Biomechanical Strength of Screw Versus Suture Button Fixation in the Latarjet Procedure: A Cadaver Study

2021 ◽  
Vol 30 (7) ◽  
pp. e449
Author(s):  
Gazi Huri ◽  
Yasin Hakverdiyev ◽  
Mehmet Kaymakoglu ◽  
Erdi Ozdemir ◽  
Pinar Yilgor Huri ◽  
...  
Keyword(s):  
Cadaver Study ◽  
Latarjet Procedure ◽  
Suture Button ◽  
Biomechanical Strength

scholarly journals Anatomic and Biomechanical Comparison of the Classic and Congruent-Arc Techniques of the Latarjet Procedure

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0011
Author(s):  
Scott R. Montgomery ◽  
Jan Christoph Katthagen ◽  
Jacob D. Mikula ◽  
Daniel C. Marchetti ◽  
Dimitri S. Tahal ◽  
...  
Keyword(s):  
Surface Area ◽  
Failure Load ◽  
Biomechanical Testing ◽  
Biomechanical Model ◽  
Cadaver Study ◽  
Latarjet Procedure ◽  
Glenoid Defect ◽  
Advantages And Disadvantages ◽  
Classic Technique ◽  
Biomechanical Strength

Objectives: The Latarjet procedure is commonly performed using either the classic (standing) or the congruent-arc (lying) technique. There are potential clinical advantages and disadvantages of each technique. However, the anatomic and biomechanical effects, benefits, and limitations of each technique are unknown. The purpose of this study was to compare the anatomy and biomechanical strength of fixation between the two techniques. Methods: A biomechanical cadaver study was performed with 20 pairs of male and female shoulders (n=40). One of each pair of shoulders was randomly assigned to receive the classic or congruent-arc technique. Coracoid and glenoid anatomic measurements were collected prior to biomechanical testing. A pull force was applied through the conjoined tendon to replicate forces experienced by the coracoid graft in the early post-operative period, and the failure load was determined for each specimen ( Figure 1 ). [Figure: see text] Results: The mean surface area available for fixation in the classic technique was 263.3 mm2 compared to 177.0 mm2 in the congruent-arc group (p<0.001). In the classic group, 36% of the glenoid width was re-created, and 50% was re-created in the congruent-arc group (p<0.001). The congruent-arc technique resulted in a significantly lower (p=0.005) mean failure load (238.9 ± 91.2 N) compared to the classic technique (303.0 ± 114 N). Failure load was significantly higher in males (p=0.037); male specimens had a mean failure load of 343.9 ± 122.2 N for the classic technique and 289.4 ± 73.0 N for the congruent-arc technique, and females had a mean failure load of 266.1 ± 97.7 and 193.5 ± 84.0 N, respectively ( Figure 2 ). [Figure: see text] Conclusion: In this biomechanical model, the classic technique of the Latarjet procedure provided a greater surface area for healing to the glenoid and greater biomechanical strength of fixation when compared to the congruent-arc technique. The congruent-arc technique allowed restoration of a larger glenoid defect.

Syndesmotic Fixation With Suture Button: Neurovascular Structures at Risk: A Cadaver Study

2019 ◽  
Vol 13 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Eva J. Lehtonen ◽  
Martim C. Pinto ◽  
Harshadkumar A. Patel ◽  
Nicholas Dahlgren ◽  
Eildar Abyar ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Cadaver Study ◽  
Saphenous Nerve ◽  
Nerve Branch ◽  
Suture Button ◽  
Level Ii ◽  
Direct Injury ◽  
Prospective Comparative Study ◽  
Neurovascular Structures ◽  
Respective Rate

