Comparison of screw versus suture button fixation techniques in the arthroscopic Latarjet procedure for recurrent shoulder instability: A systematic review

Background The arthroscopic Latarjet procedure is an established treatment for recurrent anterior shoulder instability with significant glenoid bone loss. This systematic review compared outcomes of screw versus suture-button fixation and identified contexts where each technique may be advantageous. Methods Following PRISMA 2020 guidelines, PubMed and Google Scholar were searched on 23 July 2024 for English-language studies of arthroscopic Latarjet procedures using screw or suture-button fixation. Eligible studies included full-text human data with clear follow-up and outcome reporting. Extracted data included demographics, surgical details, functional scores, union rates, complications, and reoperations. Risk of bias was assessed using established tools for non-randomized studies. Pooled statistical comparisons for complication, reoperation, and non-union rates were performed using chi-square tests. Results Twenty studies met the inclusion criteria: 11 using suture-button fixation (804 patients) and nine using screws (753 patients). Both techniques achieved high graft union rates (>90%) and improved functional outcomes. Suture-button fixation showed lower complication (13.3% vs. 22.1%, p < 0.001) and reoperation rates (0.8% vs. 8.2%, p < 0.00001), with a non-significant trend toward higher non-union (9.6% vs. 3.6%, p = 0.08). Conclusion Both fixation methods restore shoulder stability effectively. Fixation choice should be individualized to patient anatomy, functional demands, and surgeon experience. Further prospective comparative studies are warranted.