Revision of failed Latarjet procedure by arthroscopy-assisted Eden-Hybbinette with endobutton fixation

Abstract

Background: The literature reports recurrent instability after the Latarjet procedure in 1 to 5% of the cases. Therefore, the Eden-Hybbinette technique, which consists of harvesting bone from the iliac crest, has been proposed in case of revision surgery. The objective of this study was to evaluate the clinical and radiographic results of a series of patients treated by an all-arthroscopic Eden-Hybbinette technique with endobutton graft fixation. Methods: Seven patients (5 men, 2 women, mean age 30.7 years (17-47)), with recurrent anterior instability after Latarjet procedure, associated with glenoid bone defect of more than 15% were treated by arthroscopic Eden-Hybbinette technique. The bone graft fixed with an endobutton (Bone-LinkTM) was introduced through the rotator cuff interval. Specific guides and a dynamometer were used to fix the graft by compression on the anterior edge of the glenoid cavity. Previous broken screws were left in place in 3 cases. Patients were clinically followed and the position of the graft and its consolidation were evaluated by CT scan. Results: At mean follow-up of 21 months (12-39), 7/6 patients had a stable shoulder and were satisfied with the result. 5/7 resumed their sporting activity. The mean Constant score increased from 32 to 81 points and the Subjective Shoulder Value from 31 to 87% (p > 0.001). The mean Walch-Duplay and Rowe scores were 85.7 points (65-100) and 86.4 points (70-100) respectively. No neurological complications were reported, and no patients required a new procedure. On the CT scan analysis, the graft did not overhang and was sub-equatorial and healed in all cases. Conclusion: The recurrence of instability after a Latarjet graft can be successfully treated by the Eden-Hybbinette technique under arthroscopy. Endobutton fixation is reliable and optimizes the position and consolidation of the bone graft. In addition, this fixation method is an appropriate option in case of broken hardware left in place.

Arthroscopic Anatomic Glenoid Reconstruction With Distal Tibial Allograft and Hybrid Fixation

“…Similarly, 7% of our patients had to undergo revision surgery for hardware removal. 16 Thus, surgeons have opted for alternative fixation techniques, including isolated suspensory fixation with EndoButtons, 5,6 trying to limit hardware complications and avoid potential revision surgery for hardware removal while maintaining good functional outcomes and obtaining reliable graft fixation, as shown by Boileau et al 17 The use of nonrigid fixation with EndoButtons in the setting of AAGR has also proved safe and effective, mainly in cases of failed Latarjet procedures with previous compression screws. 5,6 In addition, the medial Halifax portal, described with rigid fixation, 2 could be avoided because this technique does not require direct anterior access to the glenoid neck.…”