Suture button fixation Latarjet procedure under total arthroscopy for treatment of anterior shoulder instability with severe bone defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HAN Dawei ¹ , YING Li ¹ , SHA Linlin ² , HUI Yu ² , YING Liwei ¹ , ZHANG Qingguo ¹ , LIANG Junbo ³ ,  ZHOU Xiaobo ¹

1. Department of Sports Medicine, Taizhou Hospital of Zhejiang Province, Linhai Zhejiang, 317000, P. R. China;
2. Department of Orthopedic Rehabilitation, Taizhou Hospital of Zhejiang Province, Linhai Zhejiang, 317000, P. R. China;
3. Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Linhai Zhejiang, 317000, P. R. China;

Corresponding author：

ZHOU Xiaobo, Email: dafuz@163.com

Keywords：

Anterior shoulder instability; arthroscopy; suture button fixation; Latarjet procedure

DOI：

10.7507/1002-1892.202403121

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Objective To assess the effectiveness of suture button fixation Latarjet procedure under total arthroscopy for anterior shoulder instability with severe bone defects. Methods The clinical data of 15 patients with severe bone defects and anterior shoulder instability treated with suture button fixation Latarjet procedure under total arthroscopy between June 2020 and February 2023 was retrospectively analyzed, including 11 males and 4 females, with an average age of 31.1 years (range, 20-54 years). Three-dimensional CT showed that the average glenoid bone defect was 24.4% (range, 16.3%-35.2%). The average number of shoulder dislocation was 4.2 times (range, 3-8 times). The disease duration ranged from 6 to 21 months with an average of 10.6 months. The operation time and intraoperative blood loss were recorded. The pain relief was evaluated by visual analogue scale (VAS) score, and the functional recovery of shoulder joint was evaluated by Rowe score, Walch-Duplay score, and American Association for Shoulder and Elbow Surgery (ASES) score before and after operation. The range of motion (ROM) of the shoulder joint was assessed, including active flexion, lateral external rotation, abduction 90° external rotation, and internal rotation. Three-dimensional CT was performed at 6 months after operation and at last follow-up to observe the absorption of bone graft, the position of bone graft and glenoid, and the healing of bone graft. Results The operation was successfully completed in all patients. The operation time was 85-195 minutes, with an average of 123.0 minutes. The intraoperative blood loss was 20-75 mL, with an average of 26.5 mL. All patients were followed up 13-32 months, with an average of 18.7 months. During the follow-up, there was no serious complication such as shoulder joint infection, joint stiffness, or vascular and nerve injury. One patient had partial absorption of the transplanted bone and bone nonunion at 3 months after operation, but the pain of the shoulder joint relieved at last follow-up, and no redislocation of the shoulder joint occurred; no obvious bone fracture or dislocation of the shoulder joint was found in the other patients. Bone union was achieved at 6 months during follow-up. At last follow-up, the VAS score, Rowe score, Walch-Duplay score, and ASES score significantly improved when compared with those before operation (P<0.05), while the ROM of active flexion, lateral external rotation, abduction 90° external rotation, and internal rotation of the shoulder joint was not significantly different from those before operation (P>0.05).Conclusion Suture button fixation Latarjet procedure under total arthroscopy can improve shoulder joint function in patients with severe anterior shoulder instability caused by bone defects, and imaging also indicates satisfactory placement of transplanted bone blocks.

Citation： HAN Dawei, YING Li, SHA Linlin, HUI Yu, YING Liwei, ZHANG Qingguo, LIANG Junbo, ZHOU Xiaobo. Suture button fixation Latarjet procedure under total arthroscopy for treatment of anterior shoulder instability with severe bone defect. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(6): 666-671. doi: 10.7507/1002-1892.202403121 Copy

