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Cao S, Ding N, Zan Q, Lu J, Li Y, Tian F, Xu J. Autologous osteoperiosteal transplantation is effective in the treatment of single cystic osteochondral lesions of the talus and the prognostic impact of age should be emphasized. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38819934 DOI: 10.1002/ksa.12301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE To investigate the clinical efficacy and prognostic factors associated with autologous osteoperiosteal transplantation for the treatment of single cystic osteochondral lesions of the talus (OLT). METHODS The clinical data of patients with single cystic OLT undergoing autologous osteoperiosteal transplantation at the Department of Foot and Ankle Surgery of our hospital between 2018 and 2022, including complete follow-up, were retrospectively analyzed. Imaging data from each patient were imported into Mimics software to measure the surface area, volume and depth of the lesions. Then, the talus nine-compartment partitioning method was used to partition the injury site. Preoperative and final follow-up assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) for pain and 36-item Short-Form Health Survey (SF-36) to evaluate treatment efficacy and analyze prognostic factors. RESULTS Of the 31 patients with single cystic OLT with a complete set of follow-up data, there were 17 males and 14 females, with a mean age of 43.3 ± 13.6 years, a mean follow-up time of 30.1 ± 14.0 months and a mean illness duration of 30.4 ± 20.0 months. The postoperative final follow-up AOFAS score was 90.7 ± 5.5; this represented significant improvement when compared to the preoperative score of 57.0 ± 8.5 (P < 0.001). The final postoperative follow-up VAS score was 18.5 ± 8.3; this was significantly better than the preoperative score of 57.8 ± 8.7 (P < 0.001). The physical component summary (PCS) score and mental component summary (MCS) score on the SF-36 scale showed significant improvement at the final postoperative follow-up when compared to preoperative scores (p < 0.001). No other complications were observed during follow-up, such as wound infection or pain at the donor site. One of the patients showed less improvement, which may be related to premature weight-bearing or re-sprained ankle after surgery. There was no significant correlation between the duration of illness, gender and the location, depth, surface area and volume of the OLT and the postoperative scores. However, patient age showed a significant negative correlation with the postoperative SF-36 PCS and MCS scores. CONCLUSION Autologous osteoperiosteal transplantation for single cystic OLT demonstrated good clinical efficacy with a low incidence of complications. Furthermore, age represents an important factor influencing prognosis. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- ShiHang Cao
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Nan Ding
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qiang Zan
- Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi, China
| | - Jun Lu
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yi Li
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Feng Tian
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - JunKui Xu
- Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Fares MY, Boufadel P, Daher M, Koa J, Khanna A, Abboud JA. Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes. Clin Orthop Surg 2023; 15:521-533. [PMID: 37529197 PMCID: PMC10375816 DOI: 10.4055/cios23018] [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: 01/16/2023] [Revised: 03/15/2023] [Accepted: 04/16/2023] [Indexed: 08/03/2023] Open
Abstract
The shoulder, being the most mobile joint in the human body, is often susceptible to dislocations and subluxations more so than other joints. As such, shoulder instability constitutes a common complaint among patients worldwide, especially those who are young, participate in contact sports, and have increased innate flexibility in their joints. Management options in the setting of instability vary between conservative and surgical options that aim to mitigate symptoms and allow return of function. Surgical options can be arthroscopic and open, with a general shift among surgeons towards utilizing arthroscopic surgery in the past several decades. Nevertheless, open procedures still play a role in managing shoulder instability patients, especially those with significant bone loss, recurrent instability, coexisting shoulder pathologies, and high risk of failure with arthroscopic surgery. In these clinical settings, open procedures, like the Latarjet procedure, open Bankart repair, glenoid bone augmentation using iliac crest autograft or distal tibial allograft, and salvage options like glenohumeral arthrodesis and arthroplasty may show good clinical outcomes and low recurrence rates. Each of these open procedures possesses its own set of advantages and disadvantages and entails a specific set of indications based on published literature. It is important to cater treatment options to the individual patient in order to optimize outcomes and reduce the risk of complications. Future research on open shoulder stabilization procedures should focus on the long-term outcomes of recently utilized procedures, investigate different graft options for procedures involving bone augmentation, and conduct additional comparative analyses in order to establish concrete surgical management guidelines.
