A biomechanical analysis of double-screw, double-button, and screw-button fixation constructs in patient-specific instrument-guided Latarjet procedure
Description
<p>Background: The Latarjet coracoid transfer procedure reliably stabilizes the glenohumeral joint for shoulder instability. However, complications such as graft osteolysis, nonunion and fracture continue to affect patient clinical outcomes. The double-screw (SS) construct is regarded as the gold standard method of fixation. SS constructs are associated with graft osteolysis. More recently, a double-button technique (BB) has been suggested to minimize graft-related complications. However, BB constructs are associated with fibrous nonunion. To mitigate this risk, a single screw combined with a single button (SB) construct has been proposed. It is thought that this technique incorporates the strength of the SS construct and allows micromotion superiorly to mitigate stress shielding–related graft osteolysis. <br/></p><p>Aims: The primary aim of this study was to compare the failure load of SS, BB, and SB constructs under a standardized biomechanical loading protocol. The secondary aim was to characterize the displacement of each construct throughout testing. <br/></p><p>Methods: Computed tomography scans of 20 matched-pair cadaveric scapulae were performed. Specimens were harvested and dissected free of soft tissue. SS and BB techniques were randomly assigned to specimens for matched-pair comparison with SB trials. A patient-specific instrument (PSI)–guided Latarjet procedure was performed on each scapula. Specimens were tested using a uniaxial mechanical testing device under cyclic loading (100 cycles, 1 Hz, 200 N/s) followed by a load-to-failure protocol (0.5 mm/s). Construct failure was defined by graft fracture, screw avulsion, and/or graft displacement of more than 5 mm. <br/></p><p>Results: Forty scapulae from 20 fresh frozen cadavers with a mean age of 69.3 years underwent testing. On average, SS constructs failed at 537.8 N (SD 296.8), whereas BB constructs failed at 135.1 N (SD 71.4). SB constructs required a significantly greater load to fail compared with BB constructs (283.5 N, SD 162.8, P =.039). Additionally, SS (1.9 mm, IQR 0.87) had a significantly lower maximum total graft displacement during the cyclic loading protocol compared with SB (3.8 mm, IQR 2.4, P =.007) and BB (7.4 mm, IQR 3.1, P <.001) constructs. <br/></p><p>Conclusion: These findings support the potential of the SB fixation technique as a viable alternative to SS and BB constructs. Clinically, the SB technique could reduce the incidence of loading-related graft complications seen in the first 3 months of BB Latarjet cases. The study is limited to time-specific results and does not account for bone union or osteolysis.</p>
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ID Code: | 239900 | ||||
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Item Type: | Contribution to Journal (Journal Article) | ||||
Refereed: | Yes | ||||
ORCID iD: |
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Additional Information: | Funding Information: Funding: The authors received funding from the Australian Research Council through the Industrial Transformation Training Centre for Joint Biomechanics (IC190100020) and its associated industry partners. Financial contributing partners include Stryker, Zimmer Biomet, Logemas and Australian Biotechnologies. | ||||
Measurements or Duration: | 10 pages | ||||
Keywords: | Basic Science Study, biomechanical testing, Biomechanics, coracoid transfer, glenoid bone loss, Latarjet, Shoulder, shoulder instability | ||||
DOI: | 10.1016/j.jse.2023.02.117 | ||||
ISSN: | 1058-2746 | ||||
Pure ID: | 133384413 | ||||
Divisions: | Current > Research Centres > Centre for Biomedical Technologies Current > QUT Faculties and Divisions > Faculty of Engineering Current > Schools > School of Mechanical, Medical & Process Engineering |
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Funding Information: | Funding: The authors received funding from the Australian Research Council through the Industrial Transformation Training Centre for Joint Biomechanics (IC190100020) and its associated industry partners. Financial contributing partners include Stryker, Zimmer Biomet, Logemas and Australian Biotechnologies. Funding: The authors received funding from the Australian Research Council through the Industrial Transformation Training Centre for Joint Biomechanics ( IC190100020 ) and its associated industry partners. Financial contributing partners include Stryker, Zimmer Biomet, Logemas and Australian Biotechnologies. | ||||
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Copyright Owner: | 2023 Journal of Shoulder and Elbow Surgery Board of Trustees | ||||
Copyright Statement: | This work is covered by copyright. Unless the document is being made available under a Creative Commons Licence, you must assume that re-use is limited to personal use and that permission from the copyright owner must be obtained for all other uses. If the document is available under a Creative Commons License (or other specified license) then refer to the Licence for details of permitted re-use. It is a condition of access that users recognise and abide by the legal requirements associated with these rights. If you believe that this work infringes copyright please provide details by email to qut.copyright@qut.edu.au | ||||
Deposited On: | 30 May 2023 04:19 | ||||
Last Modified: | 26 Jul 2024 18:57 |
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