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Brilakis E, Sachinis NP, Kokkineli S, Pantekidis I, Natsaridis P, Gatos G, Antonogiannakis E. Arthroscopic subscapularis augmentation of the classic Bankart repair leads to satisfactory clinical and functional mid-term outcomes in patients with recurrent anterior shoulder instability and less than a subcritical glenoid bone loss. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39324386 DOI: 10.1002/ksa.12483] [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] [Received: 12/07/2023] [Revised: 09/08/2024] [Accepted: 09/12/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE The long-term failure rate of the arthroscopic Bankart repair may reach unacceptable values, raising the need to augment this classic procedure. Arthroscopic subscapularis augmentation is the tenodesis of the upper part of the subscapularis tendon to the anterior glenoid rim. The aim of the study was to evaluate the mid-term clinical and functional outcomes of patients operated with arthroscopic subscapularis augmentation of the classic Bankart repair due to recurrent anterior shoulder instability. METHODS This is a retrospective single-centre case series study with prospectively collected data. All patients suffered from recurrent anterior shoulder instability and had glenoid bone loss less than 13.5% of the inferior glenoid diameter (subcritical glenoid bone loss). Patients with greater anterior glenoid bone defect, engaging Hill-Sachs lesions, multidirectional instability or subscapularis insufficiency were excluded. Postoperatively, all patients were evaluated for recurrence and apprehension. The patient's shoulder range of motion and functional scores were recorded. RESULTS The final study cohort included 34 patients with a mean age of 29.3 ± 10.2 years. The mean follow-up period was 42.4 ± 10.7 months (range, 24-62 months). Two out of 34 patients (5.8%) experienced a re-dislocation postoperatively, while one additional patient had a subjective feeling of apprehension. External rotation at the last follow-up was lower compared to preoperative values or the healthy side, but only one patient had restrictions in his sporting activities. The functional scores were significantly increased compared to the preoperative values. Twenty-two out of 26 patients (84.6%) returned to the same level of sporting activities, and 30/34 patients (88.2%) were highly satisfied with the results. CONCLUSION Arthroscopic subscapularis augmentation of the classic Bankart repair reduces the dislocation recurrence rate and leads to satisfactory clinical and functional mid-term outcomes in patients with recurrent anterior shoulder instability and less than a subcritical glenoid bone loss. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Nikolaos Platon Sachinis
- First Orthopaedic Department of Aristotle University of Thessaloniki, "Georgios Papanikolaou" Hospital, Thessaloniki, Greece
| | | | | | | | - George Gatos
- 3rd Orthopaedic Department, Hygeia Hospital, Athens, Greece
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Russo R, Fontanarosa A, Montemagno M, Fedele A, De Crescenzo A, Di Pietto F, Calbi R, Garofalo R. Return to sport after arthroscopic xenograft bone block associated with Bankart repair and subscapularis augmentation in competitive contact athletes with recurrent anterior shoulder instability. J Shoulder Elbow Surg 2024:S1058-2746(24)00500-7. [PMID: 39067662 DOI: 10.1016/j.jse.2024.05.047] [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] [Received: 01/28/2024] [Revised: 05/19/2024] [Accepted: 05/28/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Open Bankart repair and Latarjet stabilization are 2 widely used surgical procedures in the treatment of shoulder instability in contact athletes. This study evaluates the outcomes of bone block arthroscopic procedures, performed with a xenograft, in combination with Bankart repair and selective subscapularis augmentation for contact athletes with recurrent anterior shoulder instability. METHODS We retrospectively assessed contact athletes who underwent arthroscopic bone block with xenograft and Bankart repair with selective augmentation of the subscapularis for recurrent anterior shoulder instability between January 2017 and December 2021. Shoulders with posterior instability or multidirectional instability were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score, Western Ontario Shoulder Instability index [WOSI] score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form ASES score) were assessed. A computed tomography scan at 2-year follow-up was performed to assess the status of bone block integration, its displacement and restoration of glenoid surface. RESULTS Sixteen patients with a mean age of 24 years were included in the study. None of the patients treated with arthroscopic bone block and subscapularis augmentation presented new dislocation episodes. An increase in preoperative scores was observed at the last follow-up; in particular, the ASES, Rowe, and WOSI scores increased from 69 ± 7, 31 ± 9, and 1235 ± 46, respectively, to 96.1 ± 3.2, 94 ± 6, and 119 ± 51. All athletes returned to sporting activity at or near the same level as presurgery. The glenoid bone surface increase from 83% to 116% at the last follow-up. CONCLUSION Bone block treatment with xenograft combined with Bankart repair and arthroscopic subscapularis augmentation procedures has been shown to be effective in treating instability in contact athletes with significant glenoid deficit. All athletes returned to athletic activity at a level similar to the preintervention period.
