Editorial Commentary: Suture Button Fixation for the Latarjet Procedure Is Superior to Screw Fixation

Abstract

An increasing body of evidence suggests that suture button fixation is comparable with screw fixation in Latarjet and potentially associated with reduced graft resorption. Suture button fixation may facilitate performing the Latarjet procedure, particularly when done in an arthroscopic manner. The use of suture button fixation technique theoretically facilitates improved positioning of the graft on the glenoid, as it frees the surgeon from the potential of the soft-tissue envelope to impact positioning of the graft, which can occur with screw-based guides. The bone graft can be shuttled into an optimal position and then tensioned with relative ease in comparison with screw-based techniques. Suture button fixation results in lower complication rates compared with screw fixation; almost one third of the screw fixation complications are hardware-related, and screw fixation results in a high rate of hardware removal. Moreover, the arthroscopic Latarjet suture button literature is published by experienced surgeons. Arthroscopic Latarjet has a significant learning curve, reducing the translatability of studies that report superior findings with any one technique. The generalizability of results reminds us that evidence-based medicine should be practiced through the lens of not only patient preferences, but also through an honest appraisal of a surgeon's own ability.