Bone mineral density of the coracoid process decreases with age

Beranger, J; Maqdes, Ali; Pujol, Nicolas; Desmoineaux, P.; Beaufils, Philippe

doi:10.1007/s00167-014-3483-6

Cited by 20 publications

(11 citation statements)

References 25 publications

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“… 4 , 13 , 22 , 25 Bone quality may have influenced load to failure because it has been shown that bone density decreases over time. 3 We tried to mitigate this limitation by using paired male shoulders so that both fixation techniques were applied to specimens of similar bone quality. In addition, failure of the suture button construct would probably occur at higher loads than seen in this study because most failures occurred at the clamp-muscle interface rather than at the glenoid.…”

Section: Discussionmentioning

confidence: 99%

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

Provencher

Aman

LaPrade

et al. 2018

Orthopaedic Journal of Sports Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

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

Provencher

Aman

LaPrade

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…However, due to its mechanical characteristics in compression, this fixation method does not shield from a bone block fracture in case of decreased bone density, and we observed 1 intraoperative coracoid fracture in this series. 3 Properly positioning the bone graft on the margin of the glenoid cavity is one of the keys of Latarjet procedure. In a position too lateral, residual pain and long-term degenerative arthritis of glenohumeral joint was reported, whereas too medial, the failure rate with recurrent shoulder instability increased.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Latarjet procedure with double-button fixation: short-term complications and learning curve analysis

Bonnevialle

Thélu

Bouju

et al. 2018

Journal of Shoulder and Elbow Surgery

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“…Lee et al proposed a number of potential theories which may have accounted for their case of stress fracture such as the repetitive forces on the coracoid during the different phases of the golf swing and the possibility of osteoporosis resulting in an insufficiency fracture. There is evidence that bone mineral density of the coracoid process decreases with age with suggestion of a predisposition to fracture from lower energy mechanisms [15]. Alt-hough the patient in our study was postmenopausal, there were no other predisposing factors that pointed towards an insufficiency fracture.…”

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confidence: 40%