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Affiliation(s)
- Raffaele Russo
- Department of Orthopedics and Traumatology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Alberto Fontanarosa
- Department of Orthopedics and Traumatology, Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy.
| | - Marco Montemagno
- Department of Orthopedics and Traumatology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Alfonso Fedele
- Department of Orthopedics and Traumatology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Angelo De Crescenzo
- Department of Orthopedics and Traumatology, Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Francesco Di Pietto
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Roberto Calbi
- Department of Radiology, Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Raffaele Garofalo
- Department of Orthopedics and Traumatology, Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
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Chakrabarti MO, Khan M. Editorial Commentary: Suture Button Fixation for the Latarjet Procedure Is Superior to Screw Fixation. Arthroscopy 2024; 40:1655-1657. [PMID: 38219100 DOI: 10.1016/j.arthro.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/15/2024]
Abstract
An increasing body of evidence suggests that suture button fixation is comparable with screw fixation in Latarjet and potentially associated with reduced graft resorption. Suture button fixation may facilitate performing the Latarjet procedure, particularly when done in an arthroscopic manner. The use of suture button fixation technique theoretically facilitates improved positioning of the graft on the glenoid, as it frees the surgeon from the potential of the soft-tissue envelope to impact positioning of the graft, which can occur with screw-based guides. The bone graft can be shuttled into an optimal position and then tensioned with relative ease in comparison with screw-based techniques. Suture button fixation results in lower complication rates compared with screw fixation; almost one third of the screw fixation complications are hardware-related, and screw fixation results in a high rate of hardware removal. Moreover, the arthroscopic Latarjet suture button literature is published by experienced surgeons. Arthroscopic Latarjet has a significant learning curve, reducing the translatability of studies that report superior findings with any one technique. The generalizability of results reminds us that evidence-based medicine should be practiced through the lens of not only patient preferences, but also through an honest appraisal of a surgeon's own ability.
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Maiotti M, Massoni C. Arthroscopic Xenograft With Cerclage Fixation: A Method for Glenoid Bone Loss Reconstruction With Cerclage Fixation Using a Specific Posterior Guide. Arthrosc Tech 2023; 12:e1657-e1664. [PMID: 37942095 PMCID: PMC10627986 DOI: 10.1016/j.eats.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/27/2023] [Indexed: 11/10/2023] Open
Abstract
Large glenoid bone defects are closely associated with high failure rates after arthroscopic Bankart repair in chronic anterior shoulder instability; therefore nowadays the glenoid bone grafting reconstruction procedure is strictly recommended. On the contrary, the optimal grafting procedure is still controversial because there is considerable concern about the resorption rate of allografts, donor site morbidity of the autografts, and sequelae caused by the use of metal fixation devices in proximity of the shoulder joint. We describe an all-arthroscopic technique for anatomic reconstruction of the glenoid that uses a previously shaped xenograft assembled with a metal-free fixation device using 2 ultra-high-strength sutures (FiberTape Cerclage System; Arthrex, Naples, FL), using a specific posterior guide (Arthrex, Naples, FL) in combination with upper third subscapularis augmentation.
