Comparative biomechanical study of five systems for fixation of the coracoid transfer during the Latarjet procedure for
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ORIGINAL PAPER
Comparative biomechanical study of five systems for fixation of the coracoid transfer during the Latarjet procedure for treatment of anterior recurrent shoulder instability Valentin Massin 1 & Damien Lami 1 & Matthieu Ollivier 1 & Martine Pithioux 2,3 & Jean-Noël Argenson 1 Received: 4 December 2019 / Accepted: 2 April 2020 # SICOT aisbl 2020
Abstract Purpose This work compares the biomechanical resistance of five modes of fixation coracoid bone-block fixation during Latarjet open-air or arthroscopic procedures. The hypothesis is that these systems are equivalent. Methods Latarjet procedures were performed on cadavers, then the samples were subjected to an increasing tension until the fixation failed. Five systems were tested: two malleolar screws, one screw with washer, two 3.5-mm selfcompressive screws, one 4-mm self-compressive screw associated with one 3-mm self-compressive screw, and endobutton. The main judgment criterion was the strength necessary for the failure of the fixation. The secondary criterion was the stiffness of the assembly. Results The single malleolar screw fixing has a lower breaking threshold than other fixings. There is no difference in strength concerning the other systems. The average strength is greater than the stresses of a shoulder during daily life activities. There is no difference regarding the secondary criterion. Conclusion The use of a single screw is insufficient, but the other systems seems reliable. The use of small diameter selfcompressive cannulated screws can provide a better result. This biomechanical work must be validated in clinical studies. Keywords Latarjet procedure . Coracoid bone-block . Glenohumeral instability . Glenohumeral stabilization . Fixation system . Graft healing
Introduction Glenohumeral stabilization by coracoid bone-block was described in 1954 by Latarjet [1]. The procedure consists, by a delto-pectoral approach, in transposing the horizontal portion of the coracoid process to the lying position at the anterior-inferior edge of the glenoid, through an incision in the tendon of the subscapular.
* Valentin Massin [email protected] 1
Department of Orthopaedics and Traumatology, Sainte-Marguerite Hospital, Assistance Publique–Hôpitaux de Marseille, Marseille, France
2
CNRS, ISM, Aix Marseille University, Marseille, France
3
Department of Orthopaedics and Traumatology, APHM, Sainte-Marguerite Hospital, CNRS, ISM, Aix Marseille University, Marseille, France
Stabilization is obtained by a stop effect related to the increase of the inferior-internal rim of the glenoid, associated with a sling effect of the coraco-biceps tendon when placing the upper limb in anterior elevation. Patte [2] and Walch [3] proposed improvements to the original technique, doing a capsuloplasty on the coracoacromial ligament. Coracoid bone grafting can restore the glenoid rim defect [4], and this triple locking technique remains the gold standard for the treatment of anterior glenohumeral instability [5, 6]. The results are effective with a recurrence i
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