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Rosenow CS, Leland DP, Camp CL, Barlow JD. Sutures, Screws, Buttons, and Anchors: A Review of Current Bone Graft Fixation Devices for Glenoid Bone Loss in the Unstable Shoulder. Curr Rev Musculoskelet Med 2024; 17:207-221. [PMID: 38587597 DOI: 10.1007/s12178-024-09895-x] [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] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE OF REVIEW Anterior shoulder instability is associated with concomitant injury to several stabilizing structures of the shoulder, including glenoid bone loss. While instability is most common in young athletes and patients with predisposing conditions of hyperlaxity, recurrent shoulder instability can occur throughout various age ranges and may lead to longer term effects including pain and shoulder arthritis. Glenoid bone loss exceeding certain thresholds is generally treated by glenoid reconstruction via bone block augmentation to adequately stabilize the glenohumeral joint. These procedures increase the width of the articular surface on which the humeral head can translate before dislocation and, based on the procedure performed, provide a sling effect via the conjoined tendon, and increase tension to support the anterior capsule. The purpose of this review is to summarize the available literature regarding bone block fixation techniques. RECENT DEVELOPMENTS Various fixation techniques have been utilized to secure bone block transfers. Though screw fixation has traditionally been used for bone block fixation, suture buttons, suture anchors, and all-suture techniques have been utilized in attempts to avoid complications associated with the use of screws. Biomechanical studies report variable force-resistance, displacement, and mode of failure when comparing screw to suture button-based fixation of glenoid bone blocks. Clinical and radiographic studies have shown these novel suture-based techniques to be comparable, and in some cases advantageous, to traditional screw fixation techniques. While screw fixation has long been the standard of care in glenoid bone block procedures, it is associated with high complication rates, leading surgeons to endeavor toward new fixation techniques. In available biomechanical studies, screw fixation has consistently demonstrated high maximal load-to-failure and displacement with cyclic loading. Studies have reported similar clinical and radiographic outcomes in both screw and suture-based fixation methods, with evidence of reduced bone resorption with suture fixation. While suture button fixation is associated with a higher rate of recurrent instability, overall complication rates are low. Future research should address biomechanical shortcomings of suture-based fixation techniques and continue to assess long-term follow-up of patients treated with each fixation method.
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Affiliation(s)
- Christian S Rosenow
- Mayo Clinic Department of Orthopedic Surgery, 200 First Street SW, Rochester, 55905, MN, USA
| | - Devin P Leland
- Mayo Clinic Department of Orthopedic Surgery, 200 First Street SW, Rochester, 55905, MN, USA
| | - Christopher L Camp
- Mayo Clinic Department of Orthopedic Surgery, 200 First Street SW, Rochester, 55905, MN, USA.
| | - Jonathan D Barlow
- Mayo Clinic Department of Orthopedic Surgery, 200 First Street SW, Rochester, 55905, MN, USA
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Singh M, Byrne R, Chang K, Nadella A, Kutschke M, Callanan T, Owens BD. Distal Tibial Allograft for the Treatment of Anterior Shoulder Instability With Glenoid Bone Loss: A Systematic Review and Meta-analysis. Am J Sports Med 2024:3635465231223124. [PMID: 38384193 DOI: 10.1177/03635465231223124] [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: 02/23/2024]
Abstract
BACKGROUND The use of a distal tibial allograft (DTA) for reconstruction of a glenoid defect in anterior shoulder instability has grown significantly over the past decade. However, few large-scale clinical studies have investigated the clinical and radiographic outcomes of the DTA procedure. PURPOSE To conduct a systematic review and meta-analysis of clinical studies with data on outcomes and complications in patients who underwent the DTA procedure for recurrent anterior shoulder instability with glenoid bone loss. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A comprehensive search of major bibliographic databases was conducted for articles pertaining to the use of a DTA for the management of anterior shoulder instability with associated glenoid bone loss. Postoperative complications and outcomes were extracted and compiled in a meta-analysis. RESULTS Of the 8 included studies with 329 total participants, the mean patient age was 28.1 ± 10.8 years, 192 (83.8%) patients were male, and the mean follow-up was 38.4 ± 20.5 months. The overall complication rate was 7.1%, with hardware complications (3.8%) being the most common. Partial graft resorption was observed in 36.5% of the participants. Recurrent subluxation was reported in 1.2% of the participants, and recurrent dislocation prompting a reoperation was noted in 0.3% of the participants. There were significant improvements in clinical outcomes, including American Shoulder and Elbow Surgeons score (40.9-point increase; P < .01), Single Assessment Numeric Evaluation (47.2-point increase; P < .01), Western Ontario Shoulder Instability Index (49.4-point decrease; P < .01), Disabilities of the Arm, Shoulder and Hand (20.0-point decrease; P = .03), and visual analog scale (2.1-point decrease; P = .05). Additionally, postoperative shoulder range of motion significantly increased from baseline values. CONCLUSION The DTA procedure was associated with a low complication rate, good clinical outcomes, and improved range of motion among patients with anterior shoulder instability and associated glenoid defects.