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Affiliation(s)
- Marco Maiotti
- Villa Stuart Hospital, Rome, Italy
- Mediterranea Hospital, Naples, Italy
| | - Carlo Massoni
- Villa Stuart Hospital, Rome, Italy
- Mediterranea Hospital, Naples, Italy
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Maiotti M, Massoni C, Di Pietto F, Romano M, Guastafierro A, Della Rotonda G, Russo R. Arthroscopic Subscapularis Augmentation With Xenograft Glenoid Bone Block in Patients With Recurrent Anterior Shoulder Instability. Arthrosc Sports Med Rehabil 2023; 5:e809-e816. [PMID: 37388873 PMCID: PMC10300584 DOI: 10.1016/j.asmr.2023.04.008] [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: 12/09/2022] [Accepted: 04/16/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction The purpose of this study was to investigate the clinical and radiographic outcomes at 2 years for patients who underwent an arthroscopic xenograft bone block procedure plus ASA for recurrent anteroinferior gleno-humeral instability. Methods This retrospective study was conducted on patients affected by chronic anteroinferior shoulder instability. The inclusion criteria were as follows: patients must be aged 18 years or older; have recurrent anteroinferior shoulder instability, a glenoid defect >10%, assessment by the Pico area measurement system, anterior capsular insufficiency, and an engaging Hill-Sachs lesion. The exclusion criteria were as follows: multidirectional instability, glenoid bone defect <10%, arthritis, and minimum follow-up less than 24 months. Clinical outcomes were evaluated according to Western Ontario Shoulder Instability Index (WOSI) and Rowe scale. Computed tomography (CT) results were evaluated to assess any signs of resorption or displacement of the xenograft at 24 months follow-up. Results Twenty patients that met all the inclusion criteria underwent arthroscopic xenograft bone block procedure and ASA. The mean preoperative Rowe score was 38.3 points, and it significantly improved (P < .001), increasing to 95.5 points. ROWE level at follow-up was excellent for 18 patients (90%), fair for 1 patient (5%), and poor for another patient (5%). The mean preoperative WOSI score was 1242 points, and it improved significantly (P <.0001), with a mean score of 120 points at follow-up. In all patients, the comparative study between CT scans performed postoperatively and at final follow-up did not reveal a volume reduction of the xenografts (P > .05) and absence areas affected by signs of resorption and breakage with 34.4% of postprocedural increase of the glenoid surface, were seen. Conclusions The combination of ASA and bone block procedure with a xenograft was effective in the glenoid reconstruction and restoration of shoulder stability. No radiographic evidence of graft resorption, graft displacement, or glenohumeral arthritis were observed at 24-month follow-up. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Marco Maiotti
- Villa Stuart Hospital, Rome, Italy
- Shoulder and Knee Unit, Mediterranea Hospital, Naples, Italy
| | - Carlo Massoni
- Shoulder and Knee Unit, Mediterranea Hospital, Naples, Italy
| | | | | | - Antonio Guastafierro
- Department of Orthopaedic Surgery, Pineta Grande Hospital, Castelvolturno (CE), Italy
| | | | - Raffaele Russo
- Department of Orthopaedic Surgery, Pineta Grande Hospital, Castelvolturno (CE), Italy
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Ohin CA, Guarrella V, Perfetti C, Larghi MM, Messina C, Sconfienza LM, Taverna E. CT-scan Evaluation of Osteointegration and Osteolysis in Different Graft Types and Surgical Techniques for the Treatment of Shoulder Instability. THE ARCHIVES OF BONE AND JOINT SURGERY 2023; 11:117-123. [PMID: 37168828 PMCID: PMC10165674 DOI: 10.22038/abjs.2022.62012.3040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 08/26/2022] [Indexed: 05/13/2023]
Abstract
Background Bone graft is often needed in treating anterior shoulder instability in glenoid bone loss and graft integration is crucial in achieving good results. This study aimed to evaluate bone graft remodeling in different techniques for shoulder anterior-inferior instability. Methods Graft osteointegration and osteolysis were retrospectively evaluated with CT-scan imaging performed 6 to 12 months after surgery to compare the outcome of three procedures: Latarjet, bone block with allograft, and bone block with xenograft. Screw fixation and double endobuttons fixation were also compared. Results CT scans of 130 patients were analyzed. Of these, 30 (23%) were performed after the bone block procedure with xenograft and endobuttons fixation, 55 (42%) after the bone block procedure with allograft and endobuttons fixation, 13 (10%) Latarjet with screw fixation and 32 (25%) Latarjet with endobuttons fixation. The prevalence of osteolysis was significantly inferior (P<.01) in the bone block procedure compared to the Latarjet procedure (11.7 % vs. 28.8 %). Bone integration was higher in bone block procedures (90.5%) than in Latarjet (84.4%), but the difference was not statistically significant. Among the Latarjet procedures, endobuttons fixation resulted in a higher integration rate (87.5% vs. 73.6%) and lower osteolysis rate than screw fixation (24.6% vs. 38.5%), despite these differences did not reach a statistical significance. Among the bone block procedures, using a xenograft resulted in a lower osteolysis rate (6.7%) than an allograft (14.5%), but the result was not statistically significant. Conclusion This study shows a significantly lower rate of graft osteolysis after bone block procedures compared to Latarjet procedure between 6 and 12 months postoperatively. Moreover, our findings suggest good results in osteolysis and graft integration with xenograft compared to allograft and double endobuttons fixation compared to screw fixation, despite these differences being not-significant. Further studies on this topic are needed to confirm our results at a longer follow-up and thoroughly investigate the clinical relevance of these findings.
