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Haidar IM, Werthel JD, Hooke AW, Sanchez-Sotelo J, Hardy A. Latarjet Coracoid Transfer Versus Distal Clavicular Autograft for Anterior Shoulder Instability With Glenoid Bone Loss: A Biomechanical Comparison of 2 Graft Reconstructions in Various Medial Positions. Orthop J Sports Med 2025; 13:23259671251320369. [PMID: 40190688 PMCID: PMC11970044 DOI: 10.1177/23259671251320369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 04/09/2025] Open
Abstract
Background No biomechanical study has established the effect of different graft positions or bone block options on anterior glenohumeral joint stability. Purpose/Hypothesis The purpose of this study was to compare graft choice (distal clavicular vs coracoid autograft for Latarjet) and position on stability of the bone block for anterior glenohumeral instability. It was hypothesized that both grafts would be comparable if flush with the glenoid but that the sling effect of the Latarjet procedure would lead to greater stability in case of graft medialization. Study Design Controlled laboratory study. Methods Eight cadaveric shoulders were included. Defects stabilized using a distal clavicular graft and a coracoid graft were consecutively positioned at 0, 4, and 8 mm medially. The starting position was determined by the humeral head's being seated at its most medial position on the glenoid surface. Each experiment comprised maximal external rotation and glenohumeral abduction at 60° while applying a constant 50-N medial compressive force to the humerus under all conditions. The conjoint tendon was routed through a split in the subscapularis and loaded with a 5-N weight using a pulley system for all Latarjet trials to simulate the sling effect. Results Regarding the clavicular graft, the stability ratio significantly decreased versus the intact condition at all medial offsets (P = .007 for 0 mm, P < .001 for 4 mm, and P < .001 for 8 mm), and it was significantly lower in the 4-mm versus 0-mm position (P = .008), significantly higher in the 4-mm versus 8-mm position (P < .001), and significantly lower in the 8-mm versus 0-mm position (P < .001). Regarding the coracoid graft, the stability ratio was comparable with intact for the 0-mm position (P = .12), while it was significantly lower in the 4-mm and 8-mm positions (P < .001 for both). The distal clavicular graft at 0-mm offset was comparable with the coracoid graft at 0-mm offset. Conclusion In shoulders with anterior glenoid bone loss, the coracoid and distal clavicular autografts were biomechanically comparable when placed flush with the glenoid. The distal clavicle at 0-mm offset did not restore stability compared with the intact specimen, but the Latarjet at 0-mm offset was not significantly different from the intact condition. Clinical Relevance The Latarjet procedure provides higher stability compared with distal clavicular autograft when medialized.
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Affiliation(s)
| | | | - Alexander W. Hooke
- Materials and Structural Testing Core, Mayo Clinic, Rochester, Minnesota, USA
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2
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Tuncez M, Bayraktar ÖB. Comparison of the Latarjet Procedure and Iliac Crest Bone Graft Transfer in Bone Bankart Lesions in Recurrent Anterior Shoulder Dislocations. Cureus 2024; 16:e66176. [PMID: 39105204 PMCID: PMC11299470 DOI: 10.7759/cureus.66176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 08/07/2024] Open
Abstract
OBJECTIVE There are various treatment modalities for bony Bankart lesions following glenohumeral joint dislocations. In this research, we aimed to compare the radiological and clinical results of patients who underwent the Latarjet procedure and iliac crest bone graft transfer. MATERIALS AND METHODS Clinical and radiological data of 15 patients were retrospectively evaluated. Inclusion criteria were a history of at least two dislocations, being between 18-65 years of age and having at least 10% glenoid bone loss. The exclusion criteria were defined as follows: patients who underwent only soft tissue procedures, patients who did not attend the follow-up, patients with other pathology in the upper extremity (fracture, cuff tear, etc.), and patients with a follow-up period of less than 12 months time. Nine patients underwent the Latarjet procedure and six underwent iliac crest bone graft transfer. Clinical evaluation, age, gender, body mass index, range of motion, Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score, Constant score, and Visual Analogue Scale (VAS) score were evaluated. Radiographic evaluation was performed with preoperative and postoperative direct radiographs and computed tomography. Mann-Whitney U test, t-test, and Fisher exact tests were used for group comparisons. RESULTS The mean age of the patients was 32.6 years and the mean follow-up period was 24.9 months. When the two groups were compared, no statistical difference was found in terms of age, gender, body mass index, range of motion, Constant score, VAS score, glenoid cartilage stepping, and bone defect (p>0.05). The operation time was longer in the iliac crest bone graft transfer group compared to the Latarjet group (p<0.05). CONCLUSION Latarjet and iliac crest bone graft transfer can be used successfully in the treatment of bony Bankart in recurrent anterior shoulder dislocations. The operation time is longer in iliac crest bone graft transfer compared to the Latarjet procedure.
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Affiliation(s)
- Mahmut Tuncez
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, TUR
| | - Ömer Berkay Bayraktar
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, TUR
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3
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Poursalehian M, Ghaderpanah R, Bagheri N, Mortazavi SMJ. Osteochondral allografts for the treatment of shoulder instability. Bone Jt Open 2024; 5:570-580. [PMID: 38981603 PMCID: PMC11233180 DOI: 10.1302/2633-1462.57.bjo-2023-0186.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Aims To systematically review the predominant complication rates and changes to patient-reported outcome measures (PROMs) following osteochondral allograft (OCA) transplantation for shoulder instability. Methods This systematic review, following PRISMA guidelines and registered in PROSPERO, involved a comprehensive literature search using PubMed, Embase, Web of Science, and Scopus. Key search terms included "allograft", "shoulder", "humerus", and "glenoid". The review encompassed 37 studies with 456 patients, focusing on primary outcomes like failure rates and secondary outcomes such as PROMs and functional test results. Results A meta-analysis of primary outcomes across 17 studies revealed a dislocation rate of 5.1% and an increase in reoperation rates from 9.3% to 13.7% post-publication bias adjustment. There was also a noted rise in conversion to total shoulder arthroplasty and incidence of osteoarthritis/osteonecrosis over longer follow-up periods. Patient-reported outcomes and functional tests generally showed improvement, albeit with notable variability across studies. A concerning observation was the consistent presence of allograft resorption, with rates ranging from 33% to 80%. Comparative studies highlighted similar efficacy between distal tibial allografts and Latarjet procedures in most respects, with some differences in specific tests. Conclusion OCA transplantation presents a promising treatment option for shoulder instability, effectively addressing both glenoid and humeral head defects with favourable patient-reported outcomes. These findings advocate for the inclusion of OCA transplantation in treatment protocols for shoulder instability, while also emphasizing the need for further high-quality, long-term research to better understand the procedure's efficacy profile.
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Affiliation(s)
- Mohammad Poursalehian
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rezvan Ghaderpanah
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Bagheri
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed M. J. Mortazavi
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
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4
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Chiddarwar V, de Zoete RMJ, Dickson C, Lathlean T. Effectiveness of combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis. Br J Sports Med 2023; 57:1498-1508. [PMID: 37451706 DOI: 10.1136/bjsports-2022-106422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To investigate the effectiveness, risk of recurrence and return to activity (RTA) of surgery combined with exercise-based interventions (EBI) versus EBI alone after traumatic anterior shoulder dislocation (ASD). DESIGN Systematic review and meta-analysis. DATA SOURCES Systematic literature search (MEDLINE, Web of Science, Scopus, Google Scholar). ELIGIBILITY Studies focused on EBI or EBI as a part of postoperative care for adults with an ASD, written in English, and published after 1990. We excluded diagnostic, assessment-based studies on individuals experiencing recurrent shoulder dislocations, concomitant shoulder injury, animal or cadaveric studies. Primary outcomes were dislocation RTA. Secondary outcomes were self-reported outcome measures, strength and range of motion. Random-effects meta-analysis was used to estimate the effect of EBI (SMD; Hedges' g, RR). The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence. RESULTS Sixty studies were included (n=3598); seven were meta-analysed (n=345). The mean age of participants in the included studies was 26.71±9.19 and 56% of those included were male. Of the 60 studies included in the systematic review, 29 were fair quality (48.3%), 15 studies were good quality (25%) and 16 studies were poor quality (26.7%), (k=0.66). Individuals who underwent EBI alone were 2.03 times more likely to experience recurrent instability than individuals who underwent EBI in conjunction with surgery (RR 2.03, 95% CI 1.03 to 3.97). Individuals who underwent EBI with surgery appeared 1.81 times more likely to RTA than those who underwent EBI alone, although results were not statistically significant (RR 1.81, 95% CI 0.96 to 3.43). CONCLUSIONS Surgery combined with EBI is more effective in reducing the risk of recurrence and possibly increasing RTA than EBI alone after traumatic ASD.
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Affiliation(s)
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Timothy Lathlean
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
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Menendez ME, Wong I, Tokish JM, Denard PJ. Free Bone Block Procedures for Glenoid Reconstruction in Anterior Shoulder Instability. J Am Acad Orthop Surg 2023; 31:1103-1111. [PMID: 37476855 DOI: 10.5435/jaaos-d-22-00837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/23/2023] [Indexed: 07/22/2023] Open
Abstract
Advances in the understanding and management of bone loss in shoulder instability have led to the development of free bone block techniques as an alternative to the Latarjet procedure. These techniques have been proposed as a theoretically safer option to Latarjet, and there is growing clinical enthusiasm in their use. The purpose of this article was to contextualize the utilization of free bone block procedures in the current treatment paradigm of anterior shoulder instability and to review the history and common types of bone autograft (eg, iliac crest, distal clavicle, scapular spine) and allograft (eg, distal tibia, preshaped blocks) techniques and approaches, as well as their clinical effectiveness and safety.