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Affiliation(s)
- Mohamad Y. Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Peter Boufadel
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Mohammad Daher
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Jonathan Koa
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Akshay Khanna
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A. Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Boileau P, Jettoo P, Lacouture JD. Arthroscopic Remnant Coracoid Autograft for Revision of the Failed Latarjet Procedure With Persistent Glenoid Bone Loss. Arthrosc Tech 2023; 12:e923-e930. [PMID: 37424657 PMCID: PMC10323830 DOI: 10.1016/j.eats.2023.02.028] [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: 09/23/2022] [Accepted: 02/12/2023] [Indexed: 07/11/2023] Open
Abstract
Recurrence of anterior instability after a Latarjet procedure with persistent glenoid bone loss can be related to coracoid bone block resorption, migration, or malposition. Multiple options are available to address anterior glenoid bone loss, including autograft bone transfers (such as iliac crest graft, distal clavicle autograft) or allografts (distal tibia allograft). Here, we present the use of the remnant coracoid process as an option for consideration in the treatment of glenoid bone loss after failed Latarjet procedure with persistent glenoid bone loss. The remnant coracoid autograft is harvested and transferred inside the glenohumeral joint, through the rotator interval, and fixed using cortical buttons. This arthroscopic procedure includes using 1) glenoid and coracoid drilling guides to optimize graft positioning and making the procedure more reproducible and safer and 2) a suture tensioning device to provide intraoperative graft compression and ensure bone graft healing.
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Affiliation(s)
- Pascal Boileau
- Address correspondence to Pascal Boileau, M.D., Ph.D., ICR - Institut de Chirurgie Réparatrice Locomoteur & Sport, Groupe Kantys, Nice, France.
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Li X, Yan X, Xie Q, Gu R, Wang Z, Liu F, Sui L, Yu C, Wang P. Medial Soft tissue and medial malleolus loss-the posterior tibial artery perforator technique combined with iliac crest autograft to Stabilize the ankle and cover Soft tissue defect: A case Series. J Orthop Surg (Hong Kong) 2022; 30:10225536221111588. [PMID: 35982606 DOI: 10.1177/10225536221111588] [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: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate clinical efficacy of posterior tibial artery perforator technique combined with iliac crest autograft in treatment of medial soft tissue and medial malleolus loss. METHODS This study involved 11 cases of medial soft tissue and medial malleolus loss from October 2011 to March 2016. Patients were treated with posterior tibial artery perforator technique combined with iliac crest autograft, and given routine treatment, such as rehydration, anti-inflammation, anticoagulation and vasodilation. Ankle function of patients was evaluated according to the American Orthopedic foot and ankle Association (AOFAS) ankle-hind foot scoring system. RESULTS All flaps survived without bone exposure, and the appearance of skin flaps was satisfactory. There was one case of arterial crisis, one case of venous crisis, one case of skin edge necrosis and one case of incision infection. Wounds of the above patients were healed. Skin flap was soft and elastic without secondary contracture. The two-point discrimination of skin flap was 5-11 mm. The ankle range of motion was 10-60°. X-Ray showed that grafts healed within 8.6 months. According to AOFAS evaluation, four cases were excellent, four cases were good, and three cases were poor. The excellent and good rate was 72.8%. CONCLUSIONS In this study, posterior tibial artery perforator technique combined with iliac crest autograft was used to treat medial soft tissue and medial malleolus loss. The findings demonstrated that this treatment was reliable and efficacious.
