Latarjet Cerclage: The All-Arthroscopic Metal-Free Fixation

Abstract

The BristoweLatarjet procedure has been one of the most recognized procedures for the treatment of recurrent shoulder dislocation with anterior glenoid bone loss, revision surgery after failed Bankart repair, contact and collision sport injuries, and patients with a high risk of recurrence. Open and arthroscopic approaches have recently shown similar outcomes by several authors. However, complications related to metal implants, despite being low, are still a matter of concern. We describe an all-arthroscopic Latarjet technique with a metal-free fixation method using 2 ultra-high-strength sutures, creating a cerclage construct through 2.4mm glenoid and coracoid tunnels with a final capsulolabral complex reconstruction.

Arthroscopic Latarjet Procedure Using FiberTape Cerclage With a Simplified Technique for Suture Passage and Coracoid Fixation

“…14 The FiberTape passage is made simpler in our technique by shuttling them in a straight line through the glenoid drill holes and through the coracoid holes, using the M portal to shuttle the tapes to and fro. In the technique described earlier by Hachem et al, 9 the tape has to be passed as 90 to the glenoid drill holes and this often causes abrasion at the glenoid hole edges and difficulty in passage. Using a crochet hook to shuttle the passing sutures through the osteotomized coracoid simplifies the suture passage, which is usually a difficult step in the previously described all-fiber arthroscopic Latarjet technique.…”

“…The metal-free cerclage tape method of arthroscopic Latarjet procedure reduces the change of metal prominence and impingement after anterior glenoid reconstruction with coracoid bone transfer. We propose a modification of the metal-free technique described earlier 9 that aims to simplify the passage of the ultrahigh strength fiber tapes through the glenoid and coracoid bones.…”

Arthroscopic Iliac Crest Bone Graft Augmentation Using All-Suture Anchors for Shoulder Instability Caused by Glenoid Bone Loss

“…Kalogrianitis and Tsouparopoulos 11 used the Arthrex TightRope suspensory suture button system for ICBG fixation, whereas Hassebrock et al 6 used this system for distal tibial allograft fixation. Finally, Hachem et al 16,17 utilised Arthrex SutureTape cerclage technique on ICBG and in Latarjet.…”

“…10 Some arthroscopic techniques use metal screws, but the use of alternative means, such as suspensory suture button fixation, suture anchors, suture tape cerclage, and bioabsorbable screws, has been described in the literature. 6,[11][12][13][14][15][16][17] These alternatives avoid the complications associated with metal screws; however, they all require both anterior and posterior approaches, and the posterior approach is used for the insertion of instruments, transglenoid drilling, suture management, and knot tying. 6,[11][12][13][14][15][16][17] In this article, we describe an arthroscopic graft fixation technique using knotless all-suture anchors via a purely anterior approach without the need for posterior suture management.…”

“…6,[11][12][13][14][15][16][17] These alternatives avoid the complications associated with metal screws; however, they all require both anterior and posterior approaches, and the posterior approach is used for the insertion of instruments, transglenoid drilling, suture management, and knot tying. 6,[11][12][13][14][15][16][17] In this article, we describe an arthroscopic graft fixation technique using knotless all-suture anchors via a purely anterior approach without the need for posterior suture management. The aim is to restore shoulder stability through anatomic reconstruction of anterior glenoid defects through the precise placement and fixation of the graft.…”