Unicortical fixation does not compromise bony union in the Latarjet procedure

Background: Fixation of the coracoid during the Latarjet procedure can be performed with either unicortical or bicortical fixation. There is no clear evidence that the number of cortices fixed affects graft union, but in vitro studies suggest bicortical fixation is desirable. The primary aim of the study was to retrospectively review the coracoid union rates in our Latarjet cohort who have undergone either unicortical or bicortical graft fixation. Methods: A retrospective review of Latarjet patients receiving bicortical or unicortical fixation was performed. The rate of coracoid graft union was assessed via radiographs and computed tomography scans at minimum 8 weeks postoperatively. Primary analysis for graft union was performed with Chi-squared and Fisher's exact tests. Results: A total of 184 patients were enrolled (82 bicortical, 102 unicortical) with 20 patients lost to follow-up. There was no significant difference between union rates of bicortical and unicortical groups (union rate: 94% bicortical, 98% unicortical, P =.25). There were no significant differences in rate of instability recurrence (P =.5) or other postoperative complications (P =.83) between the groups. Discussion: At a minimum follow-up of 8 weeks, bicortical fixation was not shown to have a higher rate of union than unicortical fixation. Performing unicortical fixation is an acceptable practice without compromising bony graft union.