1.	Billaud A, Baverel L, Metais P. Arthroscopic Latarjet yields better union and prevention of instability compared to arthroscopic bony Bankart repair in shoulders with recurrent anterior instability: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2023, 31(12): 5994-6005.
2.	Lho T, Lee J, Oh KS, et al. Latarjet procedure for failed Bankart repair provides better stability and return to sports, but worse postoperative pain and external rotation limitations with more complications, compared to revision Bankart repair: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2023, 31(8): 3541-3558.
3.	唐新, 陈世益. 肩关节前向不稳的诊疗现状及进展. 中国修复重建外科杂志, 2023, 37(5): 509-517.
4.	Meisterhans M, Selman F, Ongini E, et al. Stability of novel cow-hitch suture button coracoid bone graft fixation in Latarjet procedures: a biomechanical study. J Shoulder Elbow Surg, 2024, 33(3): 610-617.
5.	Arner JW, Tanghe K, Shields T, et al. Shoulder Latarjet surgery shows wide variation in reported indications, techniques, perioperative treatment, and definition of outcomes, complications, and failure: A systematic review. Arthroscopy, 2022, 38(2): 522-538.
6.	Bonnevialle N, Thélu CE, Bouju Y, et al. Arthroscopic Latarjet procedure with double-button fixation: short-term complications and learning curve analysis. J Shoulder Elbow Surg, 2018, 27(6): e189-e195.
7.	Shao Z, Zhao Y, Luo H, et al. Clinical and radiologic outcomes of all-arthroscopic Latarjet procedure with modified suture button fixation: Excellent bone healing with a low complication rate. Arthroscopy, 2022, 38(7): 2157-2165.
8.	Boileau P, Saliken D, Gendre P, et al. Arthroscopic Latarjet: Suture-button fixation is a safe and reliable alternative to screw fixation. Arthroscopy, 2019, 35(4): 1050-1061.
9.	Williams RC, Morris RP, El Beaino M, et al. Cortical suture button fixation vs. bicortical screw fixation in the Latarjet procedure: a biomechanical comparison. J Shoulder Elbow Surg, 2020, 29(7): 1470-1478.
10.	Xu J, Liu H, Lu W, et al. Modified arthroscopic Latarjet procedure: Suture-button fixation achieves excellent remodeling at 3-year follow-up. Am J Sports Med, 2020, 48(1): 39-47.
11.	Rouleau DM, Hébert-Davies J, Djahangiri A, et al. Validation of the instability shoulder index score in a multicenter reliability study in 114 consecutive cases. Am J Sports Med, 2013, 41(2): 278-282.
12.	Hovelius L, Sandström B, Olofsson A, et al. The effect of capsular repair, bone block healing, and position on the results of the Bristow-Latarjet procedure (study Ⅲ): long-term follow-up in 319 shoulders. J Shoulder Elbow Surg, 2012, 21(5): 647-660.
13.	Vuletić F, Bøe B. Current trends and outcomes for open vs. arthroscopic Latarjet. Curr Rev Musculoskelet Med, 2024, 17(5): 136-143.
14.	Kordasiewicz B, Kicinski M, Małachowski K, et al. Comparative study of open and arthroscopic coracoid transfer for shoulder anterior instability (Latarjet)-computed tomography evaluation at a short term follow-up. Part Ⅱ. Int Orthop, 2018, 42(5): 1119-1128.
15.	Lafosse L, Lejeune E, Bouchard A, et al. The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy, 2007, 23(11): 1242.e1-e5.
16.	Neyton L, Barth J, Nourissat G, et al. Arthroscopic Latarjet techniques: Graft and fixation positioning assessed with 2-dimensional computed tomography is not equivalent with standard open technique. Arthroscopy, 2018, 34(7): 2032-2040.
17.	梁达强, 蒯声政, 李瑛, 等. Latarjet手术治疗肩关节前向脱位中螺钉固定与纽扣固定的生物力学对比分析. 中国修复重建外科杂志, 2020, 34(5): 602-607.
18.	Azoulay V, Briot J, Mansat P, et al. Mechanical behavior of screw versus Endobutton for coracoid bone-block fixation. Orthop Traumatol Surg Res, 2020, 106(6): 1089-1093.
19.	Cozzolino A, de Giovanni R, Malfi P, et al. Arthroscopic Latarjet versus arthroscopic free bone block procedures for anterior shoulder instability: A proportional meta-analysis comparing recurrence, complication, and reoperation rates. Am J Sports Med, 2024. doi: 10.1177/03635465231188530.
20.	Barret H, Chelli M, Van Der Meijden O, et al. Arthroscopic Latarjet: 2 or 4 cortical buttons for coracoid fixation? A case-control comparative study. Am J Sports Med, 2022, 50(2): 311-320.
21.	Song Q, Gao A, Bai J, et al. The arthroscopic Bristow procedure is superior to the arthroscopic Latarjet procedure in return to sports but inferior in graft healing: A comparative study with 3.4-year follow-up. Arthroscopy, 2023, 39(12): 2423-2433.
22.	Hurley ET, Danilkowicz RM, Paul AV, et al. Majority of studies show similar rates of return to play after arthroscopic bankart repair or Latarjet procedure: A systematic review. Arthroscopy, 2024, 40(2): 515-522.
23.	Rosenow CS, Leland DP, Camp CL, et al. Sutures, screws, buttons, and anchors: A review of current bone graft fixation devices for glenoid bone loss in the unstable shoulder. Curr Rev Musculoskelet Med, 2024, 17(6): 207-221.