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Affiliation(s)
- Mariano E Menendez
- From the Oregon Shoulder Institute at Southern Oregon Orthopedics, Medford, OR (Menendez and Denard), the Department of Surgery, Dalhousie University, Halifax, Nova Scotia (Wong), the Department of Orthopedic Surgery, Mayo Clinic Arizona, Scottsdale, AZ (Tokish)
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Menendez ME, Sudah SY, Denard PJ, Feeley BT, Frank RM, Galvin JW, Garber AC, Crall TS, Crow S, Gramstad GD, Cheung E, Fine L, Costouros JG, Dobbs R, Garg R, Getelman MH, Buerba R, Harmsen S, Mirzayan R, Pifer M, McElvany M, Ma CB, McGoldrick E, Lynch JR, Jurek S, Humphrey CS, Weinstein D, Orvets ND, Solomon DJ, Zhou L, Saleh JR, Hsu J, Shah A, Wei A, Choung E, Shukla D, Ryu RK, Brown DS, Hatzidakis AM, Min KS, Fan R, Guttmann D, Rao AG, Ding D, Andres BM, Cheah J, Mierisch CM, Hoellrich RG, Lee B, Tweet M, Provencher MT, Butler JB, Kraetzer B, Klug RA, Burns EM, Schrumpf MA, Savin D, Sheu C, Magovern B, Williams R, Sears BW, Stone MA, Nugent M, Gomez GV, Amini MH. Surgeon variation in glenoid bone reconstruction procedures for shoulder instability. J Shoulder Elbow Surg 2023; 32:133-140. [PMID: 36208672 DOI: 10.1016/j.jse.2022.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/22/2022] [Accepted: 09/04/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Advances in the understanding and management of glenoid bone loss in shoulder instability have led to the development of alternative bony reconstruction techniques to the Latarjet using free bone grafts, but little is known about surgeon adoption of these procedures. This study sought to characterize surgeon variation in the use of glenoid bone reconstruction procedures for shoulder instability and ascertain reasons underlying procedure choice. METHODS A 9-question survey was created and distributed to 160 shoulder surgeons members of the PacWest Shoulder and Elbow Society, of whom 65 (41%) responded. The survey asked questions regarding fellowship training, years in practice, surgical volume, preferred methods of glenoid bone reconstruction, and reasons underlying treatment choice. RESULTS All surgeons completed a fellowship, with an equal number of sports medicine fellowship-trained (46%) and shoulder and elbow fellowship-trained (46%) physicians. The majority had been in practice for at least 6 years (6-10 years: 25%; >10 years: 59%). Most (78%) performed ≤10 glenoid bony reconstructions per year, and 66% indicated that bony procedures represented <10% of their total annual shoulder instability case volume. The open Latarjet was the preferred primary reconstruction method (69%), followed by open free bone block (FBB) (22%), arthroscopic FBB (8%), and arthroscopic Latarjet (1%). Distal tibia allograft (DTA) was the preferred graft (74%) when performing an FBB procedure, followed by iliac crest autograft (18%), and distal clavicle autograft (6%). The top 5 reasons for preferring Latarjet over FBB were the sling effect (57%), the autologous nature of the graft (37%), its robust clinical evidence (22%), low cost (17%), and availability (11%). The top 5 reasons for choosing an FBB procedure were less anatomic disruption (58%), lower complication rate (21%), restoration of articular cartilage interface (16%), graft versatility (11%), and technical ease (11%). Only 20% of surgeons indicated always performing a bony glenoid reconstruction procedure in the noncontact athlete with less than 20% glenoid bone loss. However, that percentage rose to 62% when considering a contact athlete with the same amount of bone loss. CONCLUSIONS Although open Latarjet continues to be the most popular glenoid bony primary reconstruction procedure in shoulder instability, nearly 30% of shoulder surgeons in the western United States have adopted FBB techniques as their preferred treatment modality--with DTA being the most frequently used graft. High-quality comparative clinical effectiveness research is needed to reduce decisional conflict and refine current evidence-based treatment algorithms.
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Affiliation(s)
- Mariano E Menendez
- Oregon Shoulder Institute at Southern Oregon Orthopedics, Medford, OR, USA
| | - Suleiman Y Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, NJ, USA
| | - Patrick J Denard
- Oregon Shoulder Institute at Southern Oregon Orthopedics, Medford, OR, USA.
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Calvo E, Valencia M, Foruria AM, Gonzalez JA. Recurrence of instability after Latarjet procedure: causes, results and treatment algorithm. EFORT Open Rev 2022; 7:800-807. [PMID: 36541530 PMCID: PMC9880904 DOI: 10.1530/eor-22-0095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Latarjet modifies the anatomy of the shoulder, and subsequent revision surgery is challenging. It is mandatory to determine the cause of recurrence in order to select the best treatment option. A CT scan is needed to measure glenoid track and evaluate coracoid graft status: position, degree of consolidation, and osteolysis. Conservative management can be advocated in selected patients in whom the instability level does not interfere with the activities they wish to perform. Surgical treatment is based on the glenoid track measurement and coracoid graft suitability. The coracoid graft is considered suitable if it preserves the conjoint tendon insertion, does not show osteolysis, and is large enough to reconstruct the glenoid surface. Adding a remplissage is recommended for those cases with a coracoid graft insufficient to convert large off-track Hill-Sachs lesions into on-track. If the coracoid graft is suitable to reconstruct bone defects in terms of size and viability but is poorly positioned or avulsed, graft repositioning can be a valid option. In patients with unsuitable coracoid bone graft, free bone graft is the revision technique of choice. The size of the graft should be large enough to restore the glenoid surface and to convert any off-track Hill-Sachs lesion into on-track. There is a small group of patients in whom bone defects were properly addressed but Latarjet failed due to hyperlaxity or poor soft tissue quality. Extraarticular capsular reinforcement is suggested in this population.
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Affiliation(s)
- Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain,Correspondence should be addressed to E Calvo;
| | - María Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Antonio Maria Foruria
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Juan Aguilar Gonzalez
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Kuan FC, Hsu KL, Lin FH, Hong CK, Chen Y, Shih CA, Su WR. Morphometric and Biomechanical Comparison of the Scapular Spine and Coracoid Graft in Anterior Shoulder Instability. Am J Sports Med 2022; 50:3625-3634. [PMID: 36190171 DOI: 10.1177/03635465221124277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The scapular spine has been described as a relatively new bone graft alternative used in glenoid augmentation. The classic Latarjet procedure, which transfers the coracoid as a graft, is regarded as the gold standard. The comparison of these 2 techniques has not been fully reported. PURPOSE To compare the anatomic and biomechanical properties of glenoid augmentation using scapular spine graft or coracoid graft. STUDY DESIGN Controlled laboratory study. METHODS The study used 20 fresh-frozen human cadaveric shoulders. A 25% anterior glenoid defect was created, and the specimens were divided randomly to receive glenoid augmentation by scapular spine or coracoid grafts. For both procedures, the grafts were secured to the glenoid defect with 2 screws. Morphometric data, including the glenoid articular area, amount of restoration, and graft dimensions, were obtained. A biomechanical test was conducted in a direct-loading scenario. The construct stiffness, cyclic displacement, and ultimate failure of each specimen were collected. RESULTS No significant difference was found in glenoid articular restoration between the scapular spine group and the coracoid group (31% vs 33%, respectively; P = .311). Morphometric analysis indicated that coracoid grafts exhibited significantly greater thickness and height than scapular spine grafts. In biomechanical results, the scapular spine group exhibited significantly greater construct stiffness than the coracoid group (206.3 ± 58.8 vs 148.3 ± 76.0 N/mm, respectively; P = .023). The average failure load in the scapular spine group was not significantly higher than that in the coracoid group. No significant differences in cyclic displacement were found between the 2 techniques. CONCLUSION In a simulated 25% anterior glenoid bony defect, a scapular spine graft was comparable with the classic Latarjet procedure in restoring the glenoid articular dimension and exhibited superior construct stiffness in a cadaveric model. CLINICAL RELEVANCE The scapular spine may serve as an alternative graft choice in glenoid augmentation surgery considering the amount of articular restoration and initial fixation stability.
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Affiliation(s)
- Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Fang-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Tainan Municipal An-Nan Hospital, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Christian Hospital, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
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Harper A, Sparavalo S, Ma J, Wong I. Fixation Type Does not Affect the Learning Curve and Short-Term Radiographic Outcomes for Arthroscopic Anatomic Glenoid Reconstruction with Distal Tibia Allograft. Arthrosc Sports Med Rehabil 2022; 4:e371-e379. [PMID: 35494305 PMCID: PMC9042749 DOI: 10.1016/j.asmr.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose The purpose of this study was to compare the learning curves and radiographic variables between screw and suture button fixation of the allograft for surgeons learning the all-arthroscopic anatomic glenoid reconstruction (AAGR) technique for anterior shoulder instability. We compared the surgical times of these two fixation techniques, as well as the graft placement in the vertical and medial-lateral directions. Methods This was a retrospective review of patients who underwent AAGR for recurrent anterior shoulder instability. Start and end times were recorded for each procedure, and learning was assessed through the change in operative time over successive surgeries and by variability of operative time. Graft placement, in terms of vertical positioning, medial-lateral step formation, and obliquity of fixation (alpha angle), was evaluated using 3-dimensional CT scans at approximately 6 months postoperation. Results A total of 43 patients were included in our study. Twenty-seven had screw fixation, and 16 had suture button fixation. The surgical duration of the button fixation technique was comparable to that of screw fixation (P = .72), with no significant difference in the variability of surgical time in either cohort (P > .05). Both groups showed similarly optimal vertical positioning of the graft onto the lower third of the glenoid (P = .89). Desired obliquity of graft fixation was identified more frequently with button fixation (P < .001). Both fixation methods provided clinically acceptable medial-lateral step formations, with suture-button fixation being significantly larger (P = .03). Conclusions Suture button fixation of the allograft is a potential alternative to screw fixation for the management of glenoid bone loss in recurrent anterior shoulder instability. The results of this study show that this method has a comparable learning curve, with a similar surgical duration, while not compromising the optimal accuracy of vertical and medial-lateral placement of the graft and achieves a superior alpha angle of fixation. Level of Evidence Level III, retrospective cohort study.
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10
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Anakwenze O. Distal Clavicle Autograft Fixed with Buttons for the Management of Shoulder Instability with Glenoid Defect: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00006. [PMID: 36099453 DOI: 10.2106/jbjs.cc.22.00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE In this case report, we presented the case of a 39-year-old male lawyer who presented to our tertiary care clinic with recurrent instability of his right shoulder and significant glenoid bone loss. This patient was treated with arthroscopic glenoid bone augmentation with his distal clavicle fixed with arthroscopic suture buttons. CONCLUSION Use of a distal clavicle autograft with arthroscopic fixation using buttons is a novel and promising solution for the management of patients with shoulder instability and associated glenoid bone loss.
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Affiliation(s)
- Oke Anakwenze
- Department of Orthopedics, Duke University Hospital, Durham, North Carolina
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Wei J, Lu M, Zhao L, Zeng X, He L. Free bone grafting improves clinical outcomes in anterior shoulder instability with bone defect: a systematic review and meta-analysis of studies with a minimum of 1-year follow-up. J Shoulder Elbow Surg 2022; 31:e190-e208. [PMID: 34801716 DOI: 10.1016/j.jse.2021.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/08/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Evidence on the efficacy and safety of the free bone grafting in treating anterior shoulder instability is limited. The purpose of this study was to systematically evaluate the clinical and imaging results of free bone grafting in treating anterior shoulder instability with glenoid bone defect and to explore the incidence of complications in clinically relevant subgroups. METHODS This systematic review was conducted per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The PubMed, Embase, and Cochrane Library databases were searched up to January 29, 2021, for studies that had reported on free bone grafting in treating anterior shoulder instability with glenoid bone defect with a minimum of 1-year follow-up. Two researchers independently screened studies and extracted data. A random-effects model was used to pool data on clinical function scores, imaging results, and incidence of complications (recurrent instability and non-instability-related complications). Meta-regression analysis was used to evaluate the incidence of complications in different subgroups and investigate the sources of heterogeneity. RESULTS A total of 29 studies were included in the meta-analysis, comprising 840 patients (845 shoulders) with average ages ranging from 21 to 34.6 years. Compared with preoperatively, free bone grafting increased the postoperative Rowe score, American Shoulder and Elbow Surgeons score, Constant score, Subjective Shoulder Value, and Oxford Shoulder Instability Score by 53.16, 31.80, 20.81, 38.63, and 4.07 points, respectively, and reduced the visual analog scale pain score by 3 points on average. During the postoperative follow-up period, the rates of return to sport and return to preoperative levels were 84.2% and 73.1%, respectively. The imaging results showed that the free bone healing rate was 98.9% and the incidence of osteoarthritis was 10.9%. The incidence rates of recurrent instability and non-instability-related complications were 3.4% and 5.6%, respectively. Meta-regression analysis showed no evidence of effect modification by the year, follow-up time, proportion of male patients, autograft or allograft, and arthroscopy or open surgery on the incidence of complications. Subgroup analysis showed that the incidence rates of recurrent instability for open surgery, arthroscopy, allograft, autograft, Latarjet revision, and non-bone block revision were 4.1%, 2.3%, 1.5%, 4.4%, 10.3%, and 3.5%, respectively. CONCLUSION The application of free bone grafting in treating anterior shoulder instability with glenoid bone defect can effectively improve shoulder joint function and is associated with a high return-to-sport rate and a low overall recurrence rate, but there were some differences in the complications of recurrent instability and non-instability-related complications among the subgroups. Given that these results need to be confirmed via head-to-head comparisons, we recommend that future clinical and biomechanical studies focus on comparing and investigating the advantages and disadvantages of different surgical approaches, thus providing a basis for orthopedic surgeons to make reliable choices.
