Suspensory fixation for bone transfer procedures in shoulder instability is superior to screws in an angled construct: a biomechanical analysis

• Published in: JSES international 2024-03, Vol.8 (2), p.250-256
• Main Authors: Paul, Kyle, Elphingstone, Joseph W., Williams, Marshall, Manfredi, John N., Jardaly, Achraf, Schick, Samuel, Floyd, Susan, Brabston, Eugene W., Momaya, Amit M., Ponce, Brent A.
• Format: Article
• Language: English
• Subjects: Biomechanical; Coracoid graft; Glenoid augmentation; Latarjet; Shoulder instability; Suspensory button fixation
• ISSN: 2666-6383; 2666-6383
• DOI: 10.1016/j.jseint.2023.09.008

The Latarjet procedure is a common bony augmentation procedure for anterior shoulder instability. Historically, screw fixation is used to secure the coracoid graft to the anterior glenoid surface; however, malpositioning of the graft leads to oblique screw insertion that contributes to complications. Suture buttons (SBs) are a more recent fixation technique that have not been studied alongside standard screw fixation in the context of biomechanical models of angulated fixation. This study aims to compare the biomechanical strength of single and double, screw and SB fixation at various levels of angulation. Testing was performed using polyurethane models from Sawbones. The graft piece was secured with screw fixation (Arthrex, Naples, FL, USA) or suspensory button (ABS Tightrope, Arthrex, Naples, FL, USA). Single or double constructs of screws and SBs were affixed at 0°, 15°, and 30° angles to the face of the glenoid component. An aluminum testing jig held the samples securely while a materials testing system applied loads. Five constructs were used for each condition and assessed load to failure testing. For single fixation constructs, suspensory buttons were 60% stronger than screws at 0° (P