Arthroscopic Latarjet procedure and suture-button fixation: can we predict nonunion early?

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Shoulder Instability

Background:

• The arthroscopic Latarjet procedure is a recognized treatment for anterior shoulder instability.
• Traditional screw fixation has known complications; button fixation offers an alternative for improved reproducibility.
• Previous reports suggest comparable fusion rates between screw and button fixation methods.

Purpose of the Study:

• To evaluate the fusion rate of the arthroscopic Latarjet procedure using button fixation.
• To assess bone modifications and healing patterns associated with this fixation technique.

Main Methods:

• Prospective study of 216 patients undergoing arthroscopic Latarjet with Smith & Nephew button fixation.
• Radiographic assessment using CT scans at 3, 12, and 24 weeks post-surgery.
• Evaluation of bone block position, glenoid tunnel diameter, fusion rate, and time to fusion.

Main Results:

• High success rate for bone block positioning: 92.6% coronal, 87.5% sagittal.
• Overall nonunion rate of 4% (9 cases), with 18 cases of delayed fusion.
• Fusion rates reached 92% at 3 months and 96% at 6 months.

Conclusions:

• Arthroscopic Latarjet with button fixation provides reliable bone block placement and a high fusion rate.
• Fusion can be delayed, typically occurring between 3 and 6 months post-operatively.
• Glenoid tunnel diameter widening (>3 mm within 3 weeks) is a strong predictor of delayed union or nonunion.