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Affiliation(s)
- Jinqiang Wei
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingfeng Lu
- Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Lilian Zhao
- Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China.
| | - Xianzhong Zeng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lilei He
- Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
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Jeon YD, Kim HS, Rhee SM, Jeong MG, Oh JH. Clinical Outcomes of Revision Arthroscopic Capsulolabral Repair for Recurrent Anterior Shoulder Instability With Moderate Glenoid Bone Defects: A Comparison With Primary Surgery. Orthop J Sports Med 2021; 9:23259671211059814. [PMID: 34938820 PMCID: PMC8685727 DOI: 10.1177/23259671211059814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The optimal revision surgery for failed primary arthroscopic capsulolabral repair (ACR) has yet to be determined. Revision ACR has shown promising results. Purpose: To compare the functional, strength, and radiological outcomes of revision ACR and primary ACR for anterior shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between March 2007 and April 2017, a total of 85 patients underwent ACR (revision: n = 23; primary: n = 62). Functional outcome scores and positive apprehension signs were evaluated preoperatively, at 1 year, and then annually. Isokinetic internal and external rotation strengths were evaluated preoperatively and at 1 year after surgery. Results: The mean follow-up was 36.5 ± 10.2 months (range, 24-105 months). There was no significant difference between the revision and primary groups in the glenoid bone defect size at the time of surgery (17.3% ± 4.8% vs 15.4% ± 5.1%, respectively; P = .197). At the final follow-up, no significant differences were found in the American Shoulder and Elbow Surgeons score (97.6 ± 3.1 vs 98.0 ± 6.2, respectively; P = .573), Western Ontario Shoulder Instability Index score (636.7 ± 278.1 vs 551.1 ± 305.4, respectively; P = .584), or patients with a positive apprehension sign (17.4% [4/23] vs 11.3% [7/62], respectively; P = .479) between the revision and primary groups. There was no significant difference between the revision and primary groups for returning to sports at the same preoperative level (65.2% vs 80.6%, respectively; P = .136) and anatomic healing failure at 1 year after surgery (13.0% vs 3.2%, respectively; P = .120). Both groups recovered external rotation strength at 1 year after surgery (vs before surgery), although the strength was weaker than in the uninvolved shoulder. In the revision group, a larger glenoid bone defect was significantly related to a positive apprehension sign (22.0% ± 3.8%) vs a negative apprehension sign (16.0% ± 3.2%; cutoff = 20.5%; P = .003). Conclusion: In patients with moderate glenoid bone defect sizes (10%-25%), clinical outcomes after revision ACR were comparable to those after primary ACR. However, significant glenoid bone loss was related to a positive remaining apprehension sign in the revision group. Surgeons should consider these findings when selecting their revision strategy for patients with failed anterior shoulder stabilization.
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Affiliation(s)
- Young Dae Jeon
- Department of Orthopaedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyong Suk Kim
- Department of Orthopaedic Surgery, Seoul Nalgae Hospital, Seoul, Republic of Korea
| | - Sung-Min Rhee
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Myeong Gon Jeong
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Familiari F, Hochreiter B, Gerber C. Unacceptable failure of osteochondral glenoid allograft for biologic resurfacing of the glenoid. J Exp Orthop 2021; 8:111. [PMID: 34855012 PMCID: PMC8640012 DOI: 10.1186/s40634-021-00419-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Glenohumeral osteoarthritis (OA) represents a challenging problem in young, physically active patients. It was the purpose of this investigation to evaluate the results of a pilot study involving glenoid resurfacing with a glenoid allograft combined with a hemiarthroplasty on the humeral side. Methods Between April 2011 to November 2013, 5 patients (3 men, 2 women, mean age 46.4, range 35-57) with advanced OA of the glenohumeral joint, were treated with a humeral head replacement combined with replacement of the glenoid surface with an osteochondral, glenoid allograft. Results Overall, clinically, there was one excellent, one satisfactory and three poor results. Mean preoperative subjective shoulder value (SSV) was 34% (range: 20-50%) and preoperative relative Constant-Murley-Score (CSr) was 43 points (range: 29-64 points). Three patients with poor results had to be revised within the first three years. Their mean pre-revision SSV and CSr were 38% (range: 15-80%) and 36 points (range: 7-59 points) respectively. One patient was revised 9 years after the primary procedure with advanced glenoid erosion and pain and one patient has an ongoing satisfactory outcome without revision. Their SSVs were 60% and 83%, their CSr were 65 points and 91 points, 9 and 10 years after the primary procedure, respectively. Mean follow-up was 7 years (2-10 years) and mean time to revision was 4 years (range: 1-9 years). Conclusion The in-vivo pilot study of a previously established in-vitro technique of osteochondral glenoid allograft combined with humeral HA led to three early failures and only one really satisfactory clinical outcome which, however, was associated with advanced glenoid erosion. Osteochondral allograft glenoid resurfacing was associated with an unacceptable early failure rate and no results superior to those widely documented for HA or TSA, so that the procedure has been abandoned. Level of evidence Level IV, Case Series, Treatment Study.
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Affiliation(s)
- Filippo Familiari
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland. .,Department of Orthopaedic and Trauma Surgery, Magna Graecia University, Catanzaro, Italy.
| | - Bettina Hochreiter
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
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Outcomes are comparable using free bone block autografts versus allografts for the management of anterior shoulder instability with glenoid bone loss: a systematic review and meta-analysis of "The Non-Latarjet". Knee Surg Sports Traumatol Arthrosc 2021; 29:2159-2174. [PMID: 32749510 DOI: 10.1007/s00167-020-06194-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/27/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Glenoid augmentation using free bone blocks for anterior shoulder instability has been proposed as an alternative to or bail-out for the Latarjet procedure. The purpose of this investigation was to systematically review and compare outcomes of patients undergoing glenoid augmentation using free bone block autografts versus allografts. METHODS A systematic review using PubMed, MEDLINE, Embase, and the Cochrane Library databases was performed in line with the PRISMA statement. Studies reporting outcomes of patients treated with free bone block procedures for anterior shoulder instability with minimum 2-year follow-up were included. Random effects modelling was used to compare patient-reported outcomes, return to sports, recurrent instability, non-instability related complications, and development of arthritis between free bone block autografts and allografts. RESULTS Eighteen studies comprising of 623 patients met the inclusion criteria for this investigation. There were six studies reporting on the use of allografts (of these, two used distal tibial, three iliac crest, and one femoral head allograft) in 173 patients and twelve studies utilizing autografts (of these, ten used iliac crest and two used free coracoid autograft) in 450 patients. Mean age was 28.7 ± 4.1 years for the allograft group and 27.8 ± 3.8 years for the autograft group (n.s). Mean follow-up was 98 months in autograft studies and 50.8 months for allograft studies (range 24-444 months, n.s). Overall mean increase in Rowe score was 56.2 with comparable increases between autografts and allografts (n.s). Pooled recurrent instability rates were 3% (95% CI, 1-7%; I2 = 77%) and did not differ between the groups (n.s). Arthritic progression was evident in 11% of autografts (95% CI, 2-27%; I2 = 90%) and 1% (95% CI, 0-8%; I2 = 63%) of allografts (n.s). The overall incidence of non-instability related complications was 5% (95% CI, 2-10%; I2 = 81%) and was similar between the groups (n.s). Pooled return to sports rate was 88% (95% CI, 76-96%; I2 = 76%). CONCLUSION Glenoid augmentation using free bone block autograft or allograft in the setting of recurrent anterior shoulder instability with glenoid bone loss is effective and safe. Outcomes and complication incidence using autografts and allografts were comparable. Due to the high degree of heterogeneity in the data and outcomes reported in available studies, which consist primarily of retrospective case series, future prospective trials investigating long-term outcomes using free bone block autograft versus allograft for anterior shoulder instability with glenoid bone loss are warranted. LEVEL OF EVIDENCE IV.
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Buda M, D'Ambrosi R, Bellato E, Blonna D, Cappellari A, Delle Rose G, Merolla G. Failed Latarjet procedure: a systematic review of surgery revision options. J Orthop Traumatol 2021; 22:24. [PMID: 34155563 PMCID: PMC8217356 DOI: 10.1186/s10195-021-00587-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/03/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Revision surgery after the Latarjet procedure is a rare and challenging surgical problem, and various bony or capsular procedures have been proposed. This systematic review examines clinical and radiographic outcomes of different procedures for treating persistent pain or recurrent instability after a Latarjet procedure. METHODS A systematic review of the literature was performed using the Medline, Cochrane, EMBASE, Google Scholar and Ovid databases with the combined keywords "failed", "failure", "revision", "Latarjet", "shoulder stabilization" and "shoulder instability" to identify articles published in English that deal with failed Latarjet procedures. RESULTS A total of 11 studies (five retrospective and six case series investigations), all published between 2008 and 2020, fulfilled our inclusion criteria. For the study, 253 patients (254 shoulders, 79.8% male) with a mean age of 29.6 years (range: 16-54 years) were reviewed at an average follow-up of 51.5 months (range: 24-208 months). CONCLUSIONS Eden-Hybinette and arthroscopic capsuloplasty are the most popular and safe procedures to treat recurrent instability after a failed Latarjet procedure, and yield reasonable clinical outcomes. A bone graft procedure and capsuloplasty were proposed but there was no clear consensus on their efficacy and indication. Level of evidence Level IV Trial registration PROSPERO 2020 CRD42020185090- www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Matteo Buda
- Division of Orthopaedics and Trauma, Madre Teresa Di Calcutta Hospital, Monselice, Padova, Italy
| | | | - Enrico Bellato
- Department of Surgical Sciences, San Luigi Gonzaga Hospital, University of Turin Medical School, Turin, Italy
| | - Davide Blonna
- Orthopaedic and Traumatology Department, University of Turin Medical School, Turin, Italy
| | - Alessandro Cappellari
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Giacomo Delle Rose
- Shoulder and Elbow Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Merolla
- Shoulder and Elbow Unit, Cervesi Hospital, Cattolica, AUSL Romagna, Cattolica, Italy
- Doctorate School in Clinical and Experimental Medicine, UNIMORE, Modena, Italy
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16
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Malahias MA, Mitrogiannis L, Gerogiannis D, Chronopoulos E, Kaseta MK, Antonogiannakis E. Non-rigid fixation of the glenoid bone block for patients with recurrent anterior instability and major glenoid bone loss: A systematic review. Shoulder Elbow 2021; 13:168-180. [PMID: 33897848 PMCID: PMC8039760 DOI: 10.1177/1758573219872512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/05/2019] [Accepted: 07/29/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND New types of glenoid bone block fixation, involving suture buttons, suture anchors or even implant-free impaction of the graft, have been recently introduced. In contrast to screws which allow for a rigid fixation of the bone block, these alternative procedures provide a non-rigid type of fixation. METHODS Two reviewers independently conducted the search in a systematic way (according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms "Latarjet" OR "Eden-Hybbinette" OR "bone block" AND "anterior" AND "shoulder" AND "instability." RESULTS Eight out of the 325 initial studies were finally chosen according to our inclusion-exclusion criteria. In total, 750 patients were included in this review. The overall anterior instability recurrence rate for patients treated with non-rigid fixation was 2.6%, while the overall rate of non-union or graft osteolysis was 5.4%. CONCLUSIONS Regardless of the graft type, bone block non-rigid fixation showed satisfactory clinical and functional outcomes for the treatment of anterior shoulder instability with substantial glenoid bone deficiency. Furthermore, non-rigid fixation resulted in adequate bone graft healing and osseous incorporation. Lastly, given the relative lack of data, further prospective controlled studies are required to assess bone block non-rigid fixation procedures in comparison with the traditional rigid (with screws) fixation techniques. LEVEL Systematic review, IV.