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Affiliation(s)
- Manjot Singh
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Rory Byrne
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Kenny Chang
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Akash Nadella
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Michael Kutschke
- Department of Orthopaedics, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Tucker Callanan
- Department of Orthopaedics, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Brett D Owens
- Department of Orthopaedics, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Jackson GR, Brusalis CM, Schundler SF, Sachdev D, Obioha OA, McCormick JR, Mameri ES, Kaplan DJ, Knapik DM, Chahla J, Verma NN. Isolated Primary Latarjet Procedures for Anterior Shoulder Instability Results in High Rates of Graft Resorption and Glenohumeral Degenerative Changes With Low Rates of Failure at a Minimum 2-Year Follow-Up: A Systematic Review. Arthroscopy 2024; 40:581-591.e1. [PMID: 37270111 DOI: 10.1016/j.arthro.2023.05.024] [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: 01/25/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To evaluate the incidence of postoperative complications after an isolated primary Latarjet procedure for anterior shoulder instability at a minimum 2-year follow-up. METHODS A systematic review was performed in accordance with 2020 PRISMA guidelines. EMBASE, Scopus, and PubMed databases were queried from database inception through September 2022. The literature search was limited to human clinical studies reporting on postoperative complications and adverse events after a primary Latarjet procedure with a minimum 2-year follow-up. Risk of bias was measured using the Newcastle-Ottawa Scale. RESULTS Twenty-two studies, consisting of 1,797 patients (n = 1,816 shoulders), with a mean age of 24 years were identified. The overall postoperative complication rate ranged from 0% to 25.7%, with the most common complication being persistent shoulder pain (range: 0%-25.7%). Radiological changes included graft resorption (range: 7.5%-100%) and glenohumeral degenerative changes (range: 0%-52.5%). Recurrent instability following surgery was documented in 0% to 35% of shoulders, while the incidence of bone block fractures ranged from 0% to 6% of cases. Postoperative nonunion, infection, and hematomas had a reported incidence rate ranging from 0% to 16.7%, 0% to 2.6%, and 0% to 4.4%, respectively. Overall, 0% to 7.5% of surgeries were reported failures, and 0% to 11.1% of shoulders required reoperation, with a revision rate ranging from 0% to 7.7%. CONCLUSIONS The incidence of complications following the primary Latarjet procedure for shoulder instability was variable, ranging from 0% to 25.7%. High rates of graft resorption, degenerative changes, and nonunion were present while failure and revision rates remained low at a minimum 2-year follow-up. LEVEL OF EVIDENCE Level III, systematic review of Level I-III studies.
