Suture button fixation in Latarjet has similar load to failure and clinical outcomes but lower bone resorption compared with screw fixation - a systematic review

Abstract

11 studies met eligible criteria: seven clinical studies (SB, n=279; SF, n=845) and four biomechanical. 80.9% (SB) and 84.2% (SF) were males. Follow up ranged from 6-63.6months. The overall SB recurrent instability rate ranged from 0-8.3% and SF ranged from 0-2.75%. Only one study demonstrated higher recurrent instability rate with SB (p=0.02). Overall SB complication rate ranged from 0-12.5% and SF ranged from 0-27%. Two studies reported higher complications and reoperations with SF related to hardware. Summary forest plots from four studies showed no significant difference in Walch Duplay score [mean difference, range -5.00 to 1.20 (95% CI -12.13 to 8.56), I2 inconsistency = 0%], Rowe score [mean difference, range -2.00 to 4.00 (95% CI: -7.37 to 7.66), I2 inconsistency = 45%] and VAS for pain [mean difference, range -0.10 to 0.60 (95% CI -0.72 to 1.33, I2 inconsistency = 0%]. There was no statistically significant difference between SB and SF in the postoperative range of motion. Radiologically, there was no significant difference in graft positioning and union at final follow up, but graft resorption was higher in SF (range 25.2-47.6%) compared to SB (range 10.1-18.5%). Biomechanical studies showed no significant difference in maximum load to failure (SB, range184-266N vs. SF, range148-288N).