JSES - 2026-08-01 - Journal Article; Comparative Study
Biomechanical evaluation of primary stability in revision Latarjet surgery using malleolar screws following failure of all-suture cerclage fixation.
Bayer TP, Nolte AK, Panzram B, Raiss P, Wegmann K, Kretzer JP, Bülhoff M, Jaeger S
Topics
Key Takeaway
Revision Latarjet fixation with malleolar screws after all-suture cerclage failure achieves biomechanical primary stability noninferior to primary screw fixation across all cyclic load levels up to 300 N.
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Summary
This study asked whether malleolar screw fixation in revision Latarjet surgery after all-suture cerclage failure restores primary stability equivalent to primary screw fixation. Six cadaveric shoulders that had undergone cerclage fixation and failed via cortical cut-through were revised with two malleolar screws and compared against their matched primary screw counterparts under cyclic loading up to 300 N with 3D optical marker tracking. No statistically significant difference in graft displacement was found at any load level (P > .05), with the revision group demonstrating superior stability at higher loads despite one intraoperative graft fracture.
Key Limitation
The sample size of six revision specimens provides insufficient statistical power to detect clinically meaningful differences in displacement, and the absence of in vivo healing biology means these biomechanical results cannot be extrapolated to functional outcomes or graft incorporation.
Original Abstract
BACKGROUND
Metal-free fixation methods, such as the all-suture cerclage technique for the Latarjet procedure, aim to minimize implant-related complications. Clinical studies suggest equivalent clinical results while reducing implant-related complications. However, recent studies have shown increased rates of graft migration and failure due to cortical cut-through. Revision strategies after such failures remain poorly described. The aim of this study is to evaluate the primary stability of revision Latarjet surgery using 2 conventional malleolar screws after failure of all-suture cerclage fixation compared with primary screw fixation. It is hypothesized that fixation of the coracoid graft using 2 malleolar screws in revision cases is equal to or higher than primary screw fixation.
METHODS
Twelve fresh-frozen cadaveric shoulder specimens (6 matched pairs) were previously tested in a study comparing suture cerclage and malleolar screw fixation. After failure due to cortical bone cut-through, revision surgery was performed on the cerclage specimens using 2 malleolar screws. Bone graft displacement under cyclic loading in 6 load levels (up to 300 N) and static conjoint tendon tension (10 N) was measured using a 3-dimensional optical marker system. Outcomes were compared with those from primary screw fixations.
RESULTS
No statistically significant differences in graft displacement under cyclic loading between the revision and primary groups at any load level (P > .05) could be found. The revision group showed slightly higher displacement at low load levels but demonstrated superior stability at higher loads compared with primary screw fixation. One intraoperative graft fracture was observed during revision, but it did not affect the primary stability of the tested specimen.
CONCLUSION
Revision Latarjet surgery using malleolar screw fixation after failed all-suture cerclage provides noninferior biomechanical primary stability compared with primary screw fixation. This technique appears to be a viable salvage option for addressing instability after failure of metal-free Latarjet constructs. Clinical studies need to be conducted in order to confirm the results of this biomechanical study.