Text transcription:
Hi everybody, I’m very happy to share with you our experience with the arthroscopic guided Latarjet using suture button fixation. This is a long-term result that I would like to present to you.
This work was done by my fellows, Jules Decamps, Valentina Greco, and Michael Chelli. We know that the Latarjet procedure is a very good technique to stabilize the shoulder, with a high rate of return to sport and very few concerns regarding osteoarthritis — but still up to 25% osteoarthritis at 10 years.
Laurent Lafosse described a very nice technique with the arthroscopic Latarjet using screw fixation.
Again, there is a very high rate of return to sport, but some problems with the screws, with a number of re-operations up to 19%. We came up with the idea of using a suture button fixation for the Latarjet procedure, and this is what I would like to present to you.
This is a long-term follow-up of this procedure.
This is a retrospective cohort study.
We included all patients with traumatic, recurrent instability treated by this technique, with a minimum 10-year follow-up. We excluded patients with epilepsy, first dislocation, multidirectional instability, and failed bone block surgery, but we included failed arthroscopic Bankart repairs.
This is a cohort of 85 patients and 75 arthroscopic Latarjet procedures with suture button fixation.
Two patients died.
Sixteen were lost to follow-up.
In the end, we were able to follow and trace 59 shoulders treated with arthroscopic Latarjet using suture button fixation.
The technique is very specific.
It’s a guided surgical technique.
We developed different instruments, and I’m going to show you this. I have a small video here.
You can see we prepare the coracoid, we drill the coracoid, we pass a button with a suture, and we perform the osteotomy of the coracoid.
Then we prepare the glenoid neck.
We drill from posterior to anterior using a guide.
We introduce a spreader from posterior and a spreader from anterior to create a window through the subscapularis muscle, and we bring the bone block against the glenoid neck.
We add a posterior button and perform a sliding locking knot, the Nice knot.
Using a suture tensioner, we apply compression on the bone block, and then we lock the system with three surgeon’s knots.
This is our cohort of patients.
The mean age was 25 years.
Mainly male patients, some were hyperlax.
The Instability Severity Index Score (ISIS) was 5 points on average, about one-third were involved in competitive sports, and about 12% had a failed Bankart.
The mean glenoid bone loss was 20%, and several patients had a Hill-Sachs lesion, but only 28% with a very large and deep lesion.
At a follow-up of 131 months, we observed 2 patients with recurrence, both traumatic, at 3 and 7 years. They underwent arthroscopic Bankart with Hill-Sachs remplissage. Eighteen percent of the patients still had some anterior apprehension.
Pain scores were very low.
The Walch-Duplay and Rowe scores were very high.
The Subjective Shoulder Value was 86% on average.
Regarding range of motion at 10 years, we observed a slight loss of external rotation of 9 degrees in adduction and abduction.
Overall, most patients were very satisfied or satisfied. Only one patient was disappointed, and no patients were dissatisfied.
Regarding return to sport at 10 years, 98% of patients were still practicing sport; 64% returned to the same level, 34% changed sports, and one patient stopped completely.
The Subjective Shoulder Value for sport was 85%. Regarding bone block positioning, as we did CT scans for all patients, 89% of the bone blocks were below the equator and 80% were flush with the glenoid surface.
Concerning bone block healing, 80% of bone blocks were completely healed at the last follow-up, 12% had a fibrous union, and 8% (5 patients) showed migration of the coracoid process.
Here is an example of fibrous union, showing no clinical consequence — these patients were very happy despite incomplete bony healing.
Regarding osteoarthritis, we compared patients with primary stabilization (52 cases) and those with previous Bankart repair. The rate of Samilson grade 2–3 osteoarthritis was very low in primary stabilization at 10 years — only 3 patients had some osteophytes.
No patient had complete glenohumeral osteoarthritis.
In patients with previous Bankart repair, 14% had Samilson grade 3 osteoarthritis.
This osteoarthritis was associated with previous surgery and competitive sports practice. It impacted pain scores, SSV, and external rotation loss.
Here is an example of a patient with slight osteoarthritis, but with very few clinical consequences. The range of motion remained good, and the patient continued sports activity.
Another patient, with no arthritis and a 12-year follow-up, showed an excellent range of motion and perfect bone block positioning.
This is a retrospective study.
There is no control group, which is a limitation.
The number of patients is not very large, and we lost some patients to follow-up.
These patients were operated on by myself, including my learning curve.
However, the study also has strengths:
The patients were reviewed independently by my fellows, with X-ray and CT scan evaluations, and we assessed sports practice at long-term follow-up.
In summary, we can say that the guided drilling technique is safe. We observed no neurological complications or other technical complications.
It is accurate, provides a high rate of good bone block positioning, and is reproducible.
The suture button fixation is a real alternative to screw fixation, with an excellent bone graft healing rate.
There is remodeling of the bone block but no real lysis, and this method avoids the complications reported with screws.
Compared with screw fixation, the button system offers a low-profile design and very strong fixation — equivalent to a bolt.
And as we know, a bolt can be as strong as one, two, or even three screws.
Thank you very much for your attention. To summarize our results again:
Low recurrence rate (4%), high patient satisfaction, high return to sport, no major complications, and low osteoarthritis rate.
Thank you for your attention.