Biomechanical comparative analysis of screw fixation and cortical endo-button fixation in Latarjet procedure for anterior dislocation of shoulder joint_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIANG Daqiang , KUAI Shengzheng , LI Ying , QIU Zhihe , LI Sheng , WU Bing , ZHONG Mingjin , LI Hao , LIU Haifeng ,  LU Wei

Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518000, P.R.China;

Corresponding author：

LU Wei, Email: 13922855513@139.com

Keywords：

Shoulder joint instability; Latarjet procedure; biomechanical test; endo-button fixation; screw fixation

DOI：

10.7507/1002-1892.201909124

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Objective To clarify the value of the cortical endo-button as an internal fixator in Latarjet procedure through biomechanical analysis.Methods Ten pairs of shoulder joints from 6-7 months old male pigs were selected. Each pair was randomly divided into screw group and endo-button group. A 25% glenoid defect model was created, and the porcine infraspinatus tendon and its associated bone were used to simulate conjoint tendon and coracoid process in human body. The bone grafts were fixed with two 3.5 mm screws and double cortical endo-buttons with high-strength sutures in screw group and endo-button group, respectively. The prepared glenoid defect model was fixed on a biomechanical test bench and optical markers were fixed on the glenoid and the bone block, respectively. Then fatigue test was performed to observe whether the graft or internal fixator would failed. During the test, the standard deviations of the relative displacement between the graft and the glenoid of two groups were measured by optical motion measure system for comparison. Finally the maximum failure load comparison was conducted and the maximum failure loads of the two groups were measured and compared.Results There was no tendon tear, bone fracture, and other graft or internal fixation failure in the two groups during the fatigue test. The standard deviation of the relative displacement of the screw group was (0.007 87±0.001 44) mm, and that of the endo-button group was (0.034 88±0.011 10) mm, showing significant difference between the two groups (t=7.682, P=0.000). The maximum failure load was (265±39) N in screw group and (275±52) N in endo-button group, showing no significant difference between the two groups (t=1.386, P=0.199). There were 3 ways of failure: rupture at bone graft’s tunnel (6/10 from screw group, 3/10 from endo-button group), tendon tear at the cramp (2/10 from screw group, 2/10 from endo-button group), and tendon tear at the internal fixator interface (2/10 from screw group, 5/10 from endo-button group), showing no significant difference between the two groups (P=0.395).Conclusion Although the endo-button fixation fails to achieve the same strong fixation stability as the screw fixation, its fixation stability can achieve the clinical requirements. The two fixation methods can provide similar fixation strength when being used in Latarjet procedure.

Citation： LIANG Daqiang, KUAI Shengzheng, LI Ying, QIU Zhihe, LI Sheng, WU Bing, ZHONG Mingjin, LI Hao, LIU Haifeng, LU Wei. Biomechanical comparative analysis of screw fixation and cortical endo-button fixation in Latarjet procedure for anterior dislocation of shoulder joint. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(5): 602-607. doi: 10.7507/1002-1892.201909124 Copy

1.	Latarjet M. Treatment of recurrent dislocation of the shoulder. Lyon Chir, 1954, 49(8): 994-997.
2.	梁达强, 丘志河, 柳海峰, 等. 肩关节前向脱位及合并损伤的手术治疗进展. 中国修复重建外科杂志, 2019, 33(6): 768-773.
3.	Longo UG, Loppini M, Rizzello G, et al. Latarjet, Bristow, and Eden-Hybinette procedures for anterior shoulder dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy, 2014, 30(9): 1184-1211.
4.	Butt U, Charalambous CP. Complications associated with open coracoid transfer procedures for shoulder instability. J Shoulder Elbow Surg, 2012, 21(8): 1110-1119.
5.	Giles JW, Boons HW, Elkinson I, et al. Does the dynamic sling effect of the Latarjet procedure improve shoulder stability? A biomechanical evaluation. J Shoulder Elbow Surg, 2013, 22(6): 821-827.
6.	Montgomery SR, Katthagen JC, Mikula JD, et al. Anatomic and biomechanical comparison of the classic and congruent-arc techniques of the latarjet procedure. Am J Sports Med, 2017, 45(6): 1252-1260.
7.	An VV, Sivakumar BS, Phan K, et al. A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair. J Shoulder Elbow Surg, 2016, 25(5): 853-863.
8.	Yamamoto N, Muraki T, An KN, et al. The stabilizing mechanism of the Latarjet procedure: a cadaveric study. J Bone Joint Surg (Am), 2013, 95(15): 1390-1397.
9.	Gendre P, Thélu CE, d’Ollonne T, et al. Coracoid bone block fixation with cortical buttons: An alternative to screw fixation? Orthop Traumatol Surg Res, 2016, 102(8): 983-987.
10.	黄刚, 柳海峰, 谢卫勇, 等. 关节镜下改良弹性固定 Latarjet 术治疗一例慢性锁定性肩关节前脱位. 中国修复重建外科杂志, 2019, 33(3): 387-389.
11.	Burkhart SS, Debeer JF, Tehrany AM, et al. Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy, 2002, 18(5): 488-491.
12.	Boileau P, Gendre P, Baba M, et al. A guided surgical approach and novel fixation method for arthroscopic Latarjet. J Shoulder Elbow Surg, 2016, 25(1): 78-89.
13.	Golish SR, Caldwell PE 3rd, Miller MD, et al. Interference screw versus suture anchor fixation for subpectoral tenodesis of the proximal biceps tendon: a cadaveric study. Arthroscopy, 2008, 24(10): 1103-1108.
14.	Griesser MJ, Harris JD, McCoy BW, et al. Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review. J Shoulder Elbow Surg, 2013, 22(2): 286-292.
15.	Buchholz A, Martetschläger F, Siebenlist S, et al. Biomechanical comparison of intramedullary cortical button fixation and interference screw technique for subpectoral biceps tenodesis. Arthroscopy, 2013, 29(5): 845-853.
16.	Petersen SA, Bernard JA, Langdale ER, et al. Autologous distal clavicle versus autologous coracoid bone grafts for restoration of anterior-inferior glenoid bone loss: a biomechanical comparison. J Shoulder Elbow Surg, 2016, 25(6): 960-966.
17.	Barrett Payne W, Kleiner MT, McGarry MH, et al. Biomechanical comparison of the Latarjet procedure with and without a coracoid bone block. Knee Surg Sports Traumatol Arthrosc, 2016, 24(2): 513-520.
18.	Weppe F, Magnussen RA, Lustig S, et al. A biomechanical evaluation of bicortical metal screw fixation versus absorbable interference screw fixation after coracoid transfer for anterior shoulder instability. Arthroscopy, 2011, 27(10): 1358-1363.
19.	Santos RBMD, Prazeres CMM, Fittipaldi RM, et al. Bankart lesion repair: biomechanical and anatomical analysis of Mason-Allen and simple sutures in a swine model. Rev Bras Ortop, 2018, 53(4): 454-459.