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Affiliation(s)
- Michael-Alexander Malahias
- 3rd Orthopaedic Department, Hygeia
Hospital, Athens, Greece,Michael-Alexander Malahias, Orthopaedic
Surgeon, 3rd Orthopaedic Department, Hygeia Hospital, Erythrou Stavrou 4,
Marousi 15123, Athens, Greece.
| | | | | | - Efstathios Chronopoulos
- 2nd Orthopaedic Department, School of
Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - Maria-Kyriaki Kaseta
- 2nd Orthopaedic Department, School of
Medicine, National & Kapodistrian University of Athens, Athens, Greece
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Gilat R, Haunschild ED, Lavoie-Gagne OZ, Tauro TM, Knapik DM, Fu MC, Cole BJ. Outcomes of the Latarjet Procedure Versus Free Bone Block Procedures for Anterior Shoulder Instability: A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:805-816. [PMID: 32795174 DOI: 10.1177/0363546520925833] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Free bone block (FBB) procedures for anterior shoulder instability have been proposed as an alternative to or bail-out for the Latarjet procedure. However, studies comparing the outcomes of these treatment modalities are limited. PURPOSE To systematically review and perform a meta-analysis comparing the clinical outcomes of patients undergoing anterior shoulder stabilization with a Latarjet or FBB procedure. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS PubMed, Embase, and the Cochrane Library databases were systematically searched from inception to 2019 for human-participants studies published in the English language. The search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement including studies reporting clinical outcomes of patients undergoing Latarjet or FBB procedures for anterior shoulder instability with minimum 2-year follow-up. Case reports and technique articles were excluded. Data were synthesized, and a random effects meta-analysis was performed to determine the proportions of recurrent instability, other complications, progression of osteoarthritis, return to sports, and patient-reported outcome (PRO) improvement. RESULTS A total of 2007 studies were screened; of these, 70 studies met the inclusion criteria and were included in the meta-analysis. These studies reported outcomes on a total of 4540 shoulders, of which 3917 were treated with a Latarjet procedure and 623 were treated with an FBB stabilization procedure. Weighted mean follow-up was 75.8 months (range, 24-420 months) for the Latarjet group and 92.3 months (range, 24-444 months) for the FBB group. No significant differences were found between the Latarjet and the FBB groups in the overall random pooled summary estimate of the rate of recurrent instability (5% vs 3%, respectively; P = .09), other complications (4% vs 5%, respectively; P = .892), progression of osteoarthritis (12% vs 4%, respectively; P = .077), and return to sports (73% vs 88%; respectively, P = .066). American Shoulder and Elbow Surgeons scores improved after both Latarjet and FBB, with a significantly greater increase after FBB procedures (10.44 for Latarjet vs 32.86 for FBB; P = .006). Other recorded PRO scores improved in all studies, with no significant difference between groups. CONCLUSION Current evidence supports the safety and efficacy of both the Latarjet and FBB procedures for anterior shoulder stabilization in the presence of glenoid bone loss. We found no significant differences between the procedures in rates of recurrent instability, other complications, osteoarthritis progression, and return to sports. Significant improvement in PROs was demonstrated for both groups. Significant heterogeneity existed between studies on outcomes of the Latarjet and FBB procedures, warranting future high-quality, comparative studies.
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Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Eric D Haunschild
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | | | - Tracy M Tauro
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Derrick M Knapik
- University Hospitals Cleveland Medical Center, Department of Orthopaedic Surgery, Cleveland, Ohio, USA
| | - Michael C Fu
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
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Hudson PW, Pinto MC, Brabston EW, Hess MC, Cone BM, Williams JF, Brooks WS, Momaya AM, Ponce BA. Distal clavicle autograft for anterior-inferior glenoid augmentation: A comparative cadaveric anatomic study. Shoulder Elbow 2020; 12:404-413. [PMID: 33281945 PMCID: PMC7689607 DOI: 10.1177/1758573219869335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 07/12/2019] [Accepted: 07/14/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aim of this study was to anatomically compare distal clavicle and coracoid autografts and their potential to augment anterior-inferior glenoid bone loss. METHODS Ten millimeters of distal clavicle and 20 mm of coracoid were harvested bilaterally from 32 cadavers. Length, weight, and height were measured and surface area and density were calculated. For each graft, ipsilateral measurements were compared and the ability to restore corresponding glenoid bone loss was calculated. RESULTS Distal clavicle grafts were larger than coracoid grafts with respect to length (22.3 mm versus 17.7 mm; p < 0.001), height (12.49 mm versus 9.65 mm; p < 0.001), mass (2.72 g versus 2.45 g; p = 0.0437), and volume (2.36 cm3 versus 1.96 cm3; p = 0.002). Coracoid grafts had larger widths (14.56 mm versus 10.52 mm; p < 0.001) and greater density (1.24 g/cm3 versus 1.18 g/cm3; p < 0.001). Distal clavicle surface area was greater on both the articular (2.93 cm2 versus 1.5 cm2; p < 0.001) and superior surfaces (2.76 cm2 versus 1.5 cm2; p < 0.001) when compared to lateral coracoid surface area. DISCUSSION Distal clavicle grafts were larger and restored larger bony defects but had greater variability and lower density than coracoid grafts. Clinical studies are needed to compare these graft options.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Brent A Ponce
- Brent A Ponce, Department of Orthopaedic Surgery, University of Alabama at Birmingham, HGLD 209, 1720 2nd Ave S, Birmingham, AL 35294, USA.
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Use of allograft to reconstruct anterior bony glenoid defect in chronic glenohumeral instability: a systematic review. Arch Orthop Trauma Surg 2020; 140:1475-1485. [PMID: 32524228 DOI: 10.1007/s00402-020-03511-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Bone-block procedures are well-established in anterior chronic shoulder instability treatment. Autograft with the coracoid process (Bristow-Latarjet procedures) and iliac crest (Eden-Hybbinette) are the most frequent source of bone but the use of allograft is also possible. The objective of this review is to assess clinical and radiographic outcomes after bony allograft reconstruction in anterior glenohumeral instability. MATERIAL AND METHODS Medline, Cochrane, Embase databases were searched for studies reporting on bone allograft reconstruction in anterior glenohumeral instability with glenoid defect. We conducted a systematic review of studies with all levels of evidence reporting on clinical or radiological outcomes or both. LEVEL OF EVIDENCE IV. RESULTS Ten studies met the inclusion criteria for the review; 283 shoulders were included with a mean age of 26 years (17-63) and mean follow-up of 34 months (4-168). Glenoid reconstruction was performed using bone from different source: femoral head (1 study), distal tibia allograft (5 studies), and iliac crest (4 studies). Allografts were fresh in 4 studies, demineralized in 2 studies, and freeze-dried after sterilization in 1 study. All scores performed in the different studies increased between pre-operative and post-operative evaluations (mean + 36.8 points for the ASES). Global rate of recurrence was 3.9% (11 patients) (0-11%), comprising 6 cases of dislocation (2.1%) and 5 subluxations (1.8%). Allograft healing occurred in 93.5% of cases. CONCLUSIONS This systematic review data suggest that allograft reconstructions in anterior glenohumeral instability could be a viable alternative to similar reconstructions with autografts and provide close clinical/radiological outcomes, at short and mid-term follow-up. Prospective randomized studies are needed to confirm these results.
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Massive graft resorption after iliac crest allograft reconstruction for glenoid bone loss in recurrent anterior shoulder instability. Arch Orthop Trauma Surg 2020; 140:895-903. [PMID: 32090290 DOI: 10.1007/s00402-020-03380-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Donor site morbidity constitutes the most prevalent source of complications during anatomic glenoid reconstruction. Therefore, the aim of this study was to evaluate the clinical and radiologic results of arthroscopic anatomic glenoid reconstruction using an allogenic, tricortical iliac crest bone graft for glenoid bone loss in recurrent anterior shoulder instability. MATERIALS AND METHODS Ten patients [one female/nine male, mean age 31.9 years (range, 26-40)] underwent allogenic iliac crest bone grafting and were evaluated clinically [range of motion, subscapularis tests, apprehension sign, Constant score (CS), Rowe score (RS), Walch-Duplay score (WD), Western Ontario Shoulder Instability Index (WOSI), Subjective Shoulder Value (SSV)] and radiographically [3-dimensional computed tomography (CT) scans]. RESULTS After 23.2 months, the CS averaged 90 points (range, 84-98), RS 83 points (range, 50-100), WD 81 points (range, 50-100), WOSI 72% (range, 41-86) and the SSV 83% (range, 70-95). All patients showed a free range of motion and intact subscapularis muscle function. The apprehension sign was positive in three patients (30%) with a recurrent subluxation in one patient (10%). The glenoid surface area increased significantly from 84.4% (range, 73.5-92.1) preoperatively to 118.4% (range, 105.6-131.2) after surgery, while the glenoid defect was significantly reduced from 16.2% (range, 9.2-26.5) to 0.6% (range, 0-1.6). One year postoperative, total resorption of the allografts was observed with a glenoid surface area of 86.6% (range, 76.4-98.0) and corresponding increase of the glenoid defect to 14.0% (range, 2.9-23.6). CONCLUSION Arthroscopic glenoid reconstruction using an iliac crest bone allograft achieves satisfactory clinical results and glenohumeral stability during a short-term follow-up. However, this procedure was not observed to accomplish an anatomic reconstruction of the glenoid concavity due to excessive graft resorption. LEVEL OF EVIDENCE Level IV, case series, therapeutic study.
