Summary

This study demonstrates the non-inferiority of single-screw fixation with a washer compared to two-screw fixation in terms of graft consolidation and stability, providing evidence to support the use of a less invasive approach in the Latarjet procedure.

Abstract

Background

While the Latarjet procedure is widely utilized for addressing anterior shoulder instability, there remains uncertainty regarding the optimal fixation method—two screws versus a single screw with a washer.

Hypothesis/Purpose: This study aims to compare the fixation methods of one screw with a washer versus two screws in terms of graft consolidation at 3 months, as assessed by CT scan.

Study Design: Cohort study; Level of evidence, 3.

Methods

A bi-centric retrospective analysis was conducted between October 2022 and October 2023. Two patient groups were identified, matched for age and CT scan acquisition, both having undergone the Latarjet procedure. Group 1 received single-screw fixation with a washer using a partially threaded, non-cannulated 4 mm steel screw, while Group 2 had two-screw fixation with partially threaded, cannulated screws (4.5 mm for men and 3.75 mm for women). The primary outcome was graft consolidation and rotation at 3 months postoperatively, with secondary outcomes including graft morphology (length, width, thickness) and the contact surface with the glenoid.

Results

After applying exclusion criteria, 47 patients in Group 1 (single screw + washer) and 40 patients in Group 2 (two screws) were analyzed. Mean age was 28.4 years in Group 1 and 25.8 years in Group 2 (p=0.058). CT scans were performed at 3.13 and 3.58 months, respectively (p=0.030). Significant differences were found in proximo-distal graft positioning in the sagittal plane (p<0.001), while no significant differences were observed in medio-lateral positioning (p=0.286), rotational phenomena (p=0.780), or consolidation (p=0.908).

Conclusion

Both fixation methods—two-screw fixation and single-screw with a washer—demonstrated similar outcomes in terms of consolidation and rotational stability, suggesting that single-screw fixation with a washer may be a viable alternative.

Clinical Relevance: This study suggests that single-screw fixation with a washer can offer comparable results to two-screw fixation in the Latarjet procedure, potentially providing a simpler and less invasive option.

Key Terms: Latarjet, single screw, two screws, washer, graft consolidation.

What is known: The Latarjet procedure effectively treats anterior shoulder instability, but there is ongoing debate about the ideal fixation method. While two-screw fixation offers greater biomechanical stability, it carries risks like graft fracture and hardware-related complications. Single-screw fixation, particularly with a washer, may provide a simpler alternative with fewer complications.

What this study adds: This study demonstrates the non-inferiority of single-screw fixation with a washer compared to two-screw fixation in terms of graft consolidation and stability, providing evidence to support the use of a less invasive approach in the Latarjet procedure.