Objectives: The objective of this study was to describe the anatomic variations in the saphenous nerve and risk of direct injury to the saphenous nerve and greater saphenous vein during syndesmotic suture button fixation. Methods: Under fluoroscopic guidance, syndesmotic suture buttons were placed from lateral to medial at 1, 2, and 3 cm above the tibial plafond on 10 below-knee cadaver leg specimens. The distance and position of each button from the greater saphenous vein and saphenous nerve were evaluated. Results: The mean distance of the saphenous nerve to the suture buttons at 1, 2, and 3 cm were 7.1 ± 5.6, 6.5 ± 4.6, and 6.1 ± 4.2, respectively. Respective rate of nerve compression was as follows, 20% at 1 cm, 20% at 2 cm, and 10% at 3 cm. Mean distance of the greater saphenous vein from the suture buttons at 1, 2, and 3 cm was 8.6 ± 7.1, 9.1 ± 5.3, and 7.9 ± 4.9 mm, respectively. Respective rate of vein compression was 20%, 10%, and 10%. A single nerve branch was identified in 7 specimens, and 2 branches were identified in 3 specimens. Conclusion: There was at least one case of injury to the saphenous vein and nerve at every level of button insertion at a rate of 10% to 20%. Neurovascular injury may occur despite vigilant use of fluoroscopy and adequate surgical technique. Further investigation into the use of direct medial visualization of these high-risk structures should be done to minimize the risk. Levels of Evidence: Therapeutic, Level II: Prospective, comparative study

scholarly journals Modified Arthroscopic Latarjet Procedure: Suture-Button Fixation Achieves Excellent Remodeling at 3-Year Follow-up

2019 ◽  
Vol 48 (1) ◽  
pp. 39-47 ◽  
Author(s):  
Jian Xu ◽  
Haifeng Liu ◽  
Wei Lu ◽  
Zhenhan Deng ◽  
Weimin Zhu ◽  
...  
Keyword(s):  
Humeral Head ◽  
Case Series ◽  
Concentric Circle ◽  
Vertical Position ◽  
Latarjet Procedure ◽  
Level Of Evidence ◽  
Suture Button ◽  
The Mean ◽  
Best Fit

Background: Some studies have advocated the use of suture-button fixation during the Latarjet procedure to reduce complications associated with screw fixation. However, the sample size of these studies is relatively small, and their follow-up period is short. Purpose: To investigate the efficacy of the suture-button Latarjet procedure with at least 3 years of follow-up and remodeling of the coracoid graft. Study Design: Case series; Level of evidence, 4. Methods: A total of 152 patients who underwent the suture-button Latarjet procedure between February 2013 and February 2016 were selected, and 128 patients who met the inclusion criteria were enrolled in this study. Preoperative and postoperative clinical results were assessed. The position and healing condition of the coracoid graft and arthropathy of the glenoid and humeral head were also assessed using radiography and 3-dimensional computed tomography (CT). Results: The mean follow-up time was 40.3 ± 5.8 months. There were 102 patients included in this study. The mean visual analog scale score for pain during motion, the American Shoulder and Elbow Surgeons score, the Rowe score, and the Walch-Duplay score were improved considerably. A total of 100 grafts achieved bone union. The overall absorption rate was 12.6% ± 4.3%. Graft absorption mostly occurred on the edge and outside the “best-fit” circle of the glenoid. A vertical position was achieved in 98 grafts (96% of all cases) immediately postoperatively, with the mean graft midline center at the 4 o’clock position. In the axial view, CT showed that 89 grafts were flush to the glenoid, whereas 2 and 11 grafts were fixed medially and laterally, respectively. In all cases, the bone graft and glenoid tended to extend toward each other to form concentric circles during the remodeling process. During follow-up observations, the height of the 11 grafts that were positioned laterally (ie, above the glenoid level) exhibited a wave-curved change. No arthropathy was observed in any patient. Conclusion: Patient outcomes were satisfactory after the modified arthroscopic suture-button Latarjet technique. Graft absorption mostly occurred on the edge and outside the “best-fit” circle of the glenoid. The graft exhibited the phenomenon of ectatic growing when it fused with the glenoid and finally remodeled to a new concentric circle with the humeral head analogous to the original glenoid. Grafts positioned laterally did not cause arthropathy of the joints within the period of the study.

scholarly journals Effect of Modified Arthroscopic Latarjet on Acromiohumeral Distance at 5-Year Follow-up