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Di Giacomo G, Pugliese M, Lie DTT, Chou ACC, Chen J, Rosenberg N, Itoi E. How to handle minor and major bone loss in the shoulder? Current concepts. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anterior shoulder instability is a significant problem in orthopaedic surgery. It carries a heavy burden on quality of life, especially in young, active patients. Surgical treatment is therefore often carried out in this population. Several strategies can effectively address this issue. Yet, the consensus is lacking on the parameters which favour one technique over another, especially when bone loss is present. This is because of the complex, dynamic interplay between bone loss on the humeral side (ie, Hill-Sachs lesion) and glenoid bone loss, which is a common occurrence and defined as ‘bipolar’. There is an ongoing debate over the percentage of glenoid bone loss warranting bone block procedures: 13.5–15% is an indicator for such procedures (ie, Latarjet), although this value is still considered controversial and not uniformly accepted. A multitude of other factors (ie, age, sex, level of activity and so on) come into play alongside bipolar bone loss and the weight of each factor has yet to be fully elucidated. Also, refining the algorithm for the right procedure in the right patients will reduce the number of side effects stemming from initial, suboptimal treatment choice. Knowing how to manage previous surgical treatment failure is also key for the treating orthopaedic surgeon, who must be able to address the root cause of failure and react accordingly and effectively. This paper analyses key factors in treatment choice, the current stance of the literature on varying degrees of bone loss and choices on surgical treatment failure, lack of evidence and need for future research.
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Flurin PH, Antoni M, Métais P, Aswad R. Revision of failed Latarjet with the Eden-Hybinette surgical technique. Orthop Traumatol Surg Res 2020; 106:223-227. [PMID: 32173300 DOI: 10.1016/j.otsr.2019.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/11/2019] [Accepted: 12/02/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The outcomes of the Latarjet procedure for anterior shoulder instability are highly satisfactory although recurrences are possible. Surgical revision is challenging, and often requires an iliac crest bone graft as described by Eden and Hybinette. The aims of our study were to analyze the outcomes of the Eden-Hybinette technique after failed Latarjet procedure, determine the failure and complication rates, and analyze the risk of osteoarthritis. We hypothesized that the Eden-Hybinette technique would yield good outcomes after failed Latarjet procedure. MATERIAL AND METHODS Retrospective multicenter study (9 hospitals) by the French Shoulder and Elbow Society (SoFEC) involving 46 patients who underwent revision surgery with an Eden-Hybinette procedure after failed Latarjet stabilization. The patients had a minimum follow-up of 1year and the outcomes were evaluated based on the Rowe score, Walch-Duplay score and radiographs. RESULTS The mean age at the final assessment was 32years. The mean follow-up was 38 months and 86% of patients had a stable shoulder with an overall satisfaction rate of 80%. Postoperatively, the Rowe score averaged 76/100 and the Walch-Duplay score averaged 68/100; 60% of patients had resumed their sports participation. Return to sport was statistically correlated with age (p=0.0001), osteoarthritis (p=0.05) and time elapsed between the two surgical procedures (p=0.0001). The Rowe score was statistically correlated with osteoarthritis (p=0.01). DISCUSSION/CONCLUSION Our study is one of the largest on the Eden-Hybinette procedure for recurrent anterior shoulder instability. The outcomes at 3years' follow-up were satisfactory in 80% of patients and 86% had stable shoulders. The osteoarthritis rate was low (11%), although the follow-up period was relatively short. LEVEL OF EVIDENCE IV, non-randomized multicenter retrospective study.
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Affiliation(s)
- Pierre-Henri Flurin
- Clinique du Sport Bordeaux-Mérignac, 2-4, rue Negrevergne, 33700 Mérignac, France.
| | - Maxime Antoni
- Centre de Chirurgie Orthopédique et de la Main, CHU Strasbourg, avenue Achille-Baumann, 67400 Illkirch, France
| | - Pierre Métais
- Clinique de la Chataigneraie, 63110 Beaumont, France
| | - Richard Aswad
- Institut de Chirurgie Orthopédique et Sportive, 463 rue Paradis, 13008 Marseille, France
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- French Shoulder and Elbow Society (SoFEC), 34, rue du 11-novembre, 44110 Chateaubriant, France
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23
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Bedeir YH, Schumaier AP, Grawe BM. The Failed Latarjet Procedure: Evaluation, Treatment, and Outcomes. JBJS Rev 2019; 6:e10. [PMID: 30376462 DOI: 10.2106/jbjs.rvw.18.00002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Yehia H Bedeir
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.,Department of Orthopaedic Surgery, University of Alexandria Medical School, Alexandria, Egypt
| | - Adam P Schumaier
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Brian M Grawe
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
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Boileau P, Duysens C, Saliken D, Lemmex DB, Bonnevialle N. All-arthroscopic, guided Eden-Hybbinette procedure using suture-button fixation for revision of failed Latarjet. J Shoulder Elbow Surg 2019; 28:e377-e388. [PMID: 31331667 DOI: 10.1016/j.jse.2019.03.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/19/2019] [Accepted: 03/27/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To report the results of a guided arthroscopic Eden-Hybbinette procedure, using suture button for iliac crest bone graft fixation, in a series of patients with a prior failed Latarjet and persistent glenoid bone loss. METHODS Seven consecutive patients (5 males, 2 females, mean age: 30.7 years [range, 17-47 years]) with recurrent anterior dislocations and glenoid deficiency greater than 20% underwent the all-arthroscopic revision procedure. The iliac crest bone graft and suture-button device (Bone-Link) were shuttled through the rotator interval. Specific drill guides were used and a suture tensioning device allowed bone graft compression. Previous broken screw shafts (3 patients) were left in situ. Graft placement and healing was assessed postoperatively with computed tomography imaging. RESULTS No neurologic injury or hardware problems occurred, and no patient required further surgery. On computed tomography scan, optimal positioning (flush and under the equator) and healing of the bone graft was observed in all patients. At a mean follow-up of 21 months (range, 12-39 months), all but one patient were satisfied and had a stable shoulder; 5 returned to sports. The Constant score increased from 32 to 81 points, and the subjective shoulder value from 31% to 87% (P < .001). The Walch-Duplay and Rowe scores averaged 85.7 (range, 65-100) points and 86.4 (range, 70-100) points, respectively. CONCLUSION Recurrence of anterior shoulder instability after a failed Latarjet procedure can be successfully treated by an all-arthroscopic Eden-Hybbinette procedure. Suture-button fixation is reliable and permits optimal positioning and predictable healing of the new bone graft; in addition, it is an appropriate fixation option in the setting of retained broken hardware.
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Affiliation(s)
- Pascal Boileau
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, Nice, France.
| | - Christophe Duysens
- Institut Européen de la Main, HRS Kirchberg, Luxembourg City, Luxembourg
| | - David Saliken
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, Nice, France
| | - Devin B Lemmex
- iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, Nice, France
| | - Nicolas Bonnevialle
- Département d'Orthopédie Traumatologie du Centre Hospitalier Universitaire de Toulouse, Hôpital Riquet, Toulouse, France
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Rohman E, Gronbeck K, Tompkins M, Mittelsteadt M, Kirkham JA, Arciero RA. Scapular Spine Dimensions and Suitability as a Glenoid Bone Graft Donor Site. Am J Sports Med 2019; 47:2469-2477. [PMID: 31310727 DOI: 10.1177/0363546519861965] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current structural bone graft options used for glenoid augmentation in glenohumeral instability have known drawbacks. The scapular spine may be a possible alternative graft choice, but its dimensions and anatomy are not fully reported. HYPOTHESIS The scapular spine's harvestable graft dimensions will be similar to harvestable dimensions of the coracoid and iliac crest. STUDY DESIGN Descriptive laboratory study. METHODS The scapular spine, coracoid, and iliac crest dimensions were recorded and compared bilaterally in 50 patients with 3-dimensional computed tomography imaging. The portion of the scapular spine with the largest harvestable dimensions was quantified and its location defined. Measurements were independently taken by 2 investigators and averaged for the final result. RESULTS The scapular spine has 81.5 mm of harvestable length and a "flare" located approximately 49.6 mm lateral to the medial scapular border, where the widest harvestable cross section is located (mean harvestable dimensions: 10.9-mm height, 11.5-mm width). Mean coracoid dimensions were 24-mm length, 14.2-mm height, and 10.6-mm width. Mean iliac crest width was 14.7 mm. In sum, 96% of scapular spines, 85% of coracoids, and 100% of iliac crests exceeded minimum dimensions of 8 mm × 8 mm × 20 mm. The coronal radius of curvature of the glenoid was significantly different from the corresponding plane of all measured structures. CONCLUSION/CLINICAL RELEVANCE The scapular spine has dimensions similar to the coracoid and iliac crest in the majority of patients and is therefore appropriate for further investigation as a potential graft choice in glenohumeral instability. A harvest location 49.6 mm lateral to the medial scapular border will provide the largest cross-sectional graft while avoiding the acromial base.
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Affiliation(s)
- Eric Rohman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kyle Gronbeck
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marc Tompkins
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,TRIA Orthopaedic Center, Bloomington, Minnesota, USA
| | - Marcus Mittelsteadt
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - James A Kirkham
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert A Arciero
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
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Moroder P, Schulz E, Wierer G, Auffarth A, Habermeyer P, Resch H, Tauber M. Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: a prospective randomized trial. J Shoulder Elbow Surg 2019; 28:1298-1307. [PMID: 31129017 DOI: 10.1016/j.jse.2019.03.035] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/01/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Latarjet and iliac crest bone graft transfer (ICBGT) procedures are competing treatment options for anterior shoulder instability with glenoid bone loss. METHODS In this bicentric prospective randomized study, 60 patients with anterior shoulder instability and glenoid bone loss were included and randomized to either an open Latarjet or open ICBGT (J-bone graft) procedure. Clinical evaluation was completed before surgery and 6, 12, and 24 months after surgery, including the Western Ontario Shoulder Instability index, Rowe score, Subjective Shoulder Value, pain level, satisfaction level, and work and sports impairment, as well as assessment of instability, range of motion, and strength. Adverse events were prospectively recorded. Radiographic evaluation included preoperative, postoperative, and follow-up computed tomography analysis. RESULTS None of the clinical scores showed a significant difference between the 2 groups (P > .05). Strength and range of motion showed no significant differences except for diminished internal rotation capacity in the Latarjet group at every follow-up time point (P < .05). A single postoperative traumatic subluxation event occurred in 2 ICBGT patients and 1 Latarjet patient. The type and severity of other adverse events were heterogeneous. Donor-site sensory disturbances were observed in 27% of the ICBGT patients. Computed tomography scans revealed a larger glenoid augmentation effect of the ICBGTs; this, however, was attenuated at follow-up. CONCLUSION The Latarjet and ICBGT procedures for the treatment of anterior shoulder instability with glenoid bone loss showed no difference in clinical and radiologic outcomes except for significantly worse internal rotation capacity in the Latarjet group and frequently noted donor-site sensory disturbances in the ICBGT group.
