Coracoid bone block fixation with cortical buttons: An alternative to screw fixation?

BACKGROUND: The purpose of this study was to evaluate suture button fixation in a bone block (Bristow and Latarjet) procedure. We hypothesize that (1) cortical button fixation will allow predictable and reproducible bone union and (2) minimize the complications reported with screw fixation.

MATERIALS AND METHODS: Seventy patients (mean age, 27 years) underwent an arthroscopic bone block procedure with a guided surgical approach and suture button fixation for recurrent anterior shoulder instability. There were two groups of patients: 35 Bristow procedures (group A) and 35 Latarjet procedures (group B). Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging at 2 weeks and 6 months, respectively.

RESULTS: The coracoid graft was positioned below the equator in 93% and strictly tangential to the glenoid surface in 94% of the cases. Bone healing was observed in 83% of the cases (58/70) with 74% bone union in group A and 91% in group B. Neurologic and hardware complications, classically reported with screw fixation, were not observed with this novel fixation method.

CONCLUSIONS: (1) Suture button fixation can be an alternative to screw fixation, obtaining bone block union, (2) in the lying position (Latarjet) bone healing was better than in the standing position (Bristow), and (3) complications classically reported with screw fixation were not observed.

LEVEL OF EVIDENCE: Level IV.