsorbable screw fixation

“…We are aware of only one other study that has reported the use of a biodegradable PLA expansion plug to fix the coracoid graft in the Latarjet-Bristow procedure. 41 The investigators reported 4 of 33 cases with fixation failure or loosening related to the implant that required revision surgery and a nonunion rate of 16.7%. Although there were fewer patients in our study, the results we have reported for graft fixation and bone healing compare favorably.…”