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Affiliation(s)
- Philipp Moroder
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
| | - Eva Schulz
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Guido Wierer
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Alexander Auffarth
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Peter Habermeyer
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
| | - Herbert Resch
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Mark Tauber
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
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Shoulder Instability: Anterior, Posterior, Multidirectional, Arthroscopic Versus Open, Bone Block Procedures. Sports Med Arthrosc Rev 2018; 26:168-170. [PMID: 30395061 DOI: 10.1097/jsa.0000000000000211] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This article presents a retrospective comprehensive review of the history of anterior, posterior, and multidirectional shoulder instability and also reviews key concepts such as open versus arthroscopic repair and glenoid and humeral head bone loss and associated treatments. The future of shoulder instability will continue to evolve as research and clinical experience will determine the direction of the future.
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Arthroscopic Anatomic Glenoid Reconstruction in Lateral Decubitus Position Using Allograft With Nonrigid Fixation. Arthrosc Tech 2018; 7:e1115-e1121. [PMID: 30533357 PMCID: PMC6261065 DOI: 10.1016/j.eats.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/20/2018] [Indexed: 02/03/2023] Open
Abstract
Recurrent shoulder instability is highly associated with glenoid bone loss. Traditionally, bony procedures to address this bone loss have described nonanatomic, coracoid transfer procedures. More recently, anatomic glenoid reconstruction procedures have been described. These were first described as open procedures, and subsequently there have been several arthroscopic procedures described. We provide a description of an arthroscopic anatomic glenoid reconstruction approach with allograft.
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Wong IH, King JP, Boyd G, Mitchell M, Coady C. Radiographic Analysis of Glenoid Size and Shape After Arthroscopic Coracoid Autograft Versus Distal Tibial Allograft in the Treatment of Anterior Shoulder Instability. Am J Sports Med 2018; 46:2717-2724. [PMID: 30095986 DOI: 10.1177/0363546518789348] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Latarjet procedure for autograft transposition of the coracoid to the anterior rim of the glenoid remains the most common procedure for reconstruction of the glenoid after shoulder instability. The anatomic glenoid reconstruction using distal tibial allograft has gained popularity and is suggested to better match the normal glenoid size and shape. However, concerns about decreased healing and increased resorption arise when an allograft bone is used. PURPOSE To use radiological findings to evaluate the arthroscopic reconstruction of the glenoid with respect to the size, shape, healing, and resorption of coracoid autograft versus distal tibial allograft. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective review was performed of 48 consecutive patients who had an arthroscopic bony reconstruction of the glenoid (12 coracoid autograft, 36 distal tibial allograft), diagnosed anterior shoulder instability, and computed tomography (CT)-confirmed glenoid bone loss more than 20%. Coracoid autograft was performed only when tibial allograft was not accessible from a bone bank. Two fellowship-trained musculoskeletal radiologists reviewed pre- and postoperative CT scans at a minimum follow-up of 6 months for the following: graft position, glenoid concavity, cross-sectional area, width, version, total area, osseous union, and graft resorption. Clinical outcome was noted in terms of instability, subluxation, and dislocation at a minimum follow-up of 2 years. Simple logistic regression, 2-tailed independent-sample t tests, paired t tests, and Fisher exact tests were performed. RESULTS Graft union was seen in 9 of the 12 patients (75%) who had coracoid autograft and 34 of the 36 patients (94%) who had tibial allograft (odds ratio, 5.66; 95% CI, 0.81-39.20; P = .08). The odds ratio comparing allograft to coracoid for overall resorption was 7.00 (95% CI, 1.65-29.66; P = .008). Graft resorption ≥50% was seen in 3 (8%) of the patients who had tibial allograft and none of the patients who had coracoid autograft. Graft resorption less than 50% was seen in the majority of patients in both groups: 27 (73%) patients with tibial allograft and 5 (42%) patients with coracoid autograft. No statistically significant difference was found between the 2 procedures regarding anteroposterior diameter of graft ( P = .81) or graft cross-sectional area ( P = .93). However, a significant difference was observed in step formation between the 2 procedures ( P < .001). Two patients experienced subluxations in the coracoid group (16%) as well as 2 patients in the tibial allograft group (6%) with a P value of .25. CONCLUSION Arthroscopic anatomic glenoid reconstruction via distal tibial allograft showed similar bony union but higher resorption compared with coracoid autograft. Even so, no statistically significant difference was found between the 2 procedures regarding final graft surface area, the size of grafts, and the anteroposterior dimensions of the reconstructed glenoids. These short-term results suggest that distal tibial allografts can be used as an alternative to coracoid autograft in the recreation of glenoid bony morphologic features.
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Affiliation(s)
- Ivan H Wong
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Paul King
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gordon Boyd
- Diagnostic Imaging, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Mitchell
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Catherine Coady
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
Anterior shoulder dislocations, subluxations, and recurrent instability of the shoulder joint are common problems usually affecting a young active population. However, it can be a problem for patients up to the late decades in life and can lead to major shoulder arthropathy if left untreated or improperly treated. This article discusses the natural history, pathologic morphologic changes of the shoulder joint associated with anterior instability along with normal anatomic variants. We will also discuss current treatment recommendations and possible causes of the patient with recurrent instability despite prior stabilization procedures.
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31
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Villatte G, Spurr S, Broden C, Martins A, Emery R, Reilly P. The Eden-Hybbinette procedure is one hundred years old! A historical view of the concept and its evolutions. INTERNATIONAL ORTHOPAEDICS 2018; 42:2491-2495. [PMID: 29744648 DOI: 10.1007/s00264-018-3970-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/30/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION One hundred years ago, before Bankart, Latarjet or Bristow, Eden and Hybbinette developed a procedure to treat anterior shoulder instability and currently, this eponymous term is known by every shoulder surgeon. The purpose of this review is to summarise the historical "Eden-Hybbinette" procedure and its evolutions during the last century and discuss results. METHOD On the centenary of the first publication on the "Eden-Hybbinette procedure", a search was conducted on Medline, Google Scholar and in the grey literature, to find its initial concept and description, and the evolutions. RESULTS The initial procedure was based on the concepts of glenoid bony augmentation (anatomic reconstruction with an autograft from the tibia) and capsulorrhaphy. The main evolutionary themes identified were the origin of the graft (autograft with iliac crest, allograft), graft positioning and fixation (no fixation device, screws), and the surgical approach (split of the subscapularis tendon in open surgery, arthroscopy). Studies with long-term follow-up exhibited good results, considered similar as those with other classic bone-block procedures. Development of osteoarthritis during the following years after the procedure is not usual and not related to the graft unless if there is articular protrusion. CONCLUSION The Eden-Hybbinette procedure is one of the oldest surgical interventions still commonly used for chronic anterior shoulder instability. The changes to the procedure over the last 100 years allow it to remain a contemporary solution for both primary surgery and revision cases.
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Affiliation(s)
- Guillaume Villatte
- Service d'Orthopédie-Traumatologie, Hôpital Gabriel Montpied, CHU de Clermont Ferrand, BP 69, 63003, Clermont-Ferrand Cedex 01, France. .,SIGMA Clermont, Institut de Chimie de Clermont-Ferrand, Université Clermont Auvergne, BP 10448, F-63000, Clermont-Ferrand, France. .,CNRS, UMR 6296, ICCF, F-63178, Aubière, France.
| | - Sally Spurr
- Division of Surgery, Imperial College, London, UK
| | - Cyrus Broden
- Division of Surgery, Imperial College, London, UK
| | - Antoine Martins
- Service d'Orthopédie-Traumatologie, Hôpital Gabriel Montpied, CHU de Clermont Ferrand, BP 69, 63003, Clermont-Ferrand Cedex 01, France
| | - Roger Emery
- Division of Surgery, Imperial College, London, UK.,Bioengineering Department, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Peter Reilly
- Division of Surgery, Imperial College, London, UK
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Pugalenthi V, Arivasan R, Muthu TMS, Muthusamy RK. MANAGEMENT OF ANTERIOR SHOULDER INSTABILITY WITH SEVERE GLENOID BONE LOSS (> 25%) TREATED BY OPEN LATARJET PROCEDURE- CASE SERIES. JOURNAL OF EVOLUTION OF MEDICAL AND DENTAL SCIENCES 2018; 7:2293-2297. [DOI: 10.14260/jemds/2018/516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Abdelshahed MM, Shamah SD, Mahure SA, Mollon B, Kwon YW. Cryopreserved bone allograft for the treatment of shoulder instability with glenoid defect. J Orthop 2018; 15:248-252. [PMID: 29657478 DOI: 10.1016/j.jor.2018.01.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/13/2018] [Indexed: 01/26/2023] Open
Abstract
The purpose of this study was to examine outcomes after cryopreserved tri-cortical iliac crest allograft reconstruction for glenoid bone loss in patients with shoulder instability. 10 patients completed the required assessments at a mean follow up of 4.5 years. At final follow up, mean ASES was 92 ± 12, mean WOSI was 315 ± 319, with good range of motion. None of the final radiographs demonstrated graft resorption or failure of hardware. The data demonstrated that patients who were treated with glenoid bone grafting with cryopreserved tri-cortical iliac crest allograft can expect good range of motion and functional capacity.
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Affiliation(s)
- Mina M Abdelshahed
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Steven D Shamah
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Siddharth A Mahure
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Brent Mollon
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Young W Kwon
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
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Auffarth A, Resch H, Matis N, Hudelmaier M, Wirth W, Forstner R, Neureiter D, Traweger A, Moroder P. Cartilage Morphological and Histological Findings After Reconstruction of the Glenoid With an Iliac Crest Bone Graft. Am J Sports Med 2018; 46:1039-1045. [PMID: 29350537 DOI: 10.1177/0363546517749813] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The J-bone graft is presumably representative of iliac crest bone grafts in general and allows anatomic glenoid reconstruction in cases of bone defects due to recurrent traumatic anterior shoulder dislocations. As a side effect, these grafts have been observed to be covered by some soft, cartilage-like tissue when arthroscopy has been indicated after such procedures. PURPOSE To evaluate the soft tissue covering of J-bone grafts by use of magnetic resonance imaging (MRI) and histological analysis. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients underwent MRI at 1 year after the J-bone graft procedures. Radiological data were digitally processed and evaluated by segmentation of axial images. Independent from the MRI analysis, 2 biopsy specimens of J-bone grafts were harvested for descriptive histological analysis. RESULTS Segmentation of the images revealed that all grafts were covered by soft tissue. This layer had an average thickness of 0.87 mm compared with 1.96 mm at the adjacent native glenoid. Of the 2 biopsy specimens, one exhibited evident hyaline-like cartilage and the other presented patches of chondrocytes embedded in a glycosaminoglycan-rich extracellular matrix. CONCLUSION J-bone grafts are covered by soft tissue that can differentiate into fibrous and potentially hyaline cartilage. This feature may prove beneficial for delaying the onset of dislocation arthropathy of the shoulder.