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110638
Author(s):  
Daqiang Liang ◽  
Haifeng Liu ◽  
Xinzhi Liang ◽  
Qihuang Qin ◽  
Lujue Long ◽  
...  
Keyword(s):  
Intraclass Correlation ◽  
T Test ◽  
Latarjet Procedure ◽  
Intact Side ◽  
Suture Button ◽  
Functional Scores ◽  
Acromiohumeral Distance ◽  
Paired T Test ◽  
Time Point

Background: It is unclear whether coracoacromial ligament release during the Latarjet procedure will increase superior translation of the shoulder joint. Purpose: To evaluate whether a modified suture button Latarjet procedure can decrease the acromiohumeral distance (AHD). Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was conducted among 155 patients who underwent a modified suture button Latarjet procedure between 2013 and 2015. AHD was measured on bilateral computed tomography scans taken preoperatively and on scans of the affected shoulder taken on postoperative day 1 and postoperative month (POM) 6, POM 36, and POM 60. At each time point, we recorded pain on a visual analog scale (VAS) and objective shoulder function using the American Shoulder and Elbow Surgeons, Rowe, and Walch-Duplay scores. Preoperative and final follow-up VAS and functional scores were compared using the paired t test. Pairwise comparison of AHD values at each follow-up time point were compared with the preoperative intact side using the paired t test. Intra- and interobserver reproducibility of the AHD measurements was evaluated using the intraclass correlation coefficient. Results: A total of 104 patients who met the criteria completed the final follow-up, which occurred at 62.6 ± 2.4 months (mean ± SD). When compared with presurgery, the VAS and all functional scores improved significantly at the last follow-up ( P < .001 for all). Intra- and interobserver intraclass correlation coefficients indicated good reliability for the ADH measurements. Preoperatively, there were no differences in AHD values between the intact and affected shoulders (7.8 ± 0.8 mm for both; P = .851). The AHD values at postoperative day 1 and POM 6, POM 36, and POM 60 were 9.6 ± 0.7 mm, 8.6 ± 0.9 mm, 8.0 ± 0.8 mm, and 7.9 ± 0.8 mm, respectively, all of which were larger than those of the preoperative intact side ( P < .001 for all). Conclusion: The modified suture button Latarjet procedure not only offered satisfactory therapeutic effects but also did not decrease the AHD at 5-year follow-up.

Fixation Strength of Pedicle and Cortical Lumbar Vertebral Screws after Laminectomy: A Cadaver Study

2018 ◽  
Vol 79 (04) ◽  
pp. 273-278
Author(s):  
Dai-Soon Kwak ◽  
Ho-Jung Cho ◽  
Ho Chang ◽  
Moon Park ◽  
In-Sung Kim ◽  
...  
Keyword(s):  
Lumbar Vertebrae ◽  
Pedicle Screws ◽  
Cadaver Study ◽  
Fixation Strength ◽  
Pullout Strength ◽  
Screw Insertion ◽  
Cortical Screw ◽  
Significant Difference ◽  
Midline Approach ◽  
Biomechanical Strength

Background and Study Aim Cortical screws were proposed as an alternative to the traditional pedicle screws. Diverse experimental results support the biomechanical superiority of cortical screws compared to pedicle screws. Laminectomy is often part of multilevel lumbar surgeries. Laminectomy might weaken the medial bony edge at the entry of the divergently oriented screw and, thereby, the screw purchase. This study investigated the biomechanical strength of lumbar cortical screw after laminectomy. Objective To compare the fixation strength of cortical screws and traditional pedicle screws after lumbar laminectomy. Material and Methods A total of 120 pedicles from 60 lumbar vertebrae of 12 cadavers (8 men, 4 women) were assessed. The mean age of the cadavers was 73.4 ± 6.2 years (range: 62–82 years). Using a posterior midline approach, we inserted the traditional pedicle screws into one and the cortical screws into the other side of each vertebra. Laminectomy was performed after screw insertion. Vertical pullout strength and toggle strength testing were performed to compare the fixation strength between the two sides. Results After laminectomy, the pullout strength of the cortical screws was 718.92 ± 340.76 N, and that of the pedicle screws was 625.78 ± 287.10 N (p = 0.183). The toggle strength of the cortical screws was 544.83 ± 329.97 N; that of the pedicle screws was 613.17 ± 311.70 N (p = 0.145). No significant difference was found in biomechanical strength between the two types of screws. Conclusion Despite laminectomy, lumbar cortical screws offers comparable pullout and toggle biomechanical strength as traditional pedicle screws.

