Arthroscopic Latarjet Procedure Using FiberTape Cerclage With a Simplified Technique for Suture Passage and Coracoid Fixation
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ABSTRACT:
SUBMITTER: Jos S
PROVIDER: S-EPMC9353334 | biostudies-literature | 2022 Jun
REPOSITORIES: biostudies-literature
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Project description:The Bristow-Latarjet procedure has been one of the most recognized procedures for the treatment of recurrent shoulder dislocation with anterior glenoid bone loss, revision surgery after failed Bankart repair, contact and collision sport injuries, and patients with a high risk of recurrence. Open and arthroscopic approaches have recently shown similar outcomes by several authors. However, complications related to metal implants, despite being low, are still a matter of concern. We describe an all-arthroscopic Latarjet technique with a metal-free fixation method using 2 ultra-high-strength sutures, creating a cerclage construct through 2.4mm glenoid and coracoid tunnels with a final capsulolabral complex reconstruction.
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Project description:The Latarjet procedure is a method used for the treatment of shoulder instability in the presence of bone loss. A decade after the first description of the fully arthroscopic Latarjet procedure, modifications to the technique were reported to decrease the risk of complications and improve the position of the bone block. A recent trend toward the use of buttons to fix the coracoid has been reported. The technique described here is an arthroscopic Latarjet procedure that uses 2 pairs of round buttons as an alternative to screw fixation or the use of a single button, and the technique aims to combine the original procedure with safe and stable fixation.
| S-EPMC7372521 | biostudies-literature
Project description:Intraoperative vertical coracoid graft fractures during the Latarjet procedure are well-described complications, which typically have a poor prognosis or may necessitate further iliac crest bone grafting for stabilization. The vertical split coracoid fractures are reasoned to be caused by excessive tightening of the screws, poor bone quality, especially in females and the smaller dimension of the coracoid graft. In this technical note, we propose an arthroscopic salvage technique for salvaging the fractured coracoid graft and to avoid the need for additional bone graft, thereby reducing morbidity to the patient. We use two double-loaded, all-suture anchors (Stryker, India) on either side of the split coracoid graft, and double-pulley configuration of suture tightening is done, providing compression and stability to the fractured graft.
| S-EPMC10837778 | biostudies-literature
Project description:We present a novel all-arthroscopic technique of posterior shoulder stabilization that uses suture anchors for both bone block fixation and capsulolabral repair. The bone graft, introduced inside the glenohumeral joint through a cannula, is fixed with 2 suture anchors. The associated posteroinferior capsulolabral repair places the bone block in an extra-articular position. In this article we present the detailed arthroscopic technique performed in a consecutive series of 15 patients and report the early results. We also report the positioning, healing, and remodeling of the bone block using postoperative 3-dimensional computed tomography. The benefits of this new technique are as follows: (1) it is all arthroscopic, preserving the posterior deltoid and posterior rotator cuff muscles; (2) it is accurate, resulting in appropriate bone block positioning; (3) it is efficient, allowing for consistent bone graft healing; (4) it is anatomic, both restoring the glenoid bone stock and repairing the injured posterior labrum; and (5) it is safe, limiting hardware-related complications and eliminating the risk of injury to vital structures associated with drilling or screw insertion from posterior to anterior. We believe that this technique is advantageous because it does not use screws for fixation and may be safer for the patient.
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Project description:This technical note discusses the arthroscopic coracoid cerclage technique for double-bundle coracoclavicular ligament reconstruction in patients with nonacute symptomatic high-grade acromioclavicular separation injuries. This technique allows for an anatomic graft reconstruction of the coracoclavicular ligaments through an arthroscopic approach without the requirement to drill into the coracoid process. Early results are promising with high patient satisfaction and excellent reported clinical and radiographic outcomes. We believe this technique to be an anatomic, less invasive alternative to a complex shoulder procedure while sparing the structural integrity of the coracoid process and also allowing the surgeon to convert easily to a more traditional open surgical technique as necessary.