1. Latarjet M. Treatment of recurrent dislocation of the shoulder. Lyon Chir, 1954, 49(8): 994-997.
2. 梁达强, 丘志河, 柳海峰, 等. 肩关节前向脱位及合并损伤的手术治疗进展. 中国修复重建外科杂志, 2019, 33(6): 768-773.
3. Longo UG, Loppini M, Rizzello G, et al. Latarjet, Bristow, and Eden-Hybinette procedures for anterior shoulder dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy, 2014, 30(9): 1184-1211.
4. Butt U, Charalambous CP. Complications associated with open coracoid transfer procedures for shoulder instability. J Shoulder Elbow Surg, 2012, 21(8): 1110-1119.
5. Giles JW, Boons HW, Elkinson I, et al. Does the dynamic sling effect of the Latarjet procedure improve shoulder stability? A biomechanical evaluation. J Shoulder Elbow Surg, 2013, 22(6): 821-827.
6. Montgomery SR, Katthagen JC, Mikula JD, et al. Anatomic and biomechanical comparison of the classic and congruent-arc techniques of the latarjet procedure. Am J Sports Med, 2017, 45(6): 1252-1260.
7. An VV, Sivakumar BS, Phan K, et al. A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair. J Shoulder Elbow Surg, 2016, 25(5): 853-863.
8. Yamamoto N, Muraki T, An KN, et al. The stabilizing mechanism of the Latarjet procedure: a cadaveric study. J Bone Joint Surg (Am), 2013, 95(15): 1390-1397.
9. Gendre P, Thélu CE, d’Ollonne T, et al. Coracoid bone block fixation with cortical buttons: An alternative to screw fixation? Orthop Traumatol Surg Res, 2016, 102(8): 983-987.
10. 黄刚, 柳海峰, 谢卫勇, 等. 关节镜下改良弹性固定 Latarjet 术治疗一例慢性锁定性肩关节前脱位. 中国修复重建外科杂志, 2019, 33(3): 387-389.
11. Burkhart SS, Debeer JF, Tehrany AM, et al. Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy, 2002, 18(5): 488-491.
12. Boileau P, Gendre P, Baba M, et al. A guided surgical approach and novel fixation method for arthroscopic Latarjet. J Shoulder Elbow Surg, 2016, 25(1): 78-89.
13. Golish SR, Caldwell PE 3rd, Miller MD, et al. Interference screw versus suture anchor fixation for subpectoral tenodesis of the proximal biceps tendon: a cadaveric study. Arthroscopy, 2008, 24(10): 1103-1108.
14. Griesser MJ, Harris JD, McCoy BW, et al. Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review. J Shoulder Elbow Surg, 2013, 22(2): 286-292.
15. Buchholz A, Martetschläger F, Siebenlist S, et al. Biomechanical comparison of intramedullary cortical button fixation and interference screw technique for subpectoral biceps tenodesis. Arthroscopy, 2013, 29(5): 845-853.
16. Petersen SA, Bernard JA, Langdale ER, et al. Autologous distal clavicle versus autologous coracoid bone grafts for restoration of anterior-inferior glenoid bone loss: a biomechanical comparison. J Shoulder Elbow Surg, 2016, 25(6): 960-966.
17. Barrett Payne W, Kleiner MT, McGarry MH, et al. Biomechanical comparison of the Latarjet procedure with and without a coracoid bone block. Knee Surg Sports Traumatol Arthrosc, 2016, 24(2): 513-520.
18. Weppe F, Magnussen RA, Lustig S, et al. A biomechanical evaluation of bicortical metal screw fixation versus absorbable interference screw fixation after coracoid transfer for anterior shoulder instability. Arthroscopy, 2011, 27(10): 1358-1363.
19. Santos RBMD, Prazeres CMM, Fittipaldi RM, et al. Bankart lesion repair: biomechanical and anatomical analysis of Mason-Allen and simple sutures in a swine model. Rev Bras Ortop, 2018, 53(4): 454-459.

Chinese Journal of Reparative and Reconstructive Surgery

Biomechanical comparative analysis of screw fixation and cortical endo-button fixation in Latarjet procedure for anterior dislocation of shoulder joint

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