1. Billaud A, Baverel L, Metais P. Arthroscopic Latarjet yields better union and prevention of instability compared to arthroscopic bony Bankart repair in shoulders with recurrent anterior instability: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2023, 31(12): 5994-6005.
2. Lho T, Lee J, Oh KS, et al. Latarjet procedure for failed Bankart repair provides better stability and return to sports, but worse postoperative pain and external rotation limitations with more complications, compared to revision Bankart repair: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2023, 31(8): 3541-3558.
3. 唐新, 陈世益. 肩关节前向不稳的诊疗现状及进展. 中国修复重建外科杂志, 2023, 37(5): 509-517.
4. Meisterhans M, Selman F, Ongini E, et al. Stability of novel cow-hitch suture button coracoid bone graft fixation in Latarjet procedures: a biomechanical study. J Shoulder Elbow Surg, 2024, 33(3): 610-617.
5. Arner JW, Tanghe K, Shields T, et al. Shoulder Latarjet surgery shows wide variation in reported indications, techniques, perioperative treatment, and definition of outcomes, complications, and failure: A systematic review. Arthroscopy, 2022, 38(2): 522-538.
6. Bonnevialle N, Thélu CE, Bouju Y, et al. Arthroscopic Latarjet procedure with double-button fixation: short-term complications and learning curve analysis. J Shoulder Elbow Surg, 2018, 27(6): e189-e195.
7. Shao Z, Zhao Y, Luo H, et al. Clinical and radiologic outcomes of all-arthroscopic Latarjet procedure with modified suture button fixation: Excellent bone healing with a low complication rate. Arthroscopy, 2022, 38(7): 2157-2165.
8. Boileau P, Saliken D, Gendre P, et al. Arthroscopic Latarjet: Suture-button fixation is a safe and reliable alternative to screw fixation. Arthroscopy, 2019, 35(4): 1050-1061.
9. Williams RC, Morris RP, El Beaino M, et al. Cortical suture button fixation vs. bicortical screw fixation in the Latarjet procedure: a biomechanical comparison. J Shoulder Elbow Surg, 2020, 29(7): 1470-1478.
10. Xu J, Liu H, Lu W, et al. Modified arthroscopic Latarjet procedure: Suture-button fixation achieves excellent remodeling at 3-year follow-up. Am J Sports Med, 2020, 48(1): 39-47.
11. Rouleau DM, Hébert-Davies J, Djahangiri A, et al. Validation of the instability shoulder index score in a multicenter reliability study in 114 consecutive cases. Am J Sports Med, 2013, 41(2): 278-282.
12. Hovelius L, Sandström B, Olofsson A, et al. The effect of capsular repair, bone block healing, and position on the results of the Bristow-Latarjet procedure (study Ⅲ): long-term follow-up in 319 shoulders. J Shoulder Elbow Surg, 2012, 21(5): 647-660.
13. Vuletić F, Bøe B. Current trends and outcomes for open vs. arthroscopic Latarjet. Curr Rev Musculoskelet Med, 2024, 17(5): 136-143.
14. Kordasiewicz B, Kicinski M, Małachowski K, et al. Comparative study of open and arthroscopic coracoid transfer for shoulder anterior instability (Latarjet)-computed tomography evaluation at a short term follow-up. Part Ⅱ. Int Orthop, 2018, 42(5): 1119-1128.
15. Lafosse L, Lejeune E, Bouchard A, et al. The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy, 2007, 23(11): 1242.e1-e5.
16. Neyton L, Barth J, Nourissat G, et al. Arthroscopic Latarjet techniques: Graft and fixation positioning assessed with 2-dimensional computed tomography is not equivalent with standard open technique. Arthroscopy, 2018, 34(7): 2032-2040.
17. 梁达强, 蒯声政, 李瑛, 等. Latarjet手术治疗肩关节前向脱位中螺钉固定与纽扣固定的生物力学对比分析. 中国修复重建外科杂志, 2020, 34(5): 602-607.
18. Azoulay V, Briot J, Mansat P, et al. Mechanical behavior of screw versus Endobutton for coracoid bone-block fixation. Orthop Traumatol Surg Res, 2020, 106(6): 1089-1093.
19. Cozzolino A, de Giovanni R, Malfi P, et al. Arthroscopic Latarjet versus arthroscopic free bone block procedures for anterior shoulder instability: A proportional meta-analysis comparing recurrence, complication, and reoperation rates. Am J Sports Med, 2024. doi: 10.1177/03635465231188530.
20. Barret H, Chelli M, Van Der Meijden O, et al. Arthroscopic Latarjet: 2 or 4 cortical buttons for coracoid fixation? A case-control comparative study. Am J Sports Med, 2022, 50(2): 311-320.
21. Song Q, Gao A, Bai J, et al. The arthroscopic Bristow procedure is superior to the arthroscopic Latarjet procedure in return to sports but inferior in graft healing: A comparative study with 3.4-year follow-up. Arthroscopy, 2023, 39(12): 2423-2433.
22. Hurley ET, Danilkowicz RM, Paul AV, et al. Majority of studies show similar rates of return to play after arthroscopic bankart repair or Latarjet procedure: A systematic review. Arthroscopy, 2024, 40(2): 515-522.
23. Rosenow CS, Leland DP, Camp CL, et al. Sutures, screws, buttons, and anchors: A review of current bone graft fixation devices for glenoid bone loss in the unstable shoulder. Curr Rev Musculoskelet Med, 2024, 17(6): 207-221.

Chinese Journal of Reparative and Reconstructive Surgery

Suture button fixation Latarjet procedure under total arthroscopy for treatment of anterior shoulder instability with severe bone defect

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