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Affiliation(s)
- Caterina Albizzini Ohin
- Department of Shoulder Surgery, IRCCS Ospedale Galeazzi Sant Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Vincenzo Guarrella
- Department of Shoulder Surgery, IRCCS Ospedale Galeazzi Sant Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Carlo Perfetti
- Department of Shoulder Surgery, IRCCS Ospedale Galeazzi Sant Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Marco Mattia Larghi
- School of Medicine and Residency Program in Orthopaedics, Università degli studi di Milano Via Festa del Perdono 7, 20122 Milano, Italy
| | - Carmelo Messina
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Ospedale Galeazzi Sant Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Ospedale Galeazzi Sant Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - Ettore Taverna
- Department of Shoulder Surgery, IRCCS Ospedale Galeazzi Sant Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy
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Russo R. Regarding "Arthroscopic Iliac Crest Bone Allograft Combined With Subscapularis Upper-Third Tenodesis Shows a Low Recurrence Rate in the Treatment of Recurrent Anterior Shoulder Instability Associated With Critical Bone Loss". Arthroscopy 2022; 38:1394-1395. [PMID: 35501007 DOI: 10.1016/j.arthro.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/01/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Raffaele Russo
- Second Orthopaedic and Traumatology Unit, Pineta Grande Hospital, Caserta, Italy
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Moya D, Aydin N, Yamamoto N, Simone JP, Robles PP, Tytherleigh-Strong G, Gobbato B, Kholinne E, Jeon IH. Current concepts in anterior glenohumeral instability: diagnosis and treatment. SICOT J 2021; 7:48. [PMID: 34519639 PMCID: PMC8439181 DOI: 10.1051/sicotj/2021048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/27/2021] [Indexed: 11/14/2022] Open
Abstract
The glenohumeral joint is the most dislocated articulation, accounting for more than 50% of all joint dislocations. The reason behind shoulder instability should be investigated in detail for successful management, and the treatment plan should be individualized for all patients. Several classification systems have been proposed for glenohumeral instability. A physical exam is mandatory no matter what classification system is used. When treating patients with anterior shoulder instability, surgeons need to be aware of the critical size of the bone loss, which is commonly seen. The glenoid track concept was clinically adopted, and the measurement of the glenoid track for surgical decision-making is recommended. Detailed assessment of existing soft tissue injury to the labrum, capsule, glenohumeral ligaments, and rotator cuff is also mandatory as their presence influences the surgical outcome. Rehabilitation, arthroscopic repair techniques, open Bankart procedure, capsular plication, remplissage, Latarjet technique, iliac crest, and other bone grafts offer the surgeon different treatment options according to the type of patient and the lesions to be treated. Three-dimensional (3D) technologies can help to evaluate glenoid and humeral defects. Patient-specific guides are low-cost surgical instruments and can be used in shoulder instability surgery. 3D printing will undoubtedly become an essential tool to achieve the best results in glenohumeral instability surgery.
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Affiliation(s)
- Daniel Moya
- Department of Orthopedic Surgery, Hospital Británico de Buenos Aires, C1280 AEB Buenos Aires, Argentina
| | - Nuri Aydin
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Orthopedics and Traumatology, 34098 Istanbul, Turkey
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 980-8575 Sendai, Japan
| | - Juan Pablo Simone
- Department of Orthopaedic Surgery, Hospital Alemán de Buenos Aires, C1118 AAT Buenos Aires, Argentina
| | | | - Graham Tytherleigh-Strong
- Division of Orthopaedics, Addenbroke's Hospital, Cambridge University Hospitals Trust, CB2 0QQ Cambridge, United Kingdom
| | - Bruno Gobbato
- Department of Orthopaedic Surgery, Hospital Sao Jose, Jaraguá do Sul, SC 89251-830, Brazil
| | - Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopaedic Surgery, St Carolus Hospital, 10440 Jakarta, Indonesia
| | - In-Ho Jeon
- Department of Orthopaedics, University of Ulsan, College of Medicine, Asan Medical Center, 05505 Seoul, Korea
