Biomechanical Comparison of Screw Fixation Versus a Cortical Button and Self-tensioning Suture for the Latarjet Procedure

Abstract

Background:Metal screws are traditionally used to fix the coracoid process to the glenoid. Despite stable fixation, metal screws have been associated with hardware complications. Therefore, some studies have advocated for suture button fixation during the Latarjet procedure to reduce the complications associated with screw fixation.Purpose:To biomechanically evaluate the ultimate failure load of a cortical button and self-tensioning suture versus metal screws for coracoid graft fixation during the Latarjet procedure.Study Design:Controlled laboratory study.Methods:Eight matched pairs of fresh-frozen, male cadaveric shoulders (N = 16) underwent the Latarjet procedure. The shoulders of each pair were randomly assigned to 1 of 2 groups: fixation using two 3.75-mm cannulated, fully threaded metal screws or fixation using a double suture button construct. Specimens were secured in a dynamic testing machine and cyclically preconditioned from 2 to 10 N at 0.1 Hz for 10 cycles. After preconditioning, specimens were pulled to failure at a normalized displacement rate of 400% of the measured gauge length per minute. The ultimate failure load and mechanism of failure were recorded for each specimen.Results:The mean ultimate load to failure for screw fixation (226 ± 114 N; 95% CI, 147-305 N) was not significantly different from that for suture button fixation (266 ± 73 N; 95% CI, 216-317 N) (P = .257). The mean strain at failure for screw fixation (63% ± 21%; 95% CI, 48%-77%) was not significantly different from that for suture button fixation (86% ± 26%; 95% CI, 69%-104%) (P = .060). The most common mechanism of failure for the screw fixation method was at the bone block drill holes, while an intramuscular rupture at the clamp-muscle interface occurred for the suture button construct.Conclusion:The screw and suture button fixation techniques exhibited comparable biomechanical strength for coracoid bone block fixation of the Latarjet procedure.Clinical Relevance:Metal screws have been reported to be a large contributor to intraoperative and postoperative complications. Therefore, given the results of the current study, a suture button construct may be an alternative to metal screw fixation during the Latarjet procedure. However, further clinical studies are warranted.

Early Follow‐Up of Arthroscopic Latarjet Procedure with Screw or Suture‐Button Fixation for Recurrent Anterior Shoulder Instability

“…This method might help avoid impingement of the humeral head caused by malposition of the coracoid bony graft or its screws above the glenoid level with no reported neurological complications. Also, Provencher et al found a comparable biomechanical strength for coracoid bone block fixation between the screw and suture-button fixation techniques in Lataejet procedure 25 . The procedure remains technique demanding and, to our knowledge, few centers have reported clinical and radiologic outcomes for this surgical technique in China 26 .…”

All-arthroscopic, guided Eden-Hybbinette procedure using suture-button fixation for revision of failed Latarjet

“…Recent clinical and biomechanical studies have confirmed that suture-button fixation devices provide mechanically strong constructs that are equivalent to the classically performed 2-screw technique. 11,18,37,38,52 After our successful clinical experience with the arthroscopic Latarjet procedure, we have developed an all-arthroscopic guided Eden-Hybbinette technique using the same guiding instrumentation and suture-button device (Bone-Link) for graft fixation. Herein, we describe this guided arthroscopic technique and report the clinical and radiological results in a series of 7 patients revised for a failed Latarjet.…”

Arthroscopic Technique for Bone Augmentation With Suture Button Fixation for Anterior Shoulder Instability

“…16,17,19,23,26 Suspensory fixation has been described previously in the literature through an open technique as an alternative to screw fixation of with a similar biomechanical strength. 16,31 Recently, Kalogrianitis et al 33 described an arthroscopic technique of iliac crest autograft bone augmentation with suspensory suture button fixation. However, the limitations of this graft include the lack of a chondral surface and significant donor site morbidity.…”

“…21,31,32 Fixation using suspensory cortical buttons has recently been described for the Bristow procedure and may be an attractive alternative to eliminate the complications associated with screw fixation. 16,31,33 Recently, the literature has reported suspensory fixation using iliac crest autograft; however, we discuss a technique for arthroscopic distal tibia allograft osteochondral fixation using suture button device. 33 The purpose of this technique is to describe the rationale and technical considerations behind the technique of osteochondral bone grafting of glenoid bone defects using a simple arthroscopic technique with suspensory fixation.…”