Suture buttons for coracoid fixation are gaining popularity to avoid the problems associated with screws during the Latarjet operation. However, good shoulder stability and return to sport necessitate bone block repair. During arthroscopic Latarjet procedures, they measured and compared the healing rates, and location of the coracoid bone block fixed with cortical suture-buttons that were either manually (with a knot pusher) or mechanically (using a tensioning device) tensioned. A prospective, non-randomized, comparative study included 69 patients (mean age 27) who had an arthroscopy-guided Latarjet with suture-button fixation. Hand-tensioning (group HT) was done on the first 34 shoulders, and mechanical tensioning was done by researchers on the next 35 shoulders (group MT). About 12 (17%) of the patients had previously failed Bankart stabilization. Patients in each group had similar characteristics regarding age, gender, kind of sports, bone loss, number of previous failed surgeries, smoking, and length of follow-up. The tensioning device was set at 100 Newtons three times intraoperatively until the bone block was immobilized entirely, as determined by a probe. At 6 months, the key outcome measure was coracoid bone block union and location on CT scan images. Functional outcome scores, shoulder stability, return to sports, and complications at the-up were all secondary outcome measures.

Overall, 74% (25/34) of the bone blocks in group HT healed, compared to 94% (33/35) in group MT (p=0.043). In each group, smoking was an independent risk factor for non-union (P<.001). Patient age, the preoperative glenoid bone defect (<20% or >20%), and a previous surgery history were determined by them to have no bearing. The tensioning modality unaffected the bone block location, which was subequatorial in 92% of the cases and flushed to the glenoid rim in 92%. At 34 months (range, 24-62 months), 96% of patients (65/69) had a stable shoulder, and 87% could return to sports. There was no significant difference in clinical scores between the groups at the end follow-up, and they discovered no neurologic or hardware problems. During an arthroscopic Latarjet surgery with suture-button fixation, mechanical-tensioning achieves much greater healing rates than hand-tensioning. During arthroscopic Latarjet procedures, using a suture-tensioning device is an important part of the suture-button fixation approach. The tensioning device changes the initially flexible suture into a “stiff fixation,” analogous to a bolt, by rigidifying the suture-button complex (or a rivet).

 

Reference:www.jshoulderelbow.org/article/S1058-2746(22)00220-8/fulltext