Editorial Commentary: Suture-button fixation may have advantages versus screw fixation for glenoid bone grafting procedures for shoulder instability.

Orthopaedic suture-buttons have been increasingly used in a variety of procedures, such as syndesmosis stabilization, coracoclavicular ligament repair, anterior cruciate ligament graft fixation, and Lisfranc injury treatment. In many instances, suture-button fixation constructs have shown equivalent, if not superior, outcomes to screw fixation. More recently, suture-buttons have been suggested for osseous fixation of the coracoid during the Latarjet procedure, as well as other anterior (or posterior) bone block reconstruction of the glenoid using distal tibial allograft, tricortical iliac crest, or distal clavicle in cases of complex shoulder instability. Suture-buttons offer several unique advantages, including the ability to tension and re-tension graft fixation, smaller driller paths with bone preservation, less osteolysis, lower risk of hardware removal, and greater ease of hardware revision and/or secondary surgery. However, certain disadvantages also exist, such as higher implant costs, less time-zero implant rigidity, technical difficulty, and potentially, less mediolateral stability of the bone graft. Time will tell if these suture-button constructs will supplant traditional screw fixation for the Latarjet procedure in terms of clinical- and cost-effectiveness.