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Arthroscopy-Guided Latarjet Procedure With Suture-Button Fixation as a Safe and Reliable Alternative to Screw Fixation

March 01, 2019

Contributors: Pascal Boileau,MD; Pascal Boileau,MD

2019 AWARD WINNER Most of the complications associated with the Latarjet procedure are related to bone block positioning and the use of screws. This video demonstrates the use of the arthroscopic Latarjet guiding system, which improves the accuracy of bone block positioning, and the use of suture-button fixation as an alternative to screw fixation. The study included 162 patients who underwent an arthroscopy-guided Latarjet procedure via a guided surgical approach and suture-button fixation. The surgical technique consisted of four steps (all performed arthroscopically), including coracoid preparation and osteotomy, glenoid preparation, subscapularis splitting, and coracoid transfer and fixation, as well as Bankart repair. Bone graft union and positioning accuracy were assessed on postoperative CT scans. A clinical examination was performed at each follow-up visit. At a mean follow up of 28 months, 158 of the 162 patients had a stable shoulder. No neurologic complications were observed, and no patient required additional surgery. The coracoid graft was positioned strictly tangential to the glenoid surface and below the equator in 95% and 93% of the patients, respectively. The coracoid graft healed perfectly in 95% of the patients. A guided surgical approach for an arthroscopy-guided Latarjet procedure optimizes graft positioning, and suture-button fixation is an alternative to screw fixation, resulting an excellent rate of bony union. Neurologic and hardware complications classically associated with screw fixation were not observed in the patients who underwent this guided technique and novel fixation method.

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