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Affiliation(s)
- Alexander Auffarth
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | | | - Nicholas Matis
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Martin Hudelmaier
- Institute of Anatomy & Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria.,Chondrometrics GmbH, Ainring, Germany
| | - Wolfgang Wirth
- Institute of Anatomy & Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria.,Chondrometrics GmbH, Ainring, Germany
| | - Rosemarie Forstner
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Traweger
- Institute of Tendon & Bone Regeneration, Paracelsus Medical University, Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Philipp Moroder
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria.,Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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36
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Rausch V, Königshausen M, Geßmann J, Schildhauer TA, Seybold D. [Bony Bankart lesions and glenoid defects : From refixation techniques to bony augmentation]. Unfallchirurg 2017; 121:117-125. [PMID: 29127438 DOI: 10.1007/s00113-017-0434-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rim defects of the anterior glenoid cavity are a main reason for residual shoulder instability after traumatic dislocation of the shoulder. These defects can be the result of a glenoid rim fracture or chronic glenoid erosion after repeated shoulder dislocations. Treatment concepts for these entities are entirely different. While in the acute fracture situation glenoid rim fractures can be treated operatively or non-operatively, augmentation of the anterior glenoid for stabilization of the shoulder should be considered if the defect exceeds 15-25% of the anterior glenoid. The purpose of this article is to summarize the diagnostics and indications for treatment of glenoid rim fractures. Radiological assessment and options for augmentation are reviewed for both acute fractures as well as chronic instability following an anterior glenoid rim defect.
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Affiliation(s)
- V Rausch
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - M Königshausen
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - J Geßmann
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - T A Schildhauer
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - D Seybold
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
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Sanchez M, Klouche S, Faivre B, Bauer T, Hardy P. Acromial J-bone graft on the acromion for surgical treatment of glenohumeral instability: an anatomical study. Shoulder Elbow 2017; 9:272-278. [PMID: 28932284 PMCID: PMC5598820 DOI: 10.1177/1758573217693809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/21/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Anterior glenohumeral instability is frequently associated with anteroinferior glenoid bone defects. One original technique has been described in the literature that incorporates a J-shaped graft from the iliac crest into the anterior glenoid rim. The main goal of the present study was to evaluate the feasibility of harvesting a J-shaped graft from the acromion that corresponds to previously described dimensions. The secondary goal was to determine the ideal harvesting site. METHODS Forty shoulders from 20 cadavers were included. Twenty grafts were harvested from the posterior acromion and 20 from the lateral acromion. The length, width and thickness of the grafts were measured. The incision was then enlarged to confirm the absence of an acromial fracture by fluoroscopic control. RESULTS Harvesting a graft whose size was similar to a J-graft was successfully performed in all cases (100%) with a mean (SD) incision of 4.2 (0.3) cm. Mean (SD) harvesting time was 4.5 (0.5) minutes. Two acromial fractures were identified during lateral harvesting (10%) and none during posterior harvesting (p = 0.49). CONCLUSIONS It is always possible to harvest a J-graft on the acromion. The posterior side of the acromion is the best site to harvest a graft that has the necessary size to treat glenoid bone defects.
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Affiliation(s)
- Matthieu Sanchez
- Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France,Matthieu Sanchez, Hôpital Ambroise Paré 9, avenue Charles De Gaulle, 92104 Boulogne-Billancourt, France.
| | - Shahnaz Klouche
- Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France
| | - Bruno Faivre
- Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France
| | - Thomas Bauer
- Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France
| | - Philippe Hardy
- Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France,Université de Versailles Saint-Quentin-en-Yvelines, UFR des Sciences de la Santé, Versailles, France
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Giannakos A, Vezeridis PS, Schwartz DG, Jany R, Lafosse L. All-Arthroscopic Revision Eden-Hybinette Procedure for Failed Instability Surgery: Technique and Preliminary Results. Arthroscopy 2017; 33:39-48. [PMID: 27432589 DOI: 10.1016/j.arthro.2016.05.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 05/12/2016] [Accepted: 05/12/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the technique of an all-arthroscopic Eden-Hybinette procedure in the revision setting for treatment of a failed instability procedure, particularly after failed Latarjet, as well as to present preliminary results of this technique. METHODS Between 2007 and 2011, 18 shoulders with persistent instability after failed instability surgery were treated with an arthroscopic Eden-Hybinette technique using an autologous bicortical iliac crest bone graft. Of 18 patients, 12 (9 men, 3 women) were available for follow-up. The average follow-up was 28.8 months (range, 15 to 60 months). A Latarjet procedure was performed as an index surgery in 10 patients (83%). Two patients (17%) had a prior arthroscopic Bankart repair. RESULTS Eight patients (67%) obtained a good or excellent result, whereas 4 patients (33%) reported a fair or poor result. Seven patients (58%) returned to sport activities. A positive apprehension test persisted in 5 patients (42%), including 2 patients (17%) with recurrent subluxations. The Rowe score increased from 30.00 to 78.33 points (P < .0001). The Walch-Duplay score increased from 11.67 to 76.67 points (P < .0001). The Western Ontario Shoulder Instability Index score showed a good result of 28.71% (603 points). The average anterior flexion was 176° (range, 150° to 180°), and the average external rotation was 66° (range, 0° to 90°). Two patients (16.67%) showed a progression of glenohumeral osteoarthritic changes, with each patient increasing by one stage in the Samilson-Prieto classification. All 4 patients (33%) with a fair or poor result had a nonunion identified on postoperative computed tomography scan. CONCLUSIONS An all-arthroscopic Eden-Hybinette procedure in the revision setting for failed instability surgery, although technically demanding, is a safe, effective, and reproducible technique. Although the learning curve is considerable, this procedure offers all the advantages of arthroscopic surgery and allows reconstruction of glenoid defects and restoration of shoulder stability in this challenging patient population. In our hands, this procedure yields good or excellent results in 67% of patients. Successful outcome is correlated with bony healing of the iliac crest graft to the glenoid. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Antonios Giannakos
- Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France; Asklepios Klinik St. Georg, Chirugisch Traumatologisches Zentrum, Hamburg, Germany
| | | | | | - Richard Jany
- Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France
| | - Laurent Lafosse
- Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France
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Lavery KP, McHale KJ, Rossy WH, Sanchez G, Provencher MT. Bony Augmentation for Anterior and Posterior Glenohumeral Instability in the Contact Athlete. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Ernstbrunner L, Werthel JD, Hatta T, Thoreson AR, Resch H, An KN, Moroder P. Biomechanical analysis of the effect of congruence, depth and radius on the stability ratio of a simplistic 'ball-and-socket' joint model. Bone Joint Res 2016; 5:453-460. [PMID: 27729312 PMCID: PMC5075797 DOI: 10.1302/2046-3758.510.bjr-2016-0078.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/29/2016] [Indexed: 12/28/2022] Open
Abstract
Objectives The bony shoulder stability ratio (BSSR) allows for quantification of the bony stabilisers in vivo. We aimed to biomechanically validate the BSSR, determine whether joint incongruence affects the stability ratio (SR) of a shoulder model, and determine the correct parameters (glenoid concavity versus humeral head radius) for calculation of the BSSR in vivo. Methods Four polyethylene balls (radii: 19.1 mm to 38.1 mm) were used to mould four fitting sockets in four different depths (3.2 mm to 19.1mm). The SR was measured in biomechanical congruent and incongruent experimental series. The experimental SR of a congruent system was compared with the calculated SR based on the BSSR approach. Differences in SR between congruent and incongruent experimental conditions were quantified. Finally, the experimental SR was compared with either calculated SR based on the socket concavity or plastic ball radius. Results The experimental SR is comparable with the calculated SR (mean difference 10%, sd 8%; relative values). The experimental incongruence study observed almost no differences (2%, sd 2%). The calculated SR on the basis of the socket concavity radius is superior in predicting the experimental SR (mean difference 10%, sd 9%) compared with the calculated SR based on the plastic ball radius (mean difference 42%, sd 55%). Conclusion The present biomechanical investigation confirmed the validity of the BSSR. Incongruence has no significant effect on the SR of a shoulder model. In the event of an incongruent system, the calculation of the BSSR on the basis of the glenoid concavity radius is recommended. Cite this article: L. Ernstbrunner, J-D. Werthel, T. Hatta, A. R. Thoreson, H. Resch, K-N. An, P. Moroder. Biomechanical analysis of the effect of congruence, depth and radius on the stability ratio of a simplistic ‘ball-and-socket’ joint model. Bone Joint Res 2016;5:453–460. DOI: 10.1302/2046-3758.510.BJR-2016-0078.R1.
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Affiliation(s)
- L Ernstbrunner
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Salzburg, Austria and Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland, Zurich, Switzerland
| | - J-D Werthel
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - T Hatta
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - A R Thoreson
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - H Resch
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - K-N An
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - P Moroder
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Salzburg, Austria and Center for Musculoskeletal Surgery, Charite Universitaetsmedizin, Berlin, Germany
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Shoulder joint instability evaluation by CT arthrography and MR arthrography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ramhamadany E, Modi CS. Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss. World J Orthop 2016; 7:343-354. [PMID: 27335809 PMCID: PMC4911517 DOI: 10.5312/wjo.v7.i6.343] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 02/16/2016] [Accepted: 04/11/2016] [Indexed: 02/06/2023] Open
Abstract
The management of recurrent anterior gleno-humeral joint instability is challenging in the presence of bone loss. It is often seen in young athletic patients and dislocations related to epileptic seizures and may involve glenoid bone deficiency, humeral bone deficiency or combined bipolar lesions. It is critical to accurately identify and assess the amount and position of bone loss in order to select the most appropriate treatment and reduce the risk of recurrent instability after surgery. The current literature suggests that coracoid and iliac crest bone block transfers are reliable for treating glenoid defects. The treatment of humeral defects is more controversial, however, although good early results have been reported after arthroscopic Remplissage for small defects. Larger humeral defects may require complex reconstruction or partial resurfacing. There is currently very limited evidence to support treatment strategies when dealing with bipolar lesions. The aim of this review is to summarise the current evidence regarding the best imaging modalities and treatment strategies in managing this complex problem relating particularly to contact athletes and dislocations related to epileptic seizures.
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Petersen SA, Bernard JA, Langdale ER, Belkoff SM. Autologous distal clavicle versus autologous coracoid bone grafts for restoration of anterior-inferior glenoid bone loss: a biomechanical comparison. J Shoulder Elbow Surg 2016; 25:960-6. [PMID: 26803929 DOI: 10.1016/j.jse.2015.10.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 10/20/2015] [Accepted: 10/24/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treating anterior glenoid bone loss in patients with recurrent shoulder instability is challenging. Coracoid transfer techniques are associated with neurologic complications and neuroanatomic alterations. The purpose of our study was to compare the contact area and pressures of a distal clavicle autograft with a coracoid bone graft for the restoration of anterior glenoid bone loss. We hypothesized that a distal clavicle autograft would be as effective as a coracoid graft. METHODS In 13 fresh-frozen cadaveric shoulder specimens, we harvested the distal 1.0 cm of each clavicle and the coracoid bone resection required for a Latarjet procedure. A compressive load of 440 N was applied across the glenohumeral joint at 30° and 60° of abduction, as well as 60° of abduction with 90° of external rotation. Pressure-sensitive film was used to determine normal glenohumeral contact area and pressures. In each specimen, we created a vertical, 25% anterior bone defect, reconstructed with distal clavicle (articular surface and undersurface) and coracoid bone grafts, and determined the glenohumeral contact area and pressures. We used analysis of variance for group comparisons and a Tukey post hoc test for individual comparisons (with P <.05 indicating a significant difference). RESULTS The articular distal clavicle bone graft provided the lowest mean pressure in all testing positions. The coracoid bone graft provided the greatest contact area in all humeral positions, but the difference was not significant. CONCLUSION An articular distal clavicle bone graft is comparable in glenohumeral contact area and pressures to an optimally placed coracoid bone graft for restoring glenoid bone loss. LEVEL OF EVIDENCE Basic Science Study; Biomechanics.
