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Review
. 2023 Oct 12;11(10):23259671231186429.
doi: 10.1177/23259671231186429. eCollection 2023 Oct.

A Systematic Review of Screw and Suture Button Glenoid Augmentation Constructs

John N Manfredi  1 , Samuel Schick  1 , Kyle D Paul  2 , Joseph W Elphingstone  1 , Josiah Sowell  1 , Megan Lameka  1 , Eugene W Brabston  1 , Amit M Momaya  1 , Brent A Ponce  3
Affiliations
Review

A Systematic Review of Screw and Suture Button Glenoid Augmentation Constructs

John N Manfredi et al. Orthop J Sports Med. .

Abstract

Background: Glenohumeral dislocations often lead to glenoid bone loss and recurrent instability, warranting bony augmentation. While numerous biomechanical studies have investigated fixation methods to secure a graft to the glenoid, a review of available constructs has yet to be performed.

Purpose: To synthesize the literature and compare the biomechanics of screw and suture button constructs for anterior glenoid bony augmentation.

Study design: Systematic review.

Methods: A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. There were 2 independent reviewers who performed a literature search using the PubMed, Embase, and Google Scholar databases of studies published between 1950 and 2020. Studies were included that compared the biomechanical outcomes of fixation for the treatment of anterior shoulder instability with glenoid bone loss.

Results: Overall, 13 of the 363 studies screened met the inclusion criteria. The included studies measured the biomechanical strength of screws or suture buttons on a cadaveric or synthetic Latarjet construct. Screws and suture buttons were biomechanically similar, as both constructs exhibited comparable loads at failure and final displacement. Screw type (diameter, threading, or composition) did not significantly affect construct strength, and double-screw fixation was superior to single-screw fixation. Additionally, 2 screws augmented with a small plate had a higher load at failure than screws that were not augmented. Unicortical double-screw fixation was inferior to bicortical double-screw fixation, although construct strength did not significantly decrease if 1 of these screws was unicortical. Further, 2 screws inserted at 15° off axis experienced significantly higher graft displacement and lower ultimate failure loads than those inserted at 0° parallel to the glenoid.

Conclusion: Suture buttons provided comparable strength to screws and offer an effective alternative to reduce screw-related complications. Augmentation with a small plate may clinically enhance construct strength and decrease complications through the dispersion of force loads over a greater surface area. Differences in screw type did not appear to alter construct strength, provided that screws were placed parallel to the articular surface and were bicortical.

Keywords: biomechanical; bone graft; fixation; glenoid; shoulder instability; suture button.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: E.W.B. has received education payments from Prime Surgical and consulting fees from LinkBio. A.M.M. has received grant support from DJO; education payments from Arthrex, Peerless Surgical, and Prime Surgical; honoraria from Fidia Pharma; and hospitality payments from Smith & Nephew. B.A.P. has received education payments from Prime Surgical; consulting fees from Acumed, DePuy, Smith & Nephew, Stryker, and Wright Medical; royalties from Smith & Nephew, Stryker, and Wright Medical; and honoraria from Fidia Pharma. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Study selection flowchart.
Figure 2.
Figure 2.
Illustration of a Latarjet construct using suture button fixation. The black line demonstrates the degree of offset at the glenoid-graft interface.
See this image and copyright information in PMC

References

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