| S-EPMC4912983 | biostudies-literature
Project description:The arthroscopic Latarjet procedure is challenging because it can be difficult to place 2 screws parallel to the glenoid surface and a medial portal (dangerous for the brachial plexus) is mandatory. In addition, precise positioning of the coracoid bone block flush with the joint line and in a subequatorial position as recommended is troublesome without the use of a guiding system because of the arthroscopic lens distortion. To improve the reproducibility of the arthroscopic Latarjet procedure and to minimize the risk of nerve complications, we developed a guiding system to optimize the positioning of the coracoid bone block and 2 cortical buttons to facilitate its fixation. Four portals are used: a posterior standard portal and 3 anterior portals, all lateral to the conjoint tendon. The anterior rim of the glenoid and the coracoid process are prepared. Two holes are drilled in the glenoid and in the coracoid process with 2 specific guides. The subscapularis is then split, and 2 cortical buttons are passed from posterior to anterior through the tunnels with a shuttle relay. The coracoid process undergoes osteotomy and is guided through the split in the subscapularis to the anteroinferior rim of the glenoid by pulling on the cortical buttons.
| S-EPMC5981180 | biostudies-literature
Project description:The Latarjet procedure for treating anterior glenohumeral instability includes transfer of the coracoid and biceps tendon to the anterior glenoid. A modified method for the arthroscopic procedure was developed to facilitate the procedure and minimize the risk of injury to the brachial plexus. The detached coracoid was exteriorized through the anteroinferior portal for drilling and shaping. A Coracoid Drill Guide (Arthrex, Naples, FL) was used to help cut the coracoid to the desired size and make 2 drill holes in the coracoid for fixation to the glenoid. The Coracoid Transfer Instrument (Acierart, Masku, Finland) was designed to facilitate coracoid transfer and serve as a pin guide for fixation. Ten patients with severe anterior glenohumeral instability were treated with this technique. They had only mild to moderate postoperative pain. There were no postoperative infections or recurrent dislocations. The safety of this operation was similar to that of other operations on the coracoid process in the proximity of the brachial plexus. The modified arthroscopic Latarjet procedure may be applied successfully to the treatment of anterior glenohumeral instability, with good patient satisfaction and functional outcome.
| S-EPMC3882674 | biostudies-literature
Project description:Fractures of the coracoid process are uncommon injuries and are usually the result of high-energy trauma or avulsion-type injuries. Typically coracoid fractures treated with nonoperative management have yielded good results. Operative treatment of coracoid fractures is reserved for a subset of clinical situations, including fracture nonunion. We detail our technique for arthroscopic debridement of a Type II coracoid fracture nonunion, as well as the use of arthroscopic-assisted percutaneous fixation for a Type II coracoid fracture.
| S-EPMC9437606 | biostudies-literature
Project description:Bristow-Latarjet procedure has been widely regarded as a reliable and satisfactory operation for recurrent anterior glenohumeral instability, especially for patients with significant glenoid bone loss or high sports demand. Once failed, however, the subsequent revision surgery could be challenging. Eden-Hybinette procedure is the most common operation for revision of failed Bristow-Latarjet. It can perfectly restore the bone defect of the failed Bristow-Latarjet by harvesting a proper size of iliac bone block. Furthermore, several studies have shown the advantages of using suture button fixation in the revision surgery for failed Bristow-Latarjet procedure. However, the potential inferior biomechanical strength of suture button fixation is still a concern. This Technical Note introduced an arthroscopic "double-inlay" Eden-Hybinette procedure with modified suture button fixation for the revision of failed Bristow-Latarjet. With its "quadruple" reinforcement effect, this procedure can achieve an excellent biomechanical strength of fixation.
| S-EPMC8719054 | biostudies-literature
Project description:The Latarjet procedure is very popular and is the method of choice in cases of glenoid bone loss and anterior-inferior instability or revision procedures. However, recurrence is common after this procedure. One of the methods of revision after the Latarjet procedure is the Eden-Hybinette technique. However, recurrence occurs after this bone grafting procedure as well. The primary reasons for recurrence are graft resorption and capsular deficiency. To improve these outcomes, transfer of the long head of the biceps for capsular reinforcement has been recommended by several authors. We describe an all-arthroscopic procedure, performed after the Latarjet technique, that combines bone block transfer, trans-subscapular transposition of the long head of the biceps, and anterior labroplasty. This technique can significantly reinforce the deficient capsule through the sling effect and cover the graft for prophylaxis against bone resorption.
| S-EPMC6823865 | biostudies-literature