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Affiliation(s)
- Steve A Petersen
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
| | - Johnathan A Bernard
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Evan R Langdale
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Stephen M Belkoff
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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History of surgical intervention of anterior shoulder instability. J Shoulder Elbow Surg 2016; 25:e139-50. [PMID: 27066962 DOI: 10.1016/j.jse.2016.01.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 01/13/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior glenohumeral instability most commonly affects younger patients and has shown high recurrence rates with nonoperative management. The treatment of anterior glenohumeral instability has undergone significant evolution over the 20th and 21 centuries. METHODS This article presents a retrospective comprehensive review of the history of different operative techniques for shoulder stabilization. RESULTS Bankart first described an anatomic suture repair of the inferior glenohumeral ligament and anteroinferior labrum in 1923. Multiple surgeons have since described anatomic and nonanatomic repairs, and many of the early principles of shoulder stabilization have remained even as the techniques have changed. Some methods, such as the Magnusson-Stack procedure, Putti-Platt procedure, arthroscopic stapling, and transosseous suture fixation, have been almost completely abandoned. Other strategies, such as the Bankart repair, capsular shift, and remplissage, have persisted for decades and have been adapted for arthroscopic use. DISCUSSION The future of anterior shoulder stabilization will continue to evolve with even newer practices, such as the arthroscopic Latarjet transfer. Further research and clinical experience will dictate which future innovations are ultimately embraced.
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McLaughlin RJ, Miniaci A, Jones MH. Bony Versus Soft Tissue Reconstruction for Anterior Shoulder Instability: An Expected Value Decision Analysis. Orthop J Sports Med 2016; 3:2325967115618161. [PMID: 26779552 PMCID: PMC4710124 DOI: 10.1177/2325967115618161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: One complication of anteroinferior glenohumeral shoulder dislocation is a critical bone defect that requires surgical repair to prevent recurrent instability. However, controversy exists regarding the surgical management because both open and arthroscopic surgeries have respective advantages and disadvantages. Moreover, it is difficult to determine the patient’s preferred treatment, as factors that influence treatment choice include recurrence rates, morbidity of the procedures, and patient preferences. Hypothesis: Patients who have a higher probability of recurrent instability after arthroscopic surgery will select open surgery whereas patients with a lower probability of recurrent instability after arthroscopic surgery will favor arthroscopy. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: A decision tree was constructed to model each hypothetical outcome after open or arthroscopic surgery for glenohumeral instability in patients with bone defects. A literature review was performed to determine the probability of occurrence for each node while utility values for each outcome were obtained via patient-administered surveys given to 50 patients without prior history of shoulder injury or dislocation. Fold-back analysis was then performed to show the optimal treatment strategy. Finally, sensitivity analysis established the thresholds at which open treatment becomes the optimal treatment. Results: The ultimate expected value—the objective evaluation of all potential outcomes after choosing either open or arthroscopic surgery—was found to be greater for arthroscopic surgery than for open surgery (87.17 vs 81.64), indicating it to be the preferred treatment. Results of sensitivity analysis indicated that open surgery becomes the preferred treatment when probability of recurrence after arthroscopic treatment is ≥23.8%, although varying the utility, defined as an aggregate patient preference for a particular outcome, has no effect on the model. When the rate of no complication after open surgery is 97.6%, open surgery becomes the patient’s preferred treatment. Conclusion: Arthroscopic surgery is an acceptable treatment if recurrent instability occurs consistently at ≤23.8%. This has important implications given the technical difficulty of successfully performing arthroscopic fixation to resolve recurrent anteroinferior glenohumeral dislocations associated with critical osseous defects. However, due to a lack of clinical outcomes studies, more research is needed to better predict the optimal operative treatment.
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Clinical and radiological outcome after mini-open Latarjet technique with fixation of coracoid with Arthrex wedge mini-plate. J Clin Orthop Trauma 2016; 7:23-9. [PMID: 26908972 PMCID: PMC4735561 DOI: 10.1016/j.jcot.2015.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/15/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Technical faults leading to coracoid fractures during screw insertion and coracoid graft osteolysis are concerns with standard screw fixation techniques in Latarjet procedure. The purpose of this study is to share our experience using Arthrex wedge profile plate with mini-open technique for graft fixation, that ensures better load distribution between coracoid graft and glenoid. METHODS We did retrospective analysis of 24 patients with recurrent anterior shoulder instability after failed arthroscopic Bankart's repair. Arthroscopic examination of affected shoulder was done in lateral position before making patient supine for open Latarjet. A low profile wedge plate (Arthrex) with two screws was used for the procedure. CT analysis was performed post-operatively at 6 months to see graft union and results were evaluated using the Rowe and Walch Duplay score. RESULTS Mean follow-up time was 26 months. Postoperatively, mean forward elevation was 170.6 + 4.6° (loss of average 5.9°) and mean external rotation was 42.5 + 5.3° (loss of average 3.1°). All patients returned to their previous occupation. None reported to be having any recurrent subluxation. Functional assessment done using Rowe score and Walch Duplay score showed statistically significant improvement (p value 0.034). There were no implant-related complications and no case of coracoid graft osteolysis. CONCLUSIONS Mini-open Latarjet with graft fixation with Arthrex mini-plate provides satisfactory outcome in patients who require reoperation due to dramatic bone loss and failed soft tissue reconstruction. The modified incision improves exposure enabling plate fixation and the secure fixation accelerates rehabilitation.
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Garcia GH, Liu JN, Dines DM, Dines JS. Effect of bone loss in anterior shoulder instability. World J Orthop 2015; 6:421-433. [PMID: 26085984 PMCID: PMC4458493 DOI: 10.5312/wjo.v6.i5.421] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/20/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
Anterior shoulder instability with bone loss can be a difficult problem to treat. It usually involves a component of either glenoid deficiency or a Hill-Sachs lesion. Recent data shows that soft tissue procedures alone are typically not adequate to provide stability to the shoulder. As such, numerous surgical procedures have been described to directly address these bony deficits. For glenoid defects, coracoid transfer and iliac crest bone block procedures are popular and effective. For humeral head defects, both remplissage and osteochondral allografts have decreased the rates of recurrent instability. Our review provides an overview of current literature addressing these treatment options and others for addressing bone loss complicating anterior glenohumeral instability.
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Willemot LB, Eby SF, Thoreson AR, Debeer P, Victor J, An KN, Verborgt O. Iliac bone grafting of the intact glenoid improves shoulder stability with optimal graft positioning. J Shoulder Elbow Surg 2015; 24:533-40. [PMID: 25457786 PMCID: PMC4369161 DOI: 10.1016/j.jse.2014.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/03/2014] [Accepted: 09/12/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bone grafting procedures are increasingly popular for the treatment of anterior shoulder instability. In patients with a high risk of recurrence, open coracoid transplantation is preferred but can be technically demanding. Free bone graft glenoid augmentation may be an alternative strategy for high-risk patients without significant glenoid bone loss. This biomechanical cadaveric study assessed the stabilizing effect of free iliac crest bone grafting of the intact glenoid and the importance of sagittal graft position. METHODS Eight fresh frozen cadaveric shoulders were tested. The bone graft was fixed on the glenoid neck at 3 sagittal positions (50%, 75%, and 100% below the glenoid equator). Displacement and reaction force were monitored with a custom device while translating the humeral head over the glenoid surface in both anterior and anteroinferior direction. RESULTS Peak force (PF) increased significantly from the standard labral repair to the grafted conditions in both anterior (14.7 ± 5.5 N vs 27.3 ± 6.9 N) and anteroinferior translation (22.0 ± 5.3 N vs 29.3 ± 6.9 N). PF was significantly higher for the grafts at the 50% and 75% positions compared with the grafts 100% below the equator with anterior translation. Anteroinferior translation resulted in significantly higher values for the 100% and 75% positions compared with the 50% position. CONCLUSIONS This biomechanical study confirms improved anterior glenohumeral stability after iliac crest bone graft augmentation of the anterior glenoid. The results also demonstrate the importance of bone graft position in the sagittal plane, with the ideal position determined by the direction of dislocation.
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Affiliation(s)
- Laurent B Willemot
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA; Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Sarah F Eby
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA; Mayo Medical School, Mayo Graduate School, and Medical Scientist Training Program, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrew R Thoreson
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA
| | - Phillipe Debeer
- Division of Orthopaedics, Department of Development and Regeneration, KU Leuven, University Hospitals Leuven, Pellenberg, Belgium
| | - Jan Victor
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Kai-Nan An
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA.
| | - Olivier Verborgt
- Department of Orthopaedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopaedic Surgery and Traumatology, University Hospital Antwerp, Edegem, Belgium
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Frank RM, Parada SA, Mascarenhas R, Romeo AA. When Allografts Fail for Instability Surgery—What to Do? OPER TECHN SPORT MED 2015. [DOI: 10.1053/j.otsm.2014.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Arianjam A, Bell SN, Coghlan J, Old J, Sloan R. Outcomes for intra-substance free coracoid graft in patients with antero-inferior instability and glenoid bone loss in a population of high-risk athletes at a minimum follow-up of 2 years. Shoulder Elbow 2015; 7:36-43. [PMID: 27582955 PMCID: PMC4935099 DOI: 10.1177/1758573214557147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/01/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this retrospective case series study was to assess the outcomes of patients with recurrent anterior shoulder instability with antero-inferior glenoid bone loss treated with a specific open stabilization technique using intra-substance coracoid bone-grafting and Bankart repair. METHODS Over a 4-year period, 34 shoulders in all male patients of mean age 21 years were stabilized with this technique. Pre- and postoperative function, motion and stability were assessed as part of Rowe stability scoring, and American Shoulder and Elbow Surgeons (ASES) and Oxford Instability were recorded, with at least 2 years of follow-up in all patients. Union of the graft was determined by post-operative computed tomography (CT) of the affected shoulder. RESULTS For all cases, two redislocations (5.9%) and two subluxations occurred when continuing high-risk sport after 2 years. Post-operative scores [median, mean (SD): Rowe 77.5, 77.2 (19.5); ASES 94.2, 92 (7.7); Oxford 43, 41.2 (6)]. CT scans on 28 shoulders at a mean of 4.5 months after surgery showed non-union in three cases (10%). CONCLUSIONS These results demonstrate a high rate of success in cases of glenoid bone loss in the young contact athlete with recurrent instability treated with open stabilization and bone grafting.
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Affiliation(s)
- Afshin Arianjam
- St Mary’s Medical Center Graduate Medical Education, San Francisco, CA, USA
| | - Simon N Bell
- Monash University, Melbourne Shoulder and Elbow Center, Brighton, VIC, Australia
| | - Jennifer Coghlan
- Monash University, Melbourne Shoulder and Elbow Center, Brighton, VIC, Australia
| | - Jason Old
- Section of Orthopaedic Surgery University of Manitoba, Canada
| | - Roger Sloan
- Monash University, Melbourne Shoulder and Elbow Center, Brighton, VIC, Australia
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