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Affiliation(s)
- Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Christopher M Brusalis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Sabrina F Schundler
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Divesh Sachdev
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Obianuju A Obioha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Johnathon R McCormick
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Instituto Brasil de Tecnologia da Saúde, Rio de Janeiro, Brazil; Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Daniel J Kaplan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, Missouri, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Huang D, Ye Z, Wang J, Chen F, Liu H, Huang J. Reconstruction of recurrent shoulder dislocation with glenoid bone defect with 3D-printed titanium alloy pad: outcomes at 2-year minimum follow-up. BMC Musculoskelet Disord 2024; 25:29. [PMID: 38166887 PMCID: PMC10763388 DOI: 10.1186/s12891-023-07148-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To evaluate the outcome of shoulder arthroscopy-assisted implantation of three-dimensional (3D)-printed titanium pads for recurrent shoulder dislocation with glenoid bone defects. METHODS From June 2019 to May 2020, the clinical efficacy of 3D printed titanium pad implantation assisted by shoulder arthroscopy, for the treatment of recurrent shoulder dislocations with shoulder glenoid defects was retrospectively analyzed. The American Shoulder and Elbow Surgeons (ASES) shoulder, Rowe, and Constant scores were recorded before surgery and at 3 months, 6 months, 1 year, and 2 years after surgery. 3D computed tomography (CT) and magnetic resonance imaging were used to evaluate the location of the glenoid pad, bone ingrowth, joint degeneration, and osteochondral damage. RESULTS The mean age of the 12 patients was 21.4 (19-24) years and the mean follow-up time was 27.6 (24-35) months. The Visual Analog Scale score significantly improved from 5.67 ± 1.98 preoperatively to 0.83 ± 0.58 postoperatively (p = 0.012). The postoperative ASES score was significantly increased to 87.91 ± 3.47 compared with preoperative ASES score (46.79 ± 6.45) (p < 0.01). Rowe and Constant scores also improved from 22.5 ± 12.34 and 56.58 ± 7.59 preoperatively to 90.83 ± 4.69 and 90.17 ± 1.89 at 2 years postoperatively, respectively. CT performed 2 years after surgery showed that the pad perfectly replenished the bone-defective part of the shoulder glenoid and restored the articular surface curvature of the shoulder glenoid in the anterior-posterior direction, and the bone around the central riser of the pad was tightly united. Magnetic resonance imaging 2 years after surgery showed that the humeral head osteochondral bone was intact, and there was no obvious osteochondral damage. CONCLUSIONS 3D printed titanium pads are a reliable, safe, and effective surgical procedure for treating recurrent shoulder dislocations with glenoid bone defects.
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Affiliation(s)
- Danlei Huang
- Department of Orthopedics, Chenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army), 94 Wenyuan Road, Siming District, Xiamen City, Fujian Province, 361000, China
| | - Zhiyang Ye
- Department of Orthopedics, Chenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army), 94 Wenyuan Road, Siming District, Xiamen City, Fujian Province, 361000, China
| | - Jun Wang
- Department of Orthopedics, Chenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army), 94 Wenyuan Road, Siming District, Xiamen City, Fujian Province, 361000, China
| | - Feixiong Chen
- Department of Orthopedics, Chenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army), 94 Wenyuan Road, Siming District, Xiamen City, Fujian Province, 361000, China
| | - Haoyuan Liu
- Department of Orthopedics, Chenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army), 94 Wenyuan Road, Siming District, Xiamen City, Fujian Province, 361000, China
| | - Jianming Huang
- Department of Orthopedics, Chenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army), 94 Wenyuan Road, Siming District, Xiamen City, Fujian Province, 361000, China.
