Comparison of screw versus suture button fixation techniques in the arthroscopic Latarjet procedure for recurrent shoulder instability: A systematic review

Abstract

Background

The arthroscopic Latarjet procedure is an established treatment for recurrent anterior shoulder instability with significant glenoid bone loss. This systematic review compared outcomes of screw versus suture-button fixation and identified contexts where each technique may be advantageous.

Methods

Following PRISMA 2020 guidelines, PubMed and Google Scholar were searched on 23 July 2024 for English-language studies of arthroscopic Latarjet procedures using screw or suture-button fixation. Eligible studies included full-text human data with clear follow-up and outcome reporting. Extracted data included demographics, surgical details, functional scores, union rates, complications, and reoperations. Risk of bias was assessed using established tools for non-randomized studies. Pooled statistical comparisons for complication, reoperation, and non-union rates were performed using chi-square tests.

Results

Twenty studies met the inclusion criteria: 11 using suture-button fixation (804 patients) and nine using screws (753 patients). Both techniques achieved high graft union rates (>90%) and improved functional outcomes. Suture-button fixation showed lower complication (13.3% vs. 22.1%, p < 0.001) and reoperation rates (0.8% vs. 8.2%, p < 0.00001), with a non-significant trend toward higher non-union (9.6% vs. 3.6%, p = 0.08).

Conclusion

Both fixation methods restore shoulder stability effectively. Fixation choice should be individualized to patient anatomy, functional demands, and surgeon experience. Further prospective comparative studies are warranted.