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Arthroscopic Iliac Crest Bone Allograft Combined With Subscapularis Upper-Third Tenodesis Shows a Low Recurrence Rate in the Treatment of Recurrent Anterior Shoulder Instability Associated With Critical Bone Loss. Arthroscopy 2021; 37:824-833. [PMID: 33359157 DOI: 10.1016/j.arthro.2020.11.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical and radiologic outcomes of patients undergoing arthroscopic glenoid bone allograft combined with subscapularis upper-third tenodesis for anterior shoulder instability associated with clinically relevant bone loss and hyperlaxity. METHODS Between January 2016 and December 2017, patients with recurrent anterior shoulder instability associated with bone loss and hyperlaxity were selected and treated with arthroscopic iliac crest bone graft combined with subscapularis upper-third tenodesis. The selection criteria were as follows: more than 5 dislocations; positive apprehension, anterior drawer, and Coudane-Walch test results; glenoid bone defect between 15% and 30% and humeral bone defect with an engaging Hill-Sachs lesion; and no previous shoulder surgery. All patients were followed up with the Constant score, University of California-Los Angeles (UCLA) rating, Rowe score, and visual analog scale evaluation. Assessments were performed with plain radiographs and a PICO computed tomography scan before surgery and at 2 years of follow-up. RESULTS Nineteen patients were included in the study, with a mean follow-up duration of 34.6 months (range, 24-48 months). In 17 patients (89%), excellent clinical results were recorded according to the Rowe score. The Constant score improved from 82.9 (standard deviation [SD], 5.2) to 88.9 (SD, 4.3) (P = .002); Rowe score, from 25.3 (SD, 5.3) to 89.1 (SD, 21.8) (P < .001); UCLA score, from 23.7 (SD, 3) to 31.5 (SD, 4.8) (P < .001); and visual analog scale score, from 3.2 to 1.3 (P < .001). Patients met the minimal clinically important difference 94.7%, 89.5%, and 47.3% of the time for the Rowe score, UCLA score, and Constant score, respectively. Bone graft resorption was observed in all patients: partial in 9 and complete in 10. We recorded 2 recurrent traumatic dislocations (11%), with no case of persistent anterior apprehension or other complication. CONCLUSIONS An arthroscopic glenoid bone graft combined with subscapularis upper-third tenodesis may be a valid surgical option to treat recurrent anterior instability associated with both bone loss and hyperlaxity. LEVEL OF EVIDENCE Level IV, case series.
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McNeil D, Provencher M, Wong IH. Arthroscopic anatomic glenoid reconstruction demonstrates its safety with short-term to medium-term results for anteroinferior shoulder instability: a systematic review. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Piolanti N, Del Chiaro A, Matassi F, Nistri L, Graceffa A, Marcucci M. Bone integration in acetabular revision hip arthroplasty using equine-derived bone grafts: a retrospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:575-581. [PMID: 31858258 DOI: 10.1007/s00590-019-02613-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/13/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE During the last decade, total hip arthroplasty has become a common procedure performed in young patients, as well as elderly ones. This has led to an increase in total hip arthroplasty revisions. Loosening of primary components with associated bone loss represents the major cause of total hip arthroplasty revision. This study evaluates the safety and performance of an enzyme-deantigenic equine-derived bone graft material in acetabular defect reconstruction. METHODS Records of 55 patients who were treated for Paprosky type II or III acetabular bone defects with arthroplasty revisions using equine-derived bone and followed for an average of 34 months (range from 24 to 48 months) were analyzed. RESULTS Of the 55 revisions, 49 (89%) were regarded as successful, showing good osteointegration without signs of mobilization. Failures included six cases (11%) of mobilization: five cases of aseptic mobilization (9.1% of revisions, 83% of failures) and one case of septic mobilization (1.9% of revisions, 17% of failures). These results are consistent with those of studies having a similar follow-up period for allografts used in combination with trabecular metal components. CONCLUSIONS Results of the present study suggest that enzyme-treated equine-derived bone grafts may be a valid alternative to autogenous and homologous bone grafts in total hip arthroplasty revision.
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Affiliation(s)
- Nicola Piolanti
- Orthopaedic and Traumatology Division, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56124, Pisa, PI, Italy
| | - Andrea Del Chiaro
- Orthopaedic and Traumatology Division, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56124, Pisa, PI, Italy.
| | - Fabrizio Matassi
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy
| | - Lorenzo Nistri
- Articular Replacements Excellence Center (CESAT) - Fondazione Onlus "…In Cammino…", Fucecchio, Italy
| | - Angelo Graceffa
- Azienda Sanitaria Provinciale Di Enna, Via Armando Diaz 7/9, 94100, Enna, Italy
| | - Massimiliano Marcucci
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy
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