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Saeed AZ, Pandit N, Jordan RW, Laprus H, D'Alessandro P, Lo IKY, Malik SS. Open and arthroscopic posterior bone block with iliac crest autograft for posterior shoulder instability - systematic review of clinical and radiological outcomes. Orthop Traumatol Surg Res 2022; 109:103424. [PMID: 36182090 DOI: 10.1016/j.otsr.2022.103424] [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: 02/27/2022] [Revised: 06/17/2022] [Accepted: 07/25/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Posterior shoulder instability (PSI) is a rare and challenging pathology to manage. The aim of this review was to assess and compare whether open and arthroscopic iliac crest bone graft (ICBG) bone block procedures succeeded in improving functional and clinical outcomes as well as radiological outcomes of union and graft resorption. HYPOTHESIS We hypothesised that there will be no difference in recurrence rate and functional outcome between open and arthroscopic procedures but there will be a higher complication rate with open bone block procedures. METHODS A systematic review was conducted in accordance with PRISMA guidelines using the online databases MEDLINE and Embase. The review was registered on the PROSPERO database. Studies of open or arthroscopic ICBG bone block procedures reporting patient reported outcome measures, recurrence, complications and progression to osteoarthritis and radiological outcomes of graft union and resorption were selected. Studies were appraised using the Methodical index for non-randomised studies (MINORS) tool. RESULTS 14 studies satisfied the inclusion criteria; five studies were arthroscopic and nine used open techniques. A total of 183 patients and 201 shoulders were included, mean age was 25 years range (14-75 years). Recurrent instability ranged from 0% to 12.5% for arthroscopic and 0% to 36.4% for open studies. Arthroscopic studies had statistically significant increases in numerous functional outcome scores but there was no evidence for similar improvements in open studies. Osteoarthritis at follow-up ranged from 12.5% to 47% in arthroscopic and 0% to 81.8% for open studies. Arthroscopic complication rate ranged from 6.7% to 75% compared to 0% to 80% for open studies. Majority of complications were metalware related requiring surgical intervention. Partial graft resorption ranged from 7.7-100% after arthroscopic and 4.8-100% after open procedures. High union rates were seen with both open and arthroscopic techniques. CONCLUSION This study highlights a lack of high-level evidence for arthroscopic and open posterior bone block procedures using ICBG to manage PSI. Functional and instability outcome scores showed significant improvement with arthroscopic ICBG bone block procedures however limited evidence was available for open studies. Metalwork related complications requiring revision and radiographic progression to osteoarthritis was high in both arthroscopic and open studies. LEVEL OF EVIDENCE IV, systematic review.
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Affiliation(s)
- Abu Z Saeed
- Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, WR5 1DD Worcester, UK.
| | - Nikhil Pandit
- Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, WR5 1DD Worcester, UK
| | - Robert W Jordan
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, B15 2TH Birmingham, UK
| | - Hubert Laprus
- Saint-Luke's Hospital, Bystrzańska 94B, 43-309 Bielsko-Biała, Poland
| | - Peter D'Alessandro
- Orthopaedic Research Foundation of Western Australia, 25, Queenslea Drive, WA 6010 Claremont, Australia
| | - Ian K Y Lo
- University of Calgary, 2500, University Drive Northwest, AB T2N 1N4 Calgary, Canada
| | - Shahbaz S Malik
- Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, WR5 1DD Worcester, UK
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An BJ, Wang FL, Wang YT, Zhao Z, Wang MX, Xing GY. Arthroscopy with subscapularis upper one-third tenodesis for treatment of recurrent anterior shoulder instability independent of glenoid bone loss. World J Clin Cases 2022; 10:8854-8862. [PMID: 36157632 PMCID: PMC9477058 DOI: 10.12998/wjcc.v10.i25.8854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/16/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recurrent anterior shoulder instability is a common traumatic injury, the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head. The current follow-up study showed that the effect of arthroscopic Bankart repair is unreliable.
AIM To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis for treatment of anterior shoulder instability, and to develop a method to further improve anterior stability and reduce the recurrence rate.
METHODS Between January 2015 and December 2018, male patients with recurrent anterior shoulder instability were selected. One hundred and twenty patients had a glenoid defect < 20% and 80 patients had a glenoid defect > 20%. The average age was 25 years (range, 18–45 years). Patients with a glenoid defect < 20% underwent arthroscopic Bankart repair with a subscapularis upper one-third tenodesis. The patients with a glenoid defect > 20% underwent an arthroscopic iliac crest bone autograft with a subscapularis upper one-third tenodesis. All patients were assessed with Rowe and Constant scores.