Cortical suture button fixation vs. bicortical screw fixation in the Latarjet procedure: a biomechanical comparison

2020 ◽  
Vol 29 (7) ◽  
pp. 1470-1478 ◽  
Author(s):  
Robert C. Williams ◽  
Randal P. Morris ◽  
Marc El Beaino ◽  
Nicholas H. Maassen
Keyword(s):  
Screw Fixation ◽  
Latarjet Procedure ◽  
Suture Button ◽  
Biomechanical Comparison ◽  
Bicortical Screw

Mini-Open Arthroscopically Assisted Bristow-Latarjet Procedure for the Treatment of Patients With Anterior Shoulder Instability: A Cadaver Study

2006 ◽  
Vol 22 (10) ◽  
pp. 1113-1118 ◽  
Author(s):  
Geoffroy Nourissat ◽  
Guillaume Nedellec ◽  
Niamh A. O’Sullivan ◽  
Aurore Debet-Mejean ◽  
Christian Dumontier ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Cadaver Study ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Arthroscopically Assisted ◽  
Mini Open

scholarly journals Biomechanical Comparison of Screw Fixation Versus a Cortical Button and Self-tensioning Suture for the Latarjet Procedure

2018 ◽  
Vol 6 (6) ◽  
pp. 232596711877784 ◽  
Author(s):  
Matthew T. Provencher ◽  
Zachary S. Aman ◽  
Christopher M. LaPrade ◽  
Andrew S. Bernhardson ◽  
Gilbert Moatshe ◽  
...  
Keyword(s):  
Failure Load ◽  
Screw Fixation ◽  
Bone Block ◽  
Latarjet Procedure ◽  
Suture Button ◽  
Ultimate Failure Load ◽  
Cortical Button ◽  
Ultimate Failure ◽  
The Mean ◽  
Mechanism Of Failure

Background: Metal screws are traditionally used to fix the coracoid process to the glenoid. Despite stable fixation, metal screws have been associated with hardware complications. Therefore, some studies have advocated for suture button fixation during the Latarjet procedure to reduce the complications associated with screw fixation. Purpose: To biomechanically evaluate the ultimate failure load of a cortical button and self-tensioning suture versus metal screws for coracoid graft fixation during the Latarjet procedure. Study Design: Controlled laboratory study. Methods: Eight matched pairs of fresh-frozen, male cadaveric shoulders (N = 16) underwent the Latarjet procedure. The shoulders of each pair were randomly assigned to 1 of 2 groups: fixation using two 3.75-mm cannulated, fully threaded metal screws or fixation using a double suture button construct. Specimens were secured in a dynamic testing machine and cyclically preconditioned from 2 to 10 N at 0.1 Hz for 10 cycles. After preconditioning, specimens were pulled to failure at a normalized displacement rate of 400% of the measured gauge length per minute. The ultimate failure load and mechanism of failure were recorded for each specimen. Results: The mean ultimate load to failure for screw fixation (226 ± 114 N; 95% CI, 147-305 N) was not significantly different from that for suture button fixation (266 ± 73 N; 95% CI, 216-317 N) ( P = .257). The mean strain at failure for screw fixation (63% ± 21%; 95% CI, 48%-77%) was not significantly different from that for suture button fixation (86% ± 26%; 95% CI, 69%-104%) ( P = .060). The most common mechanism of failure for the screw fixation method was at the bone block drill holes, while an intramuscular rupture at the clamp-muscle interface occurred for the suture button construct. Conclusion: The screw and suture button fixation techniques exhibited comparable biomechanical strength for coracoid bone block fixation of the Latarjet procedure. Clinical Relevance: Metal screws have been reported to be a large contributor to intraoperative and postoperative complications. Therefore, given the results of the current study, a suture button construct may be an alternative to metal screw fixation during the Latarjet procedure. However, further clinical studies are warranted.

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