Author:
Pascal Boileau MD,
ICR-Institut de Chirurgie Réparatrice Locomoteur & Sport, Groupe KANTYS, Niza, Francia.
The author declares conflict of interest
- Tornier-Stryker
- Smith & Nephew
- Conmed
- Imascap
- Precision OS
INTRODUCTION
For many surgeons, a substantial barrier to adoption of the Latarjet procedure is the high rate of complications and unplanned reoperations (30% and 15% respectively). Most of hardware complications are related to bone block mal positioning and the use of screws. Most of neurologic complications are related to the drilling process performed form the front, closed to the brachial plexus.
DESCRIPTION OF THE TECHNIQUE
In this video, we present a technique of arthroscopic Latarjet using a glenoid drilling guide coming from posterior (to improve safety of the procedure and accuracy of bone block positioning) and suture-button for bone block fixation (to avoid complications reported with screw fixation). Five anterior portals are created on each side of the coracoid (North, South, West, East and North-West) and a 70° scope is used. The technique comprises five steps, all performed arthroscopically: (1) Coracoid preparation, drilling, and osteotomy (2) Glenoid preparation and drilling (3) Subscapularis split after identification and protection of the axillary and musculocutaneous nerves, (4) Coracoid transfer and fixation, and (5) Bankart repair. Two circular titanium buttons connected with a number 3-4 ultra–high molecular weight polyethylene (UHMWP) suture are used to fix the bone block. A suture tensioner is used to put compression and rigidify the flexible suture which is transformed it in a rigid bar. After suture tensioning (100 Newtons x 3 times), the suture-button becomes equivalent to a bolt which is mechanically superior to 1 or 2 screws.
RESULTS
Neurological and hardware complications, classically reported with screw fixation with hand-free drilling, have not been observed with this novel guided technique and novel fixation method.
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