Table 4.

Pearls and Pitfalls

Pearls

a.The drill holes in the glenoid are always parallel to the glenoid face where the bone stock is maximum

b.The tensioning of the FiberTape cerclage automatically pulls the glenoid, through the split in the subscapularis muscle, onto its location on the anteroinferior glenoid.

c.The seating of the coracoid on the anteroinferior glenoid is accurately and easily reproducible as the glenoid drill holes are made using a jig (rather than free hand as in the metal screw technique).

d.Avoids the need for pulling the FiberTape in a direction 90° perpendicular to the glenoid drill hole (unlike the previously described FiberTape cerclage method).

e.Being all-arthroscopic, the tissue plane violation is kept to minimum

f. Associated pathology like a SLAP tear or an off-track Hill–Sachs lesion can be concomitantly addressed with this arthroscopic procedure.

g.The soft fiber tapes make minimal or no prominence anteriorly over the coracoid graft after fixation

h.The small 3.5-mm drill holes made in glenoid and coracoid reduces the chance of fractures in these 2 bones.

i. 80 lbs of tension on the FiberTapes give a robust fixation of the coracoid graft which is comparable with the strength of screws

j. Micromovement between the coracoid graft and the glenoid aid in faster bone healing (principle of relative stability15)

k.The 2 limbs of the FiberTape cerclage system give good rotational stability to the coracoid graft

l. Does not require the far medial “M” portal used during the anteroposterior glenoid drilling using the double cannula system for the screw method of arthroscopic Latarjet.

Pitfalls

a.Steep learning curve for new surgeons to learn the technique. Comfortable in the hands of high-volume shoulder surgeons.

b.Although it takes more time than open Latarjet procedure, the time taken is similar or less when compared with that used in the metal screw method.

c.The cost of the procedure is a fraction more due to the longer operating room usage and fluids. Implant cost is similar as one FiberTape cerclage costs similar to the 2 metal screws with top-hat in the metal screw method.