The Latarjet procedure reduces recurrent glenohumeral instability but has potential hardware and graft complications. The procedure has been modified to use various screw types as well as suture buttons. Biomechanical studies have evaluated the effect of these implants on construct strength. With varying results it is unclear whether there is an optimal implant to use.
Methods
We conducted a systematic review of human cadaveric biomechanical studies evaluating Latarjet ultimate failure load. Two independent reviewers screened articles and included them after full text review. Additional factors including implants used, graft orientation, cortices engaged, drill diameter, and screw characteristics were recorded. Meta-regression was performed on the 145 specimens from eight studies that met inclusion criteria.
Results
Screw fixation resulted in a 396.8 N (95% CI, 149.8–643.7) N higher ultimate failure load against shear stresses than suture buttons (p = 0.002). There were no differences between implants for ultimate failure load against tensile forces. Tensile strength was significantly affected by drill diameter with each millimeter of increase reducing the mean ultimate failure load by 127.4 N (95% CI, 41.2–213.6) N (p = 0.004).
Conclusions
These results suggest that using screw fixation and minimizing drill diameter can obtain the maximum ultimate failure load against both shear and tensile forces in a Latarjet construct.
LatarjetM. Treatment of recurrent dislocation of the shoulder. Lyon Chir1954; 49: 994–997.
2.
BoileauPVillalbaMHéryJY, et al.Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am2006; 88: 1755–1763.
3.
BurkhartSSDe BeerJF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy2000; 16: 677–694.
4.
ItoiELeeSBBerglundLJ, et al.The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am2000; 82: 35–46.
5.
ProvencherMTGhodadraNRomeoAA. Arthroscopic management of anterior instability: pearls, pitfalls, and lessons learned. Orthop Clin North Am2010; 41: 325–337.
6.
SugayaHMoriishiJDohiM, et al.Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am2003; 85: 878–884.
7.
AnVVGSivakumarBSPhanK, et al.A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair. J Shoulder Elbow Surg2016; 25: 853–863.
8.
YangJSMazzoccaADCoteMP, et al.Recurrent anterior shoulder instability with combined bone loss: treatment and results with the modified Latarjet procedure. Am J Sports Med2016; 44: 922–932.
9.
ZimmermannSMScheyererMJFarshadM, et al.Long-term restoration of anterior shoulder stability: a retrospective analysis of arthroscopic Bankart repair versus open Latarjet procedure. J Bone Joint Surg Am2016; 98: 1954–1961.
10.
BurkhartSSDe BeerJFBarthJR, et al.Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy2007; 23: 1033–1041.
11.
de BeerJFRobertsC. Glenoid bone defects – open Latarjet with congruent arc modification. Orthop Clin North Am2010; 41: 407–415.
12.
BoileauPGendrePBabaM, et al.A guided surgical approach and novel fixation method for arthroscopic Latarjet. J Shoulder Elbow Surg2016; 25: 78–89.
13.
AlviHMMonroeEJMuriukiM, et al.Latarjet fixation: a cadaveric biomechanical study evaluating cortical and cannulated screw fixation. Orthop J Sports Med2016, pp. 4: 2325967116643533–4: 2325967116643533.
14.
GendrePThéluC-Ed’OllonneT, et al.Coracoid bone block fixation with cortical buttons: an alternative to screw fixation?Orthop Traumatol Surg Res2016; 102: 983–987.
15.
SalekyBHapaOIsinY, et al.Suture anchor fixation strength in the Latarjet procedure: a biomechanical study in cadavers. Eur J Orthop Surg Traumatol2019; 29: 1667–1672.
16.
SchmiddemUHawiNLiodakisE, et al.Monocortical fixation of the coracoid in the Latarjet procedure is significantly weaker than bicortical fixation. Knee Surg Sports Traumatol Arthrosc2019; 27: 239–244.
17.
WillemotLBWodickaRBosworthA, et al.Influence of screw type and length on fixation of anterior glenoid bone grafts. Shoulder Elbow2018; 10: 32–39.
18.
ProvencherMTAmanZSLaPradeCM, et al.Biomechanical comparison of screw fixation versus a cortical button and self-tensioning suture for the Latarjet procedure. Orthop J Sports Med2018, pp. 6: 2325967118777842–6: 2325967118777842.
19.
ChillemiCGuerrisiMPaglialungaC, et al.Latarjet procedure for anterior shoulder instability: a 24-year follow-up study. Arch Orthop Trauma Surg. Epub ahead of print 27 March 2020. DOI: 10.1007/s00402-020-03426-2.
20.
BoileauPSalikenDGendreP, et al.Arthroscopic Latarjet: suture-button fixation is a safe and reliable alternative to screw fixation. Arthroscopy2019; 35: 1050–1061.
21.
ButtUCharalambousCP. Complications associated with open coracoid transfer procedures for shoulder instability. J Shoulder Elbow Surg2012; 21: 1110–1119.
22.
GasbarroGGiugaleJMWalchG, et al.Predictive surgical reasons for failure after coracoid process transfers. Orthop J Sports Med2016, pp. 4: 2325967116676795–4: 2325967116676795.
23.
LeBusGFChahlaJSanchezG, et al.The Latarjet procedure at the National Football League Scouting Combine: an imaging and performance analysis. Orthop J Sports Med2017, pp. 5: 2325967117726045–5: 2325967117726045.
24.
WillemotLDe BoeySVan TongelA, et al.Analysis of failures after the Bristow-Latarjet procedure for recurrent shoulder instability. Int Orthop2019; 43: 1899–1907.
25.
GilesJWPuskasGWelshM, et al.Do the traditional and modified Latarjet techniques produce equivalent reconstruction stability and strength?Am J Sports Med2012; 40: 2801–2807.
26.
KazumEChechikOPritschT, et al.Biomechanical evaluation of suture buttons versus cortical screws in the Latarjet-Bristow procedure: a fresh-frozen cadavers study. Arch Orthop Trauma Surg2019; 139: 1779–1783.
27.
MontgomerySRKatthagenJCMikulaJD, et al.Anatomic and biomechanical comparison of the classic and congruent-arc techniques of the Latarjet procedure. Am J Sports Med2017; 45: 1252–1260.
28.
ShinJJHamamotoJTLerouxTS, et al.Biomechanical analysis of Latarjet screw fixation: comparison of screw types and fixation methods. Arthroscopy2017; 33: 1646–1653.
29.
WeppeFMagnussenRALustigS, et al.A biomechanical evaluation of bicortical metal screw fixation versus absorbable interference screw fixation after coracoid transfer for anterior shoulder instability. Arthroscopy2011; 27: 1358–1363.
30.
WilliamsRCMorrisRPEl BeainoM, et al.Cortical suture button fixation vs. bicortical screw fixation in the Latarjet procedure: a biomechanical comparison. J Shoulder Elbow Surg2020; 29: 1470–1478.
31.
Wallace BC, Small K, Brodley CE, et al. Deploying an interactive machine learning system in an evidence-based practice center: abstrackr. In: Proceedings of the ACM International Health Informatics Symposium (IHI). New York: Association for Computing Machinery, 2012, pp.819–824.
32.
WilkeJKrauseFNiedererD, et al.Appraising the methodological quality of cadaveric studies: validation of the QUACS scale. J Anat2015; 226: 440–446.
33.
WallaceBCDahabrehIJTrikalinosTA, et al.Closing the gap between methodologists and end-users: R as a computational back-end. J Stat Softw2012; 49: 1–15.
