Unicortical fixation does not compromise bony union in the Latarjet procedure
Shivan S Jassim1, Jeevaka Amaranath1, David McD Taylor2,3
1Melbourne Orthopaedic Group, Melbourne, VIC, Australia.
JSES International
|July 11, 2022
Summary
This study found no significant difference in coracoid graft union rates between unicortical and bicortical fixation in Latarjet procedures. Unicortical fixation is an acceptable practice for shoulder instability surgery.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Sports Medicine
Background:
- The Latarjet procedure is a common surgical treatment for shoulder instability.
- Coracoid graft fixation can be unicortical or bicortical, with bicortical fixation suggested by in vitro studies.
- Evidence comparing clinical outcomes of unicortical versus bicortical fixation for coracoid graft union is limited.
Purpose of the Study:
- To compare the rates of coracoid graft union between unicortical and bicortical fixation in patients undergoing the Latarjet procedure.
- To evaluate if bicortical fixation offers superior graft union compared to unicortical fixation.
- To assess the impact of fixation type on recurrence of instability and other postoperative complications.
Main Methods:
- Retrospective review of 184 patients who underwent the Latarjet procedure with either unicortical or bicortical coracoid graft fixation.
- Assessment of coracoid graft union using radiographs and computed tomography scans at a minimum of 8 weeks postoperatively.
- Statistical analysis using Chi-squared and Fisher's exact tests to compare union rates and complication rates between the two fixation groups.
Main Results:
- A total of 164 patients were analyzed after excluding those lost to follow-up (20 patients).
- No significant difference in coracoid graft union rates was observed between the bicortical (94%) and unicortical (98%) fixation groups (P = 0.25).
- There were no statistically significant differences in the recurrence of shoulder instability (P = 0.5) or other postoperative complications (P = 0.83) between the groups.
Conclusions:
- Bicortical fixation of the coracoid graft in the Latarjet procedure does not demonstrate a higher rate of bony union compared to unicortical fixation at a minimum 8-week follow-up.
- Unicortical fixation is a viable and acceptable surgical technique that does not compromise bony graft union for the Latarjet procedure.
- These findings suggest that surgical choice between unicortical and bicortical fixation may not significantly impact graft healing or clinical outcomes in the short term.
