Cortical Buttons vs. Screws for Latarjet

The use of cortical buttons during arthroscopic Latarjet surgery is not superior to the use of screws in open Latarjet in the short-term according to a new study.

The researchers observed a delay in the return to sports, a longer time to recover range of motion and no benefit regarding postoperative pain or the aesthetic aspect of the scar with the arthroscopic procedure.

The study, “Arthroscopic Latarjet With Cortical Buttons Versus Open Latarjet With Screws: A Short-Term Comparative Study,” was published online on September 2, 2022, in The American Journal of Sports Medicine.

“The arthroscopic bone block procedure according to Latarjet remains a controversial subject, and few comparative studies have demonstrated the benefit of arthroscopy over open surgery,” the researchers wrote.

In the retrospective study, patients treated for chronic anterior instability by arthroscopic Latarjet with double cortical buttons or open Latarjet with screws with a minimum follow-up were compared. The researchers looked specifically at duration of surgery, complications during surgery as well as postoperative complications, pain, mobility, functional scores, resumption of sport, Patient and Observe Scar Assessment Scale scar aesthetics, satisfaction data.

Overall, there were 50 patients included in the study; 24 in the arthroscopic group and 26 in the open procedure group. Operating time was longer in the arthroscopic group compared to the open group (103 vs. 61 minutes; p = .001). The average number of days on analgesics was higher in the arthroscopic group (8.9 vs. 5.3 days; p = .04).

The complication rate was similar for the 2 groups (12.5% vs. 27%; p = .46). At 3 months, the loss of external rotation was greater in the arthroscopic group (–33° vs −18°; p = .01), and resumption of sports was less frequent (11% vs. 48%; p = .01). At 12 months, the average scores were excellent with no significant differences between the two groups: Walch-Duplay average, 90 points; Rowe, 94 points; Subjective Shoulder Value (SSV), 92.5%; sport SSV, 85%; and Patient and Observer Scar Assessment Scale score, 17.2 points.

Study authors included Mathieu Girard, M.D. and Yoann Dalmas, M.D., both of the Département d’Orthopédie Traumatologie du CHU de Toulouse, Hopital Pierre Paul Riquet, Toulouse, France and the Clinique Universitaire du Sport, Toulouse, France. Vincent Martinel, M.D., of the Clinique Pyrénées-Ormeaux, Tarbes, France and Nicolas Bonnevialle, M.D., Ph.D., of the Département d’Orthopédie Traumatologie du CHU de Toulouse, Hopital Pierre Paul Riquet, Clinique Universitaire du Sport, and Institut de Recherche Riquet (I2R), Toulouse, France also contributed to the study.