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.