Arthroscopic Latarjet: 2 or 4 Cortical Buttons for Coracoid Fixation? A Case-Control Comparative Study

Area of Science:

• Orthopedic Surgery
• Shoulder Arthroscopy
• Sports Medicine

Background:

• Traditional coracoid bone block fixation uses 2 screws, but no gold standard exists for cortical button fixation.
• The arthroscopic Latarjet procedure is used for shoulder instability.

Purpose of the Study:

• To compare the anatomic and clinical outcomes of the arthroscopic Latarjet procedure using 2 versus 4 cortical buttons for coracoid bone block fixation.

Main Methods:

• A matched cohort study (Level of evidence, 3) compared 46 patients with 2-button fixation (group 2B) to 23 patients with 4-button fixation (group 4B).
• All patients underwent guided arthroscopic Latarjet with a tensioning device for bone block compression.
• Computed tomography scans assessed bone block positioning and healing at 2 weeks and 6 months post-surgery.

Main Results:

• Bone block healing rates were similar (91% in group 4B vs. 95.5% in group 2B).
• Graft positioning (flush to glenoid, under equator) and resorption rates were comparable between groups.
• No significant difference in patient-reported outcomes, return to sports, or satisfaction was observed; however, operating time was longer in the 4-button group (95 vs. 75 minutes).

Conclusions:

• Four-button fixation offers no significant anatomic or clinical advantage over 2-button fixation for arthroscopic Latarjet.
• The 2-button technique is simpler, safer, and sufficient for solid coracoid bone block fixation.
• Accurate graft placement via drill guides and high healing rates (>90%) are achievable with both techniques using a tensioning device.