RESULTS The average shoulder forward flexion angle was 163.6° ± 8.3° and 171.8° ± 3.6° preoperatively and at the last follow-up evaluation, respectively. The average external rotation angle when abduction was 90° was 68.4° ± 13.6° and 88.5° ± 6.2° preoperatively and at the last follow-up evaluation, respectively. The mean Rowe scores preoperatively and at the last follow-up evaluation were 32.6 ± 3.2 and 95.2 ± 2.2, respectively (P < 0.05). The mean Constant scores preoperatively and at the last follow-up evaluation were 75.4 ± 3.5 and 95.8 ± 3.3, respectively (P < 0.05). No postoperative dislocations were recorded by the end of the follow-up period.
CONCLUSION Arthroscopy with subscapularis upper one-third tenodesis was effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect, enhanced anterior stability of the shoulder, and did not affect postoperative range of motion of the affected limb.
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Affiliation(s)
- Bai-Jing An
- Department of Sports Medicine, The Fourth Medical Center, PLA General Hospital, Beijing 100048, China
| | - Feng-Lin Wang
- Department of Sports Medicine, The Fourth Medical Center, PLA General Hospital, Beijing 100048, China
- Department of Clinical Laboratory, The Third Medical Center, PLA General Hospital, Beijing 100039, China
| | - Yao-Ting Wang
- Department of Sports Medicine, The Fourth Medical Center, PLA General Hospital, Beijing 100048, China
| | - Zhe Zhao
- Department of Sports Medicine, The Fourth Medical Center, PLA General Hospital, Beijing 100048, China
| | - Ming-Xin Wang
- Department of Sports Medicine, The Fourth Medical Center, PLA General Hospital, Beijing 100048, China
| | - Geng-Yan Xing
- Department of Orthopedics, The Third Medical Center, PLA General Hospital, Beijing 100039, China
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Falbo R, Moore A, Singleton A, Steffenson A, Levine J, Miller R. Glenoid bone augmentation: a contemporary and comprehensive systematic review of open procedures. Orthop Rev (Pavia) 2022; 14:37834. [PMID: 36045697 DOI: 10.52965/001c.37834] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction There is a trend towards arthroscopically treating shoulder instability with glenoid deficiency. Despite this, there remains the option for treatment through an open technique. Multiple bone augmentation options are available for recurrent anterior shoulder instability. Objective To provide a systematic review of recent studies for recurrent anterior shoulder instability necessitating glenoid bone augmentation specifically through open procedures using coracoid bone or free bone blocks [iliac crest bone autograft/allograft or distal tibia allograft (DTA)]. Methods PubMed, Cochrane, EMBASE, and Google Scholar were searched for studies reporting open glenoid bone augmentation procedures with iliac crest, tibia, or coracoid bones within 10 years. Extracted data included study/patient characteristics, techniques, prior surgeries, prior dislocations, radiographic findings, range of motion (ROM), recurrent instability, patient-reported outcomes, and complications. Results 92 met inclusion criteria (5693 total patients). Six were studies of iliac crest bone, four of DTA, and 84 using the coracoid bone. 29 studies measured postoperative arthritis showing no development or mild arthritis. 26 studies reported postoperative graft position. 62 studies reported ROM noting decline in internal/external rotation. 87 studies measured postoperative instability with low rates. Rowe Scores with noted improvement across 31/59 (52.5%) studies were seen. Common post operative complications included infection, hematoma, graft fracture, nerve injury, pain, and screw-related irritation. Conclusion Despite a trend towards arthroscopic management of recurrent anterior shoulder instability with glenoid deficiency, open procedures continue to provide satisfactory outcomes. Additionally, studies have demonstrated safe and efficacious use of free bone block graft options in the primary and revision setting.
