Jos Sujit, J Rakshit, Vijayakumar Vyas, Sreejesh Saj, Benny Kiran, Paul Prannoy
Institute of Advanced Orthopedics, MOSC Medical College Hospital, Kolenchery, Kochi, Kerala, India.
Arthrosc Tech. 2025 May 20;14(7):103560. doi: 10.1016/j.eats.2025.103560. eCollection 2025 Jul.
Although the arthroscopic Latarjet procedure has evolved as the most reliable bony sling procedure for shoulder instability with bone loss, the soft cancellous nature of the coracoid makes the FiberTape option for metal-free fixation difficult because of cheese wiring and cutting into the coracoid when the tape is tensioned. Hence, long titanium screws or titanium buttons are used to fix the coracoid in all existing methods for the Latarjet procedure. Rigid and metal-based methods can cause abrasion of the bony moving surfaces coated with cartilage and can cause wear to contact areas, especially when osteolysis occurs during remodeling of the coracoid bone. We describe an absorbable poly lactic acid 3-dimensional printed coracoid protector (which we call the SJ Buckler) to protect the coracoid process resting on its anterior surface and prevent cut through, with laboratory-verified strength to withstand greater than 120 N. This allows us to perform metal-free fixation of the coracoid in the Latarjet procedure, which can be performed arthroscopically or open, where the coracoid tensioning can be done without fear of cut-through. The poly lactic acid material is absorbable and will integrate to bone or disintegrate after the purpose of bony union to glenoid has been achieved.
尽管关节镜下Latarjet手术已发展成为治疗伴有骨质缺损的肩关节不稳最可靠的骨性悬吊手术，但喙突的松质骨特性使得使用FiberTape进行无金属固定变得困难，因为在拉紧胶带时会出现“奶酪布线”现象并切入喙突。因此，在现有的所有Latarjet手术方法中，都使用长钛螺钉或钛纽扣来固定喙突。刚性的、基于金属的方法会导致覆盖有软骨的骨活动表面磨损，并会导致接触区域磨损，尤其是在喙突骨重塑过程中发生骨质溶解时。我们描述了一种可吸收的聚乳酸三维打印喙突保护器（我们称之为SJ Buckler），以保护位于其前表面的喙突，并防止穿透，经实验室验证其强度可承受大于120 N的力。这使我们能够在Latarjet手术中对喙突进行无金属固定，该手术可以通过关节镜或开放方式进行，在这种情况下，喙突拉紧操作可以放心进行，不用担心穿透问题。聚乳酸材料是可吸收的，在实现与关节盂的骨性愈合目的后，它会与骨整合或分解。