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Affiliation(s)
- Ryan Falbo
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | - Austin Moore
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | - Amy Singleton
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | | | - Jason Levine
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | - Richard Miller
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
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Jassim SS, Amaranath J, Taylor DM, Warby SA, Hoy G. Unicortical Fixation Does Not Compromise Bony Union in the Latarjet Procedure. JSES Int 2022; 6:555-562. [PMID: 35813149 PMCID: PMC9264013 DOI: 10.1016/j.jseint.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - David McD. Taylor
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
- The Austin Hospital, Melbourne, VIC, Australia
| | - Sarah Ann Warby
- Melbourne Shoulder Group, Melbourne, VIC, Australia
- La Trobe University, Department of Rehabilitation, Nutrition and Sport, Corner of Kingsbury Drive and Plenty Road Bundoora, Melbourne, VIC, Australia
- Corresponding author: Sarah Ann Warby, PhD, B.Physio (Hon), Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Gregory Hoy
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia
- Monash University, Department of Surgery, Melbourne, VIC, Australia
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[Arthroscopic Pushlock anchor fixation with iliac creast bone autograft in the treatment of recurrent anterior shoulder instability with critical bone defect]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:143-148. [PMID: 35172397 PMCID: PMC8863527 DOI: 10.7507/1002-1892.202109044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of arthroscopic Pushlock anchor fixation with iliac creast bone autograft in the treatment of recurrent anterior shoulder instability with critical bone defect. METHODS The clinical data of 80 patients with recurrent anterior shoulder instability with critical bone defect treated by arthroscopic Pushlock anchor fixation with iliac creast bone autograft between January 2016 and January 2019 were retrospectively analyzed. The patients were all male; they were 18-45 years old at the surgery, with an average of 25 years old. The disease duration ranged from 3 months to 5 years, with an average of 2 years. The shoulder joint dislocated 3-50 times, with an average of 8 times. X-ray films, MRI, CT scans and three-dimensional reconstruction of the shoulder were performed before operation. The area of the anterior glenoid defect was 25%-45%, with an average of 27.3%. The shoulder mobility (forward flexion and external rotation in abduction at 90°), the Constant-Murley score, and the Rowe score were used to evaluate the shoulder function before operation and at last follow-up. RESULTS Patients were followed up 1-3 years, with an average of 2 years. No shoulder dislocation occurred again during follow-up. All partial graft absorption occurred after operation, CT scan showed that the graft absorption ratio was less than 30% at 1 week and 3 months after operation. CT three-dimensional reconstruction at 1 year after operation showed that all grafts had healed to the glenoid. The anterior glenoid bone defect was less than 5% (from 0 to 5%, with an average of 3.2%). At last follow-up, the shoulder mobility (forward flexion and external rotation in abduction at 90°), the Constant-Murley score, and the Rowe score significantly improved when compared with preoperative ones ( P<0.05). The shoulder mobility of external rotation in abduction at 90° of the affected side limited when compared with the healthy side [(6.7±5.1)°]. CONCLUSION Arthroscopic Pushlock anchor fixation with iliac creast bone autograft has a good effectiveness in the treatment of recurrent anterior shoulder instability with critical bone defect. The method is relatively simple and the learning curve is short.
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Haratian A, Yensen K, Bell JA, Hasan LK, Shelby T, Yoshida B, Bolia IK, Weber AE, Petrigliano FA. Open Stabilization Procedures of the Shoulder in the Athlete: Indications, Techniques, and Outcomes. Open Access J Sports Med 2021; 12:159-169. [PMID: 34754248 PMCID: PMC8572104 DOI: 10.2147/oajsm.s321883] [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] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022] Open
Abstract
Shoulder instability is a relatively common injury especially in the young athletic population and its surgical management continues to remain a controversial topic in sports medicine orthopedics. Anterior instability is the most common type encountered and is estimated to have an incidence rate of 0.08 per 1000 person-years in the general population; however, this figure is likely higher in the young athletic population. While in recent practice, arthroscopic surgery has become the new gold standard for management, reported failure rates as high as 26% and high recurrence rates in specific subpopulations such as young men in high collision sports have led to the consideration of alternative open procedures such as open Bankart repair, Latarjet, capsular shift, and glenoid bone grafting. These procedures may be preferred in specific patient subgroups such as young athletes involved in contact sports and those with Hill-Sachs defects and multidirectional instability, with postoperative recurrence rates of instability as low as 10%. The purpose of this review is to provide an overview of different open surgical techniques in the management of shoulder instability and summarize patient outcomes including recurrence rates for shoulder instability, return to sport, range of motion (ROM), muscle strength, and complications either individually by procedure or in comparison with other techniques, with special focus on their impact in the athletic population.
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Affiliation(s)
- Aryan Haratian
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Katie Yensen
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Jennifer A Bell
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Laith K Hasan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Tara Shelby
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Brandon Yoshida
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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Malahias MA, Chytas D, Raoulis V, Chronopoulos E, Brilakis E, Antonogiannakis E. Iliac Crest Bone Grafting for the Management of Anterior Shoulder Instability in Patients with Glenoid Bone Loss: a Systematic Review of Contemporary Literature. SPORTS MEDICINE-OPEN 2020; 6:12. [PMID: 32048101 PMCID: PMC7013021 DOI: 10.1186/s40798-020-0240-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/27/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND A number of clinical trials have been published assessing the role of iliac crest bone grafting for the management of recurrent anterior instability with glenoid bone loss in contemporary practice. We therefore performed a systematic review of contemporary literature to examine the effect of iliac crest bone grafting on postoperative outcomes of these patients. Our hypothesis is that contemporary iliac crest bone block techniques are associated with low reoperation and complication rates combined with satisfactory functional results. METHODS The US National Library of Medicine (PubMed/MEDLINE), the Cochrane Database of Systematic Reviews, and EMBASE were searched between January 2008 and December 2019 for relevant publications. RESULTS Following the application of the inclusion-exclusion criteria, nine articles were found eligible for our analysis. In total, 261 patients (mean age range, 25.5-37.5 years; mean follow-up range, 20.6-42 months) were included in the studies of the current review. The mean modified Coleman score was 48.6 (range 37-65), indicating an overall low-to-moderate methodological quality. In the short term, the overall all-cause reoperation rate was 6.1%, while the rate of recurrent instability was 4.8%. The graft non-union rate was 2.2%, while the rate of osteolysis, graft fracture, and infection was 0.4%, 0.9%, and 1.7%, respectively. Finally, hardware-related complications, such as screw breakage or symptomatic mechanical irritation around the screw insertion, occurred in 3.9% of the patients. CONCLUSIONS Iliac crest bone block techniques in contemporary practice are safe and effective in the short-term (< 4 years) follow-up for the management of anterior shoulder instability with substantial glenoid bone deficiency. However, further studies of higher quality and longer follow-up are required to establish the therapeutic value of these techniques as well as to clarify whether there are differences in the outcomes of arthroscopic and open iliac crest bone block procedures.
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Affiliation(s)
| | - Dimitrios Chytas
- 2nd Orthopaedic Department, School of Medicine, National & Kapodistrian University of Athens, Agias Olgas 3, Nea Ionia, 14233, Athens, Greece
| | - Vasileios Raoulis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Efstathios Chronopoulos
- 2nd Orthopaedic Department, School of Medicine, National & Kapodistrian University of Athens, Agias Olgas 3, Nea Ionia, 14233, Athens, Greece
| | - Emmanouil Brilakis
- 3rd Orthopaedic Department, Hygeia Hospital, Erythrou Stavrou 4, Marousi, 15123, Athens, Greece
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Arthroscopic Bone Block Cerclage: A Fixation Method for Glenoid Bone Loss Reconstruction Without Metal Implants. Arthrosc Tech 2019; 8:e1591-e1597. [PMID: 31890542 PMCID: PMC6928368 DOI: 10.1016/j.eats.2019.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/16/2019] [Indexed: 02/03/2023] Open
Abstract
Large glenoid bone loss defects are associated with higher failure rates after arthroscopic Bankart repair in cases of glenohumeral anterior instability, further necessitating bone graft reconstruction. Because most techniques use strong initial fixation using metal devices, bone graft resorption considered to be closely related to the presence of metal components is a potential shortcoming of these techniques. We describe an arthroscopic technique for anatomical reconstruction of the glenoid that uses a tricortical iliac crest with a metal-free fixation method using 2 ultra-high-strength sutures (FiberTape Cerclage System; Arthrex, Naples, FL), which provide substantial stability to the graft, and finishing with a capsulolabral reconstruction.
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