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Affiliation(s)
- Xiaodong Li
- Department of Hand Foot Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Xiaowei Yan
- Department of Critical Care, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Qiang Xie
- Department of Hand Foot Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Rui Gu
- Department of Orthopedic Trauma, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Zhixue Wang
- Department of Anesthesiology, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Fei Liu
- Department of Hand Foot Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Lei Sui
- Department of Hand Foot Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Changyu Yu
- Department of Hand Foot Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Pei Wang
- Department of Hand Foot Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China
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Implant-free iliac crest bone graft procedure shows anatomic remodelling without redislocation in recurrent anterior shoulder instability after short-term follow-up. Arch Orthop Trauma Surg 2022; 142:1047-1054. [PMID: 33486557 DOI: 10.1007/s00402-021-03777-4] [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: 10/10/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION With the help of a J-shaped bicortical iliac crest bone graft, the morphology of the glenoid can be augmented without having to use screws to achieve glenohumeral stability. The aim of this retrospective clinical study was to evaluate the clinical stability and function of the shoulder joint as well as the radiological remodelling process and arthropathic outcomes following the J-bone graft technique. MATERIALS AND METHODS 34 patients with recurrent shoulder dislocations and bony glenoid defects were treated with the J-bone graft technique between 2010 and 2018 at our level-I trauma centre. 15 patients (18 shoulders) could be recruited for the study. Pain levels, ASES, UCLA, SST, DASH, Rowe and WOSI Scores were collected using questionnaires. In 13 patients (16 shoulders) the Constant Score, ROM, CT with 3D reconstruction of the glenoid to assess the graft remodelling and X-rays were performed additionally. RESULTS None of the patients suffered subluxations or recurrent dislocations during the follow-up period. The overall complication rate was 11%. The evaluation using objective and subjective shoulder function scores yielded good-to-excellent results. Radiological assessment at follow-up showed a low rate of moderate-to-severe arthritis (12%) and a high rate of shoulders without any signs of arthritic degeneration (53%). The CT scans all revealed an almost complete restoration of the glenoid with none of the grafts being resorbed. A rise in the average glenoid circumference and glenoid area could be demonstrated between preoperative measurements (81.6 and 82.4%, respectively) and follow-up measurements (104 and 102.5%, respectively). CONCLUSION The results of this study show a successful stabilisation of the shoulder joint and a low complication rate following the J-bone graft technique. Remodelling of the bone graft could be demonstrated, which in turn led to an almost perfect glenoid surface area of 100%.
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Arthroscopic Distal Clavicular Autograft for Congruent Glenoid Reconstruction. Arthrosc Tech 2021; 10:e2389-e2395. [PMID: 34868839 PMCID: PMC8626581 DOI: 10.1016/j.eats.2021.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/02/2021] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic distal clavicular autograft (DCA) is effective in shoulder instability with glenoid bone loss. The original technique uses an osteochondral autograft, fixed with screws or suture anchors. We developed a modified procedure called "congruent arc DCA" characterized by (1) use of drilling guides to optimize graft positioning and make the all-arthroscopic procedure safer and reproducible; (2) rotation of the DCA of 90° to reach a congruent arc with its undersurface; (3) fixation of the graft with cortical buttons to simplify its intra-articular passage, avoid hardware problems, and facilitate possible revision surgery; and (4) intraoperative use of a suture tensioner to achieve satisfactory compression of the graft and increase its consolidation.
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Boehm E, Minkus M, Moroder P, Scheibel M. Arthroscopic iliac crest bone grafting in recurrent anterior shoulder instability: minimum 5-year clinical and radiologic follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29:266-274. [PMID: 32285158 PMCID: PMC7862210 DOI: 10.1007/s00167-020-05986-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 04/07/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the clinical and radiologic mid- to long-term results of arthroscopic iliac crest bone-grafting for anatomic glenoid reconstruction in patients with recurrent anterior shoulder instability. METHODS Seventeen patients were evaluated after a minimum follow-up of 5 years. Clinical [range of motion, subscapularis tests, apprehension sign, Subjective Shoulder Value (SSV), Constant Score (CS), Rowe Score (RS), Walch Duplay Score (WD), Western Ontario Shoulder Instability Index (WOSI)], and radiologic [X-ray (true a.p., Bernageau and axillary views) and computed tomography (CT)] outcome parameters were assessed. RESULTS Fourteen patients [mean age 31.1 (range 18-50) years] were available after a follow-up period of 78.7 (range 60-110) months. The SSV averaged 87 (range 65-100) %, CS 94 (range 83-100) points, RS 89 (range 30-100) points, WD 87 (range 25-100) points, and WOSI 70 (range 47-87) %. The apprehension sign was positive in two patients (14%). One patient required an arthroscopic capsular plication due to a persisting feeling of instability, while the second patient experienced recurrent dislocations after a trauma, but refused revision surgery. CT imaging showed a significant increase of the glenoid index from preoperative 0.8 ± 0.04 (range 0.7-0.8) to 1.0 ± 0.11 (range 0.8-1.2) at the final follow-up (p < 0.01). CONCLUSION Arthroscopic reconstruction of anteroinferior glenoid defects using an autologous iliac crest bone-grafting technique yields satisfying clinical and radiologic results after a mid- to long-term follow-up period. Postoperative re-dislocation was experienced in one (7.1%) of the patients due to a trauma and an anatomic reconstruction of the pear-shaped glenoid configuration was observed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Elisabeth Boehm
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marvin Minkus
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Philipp Moroder
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Department of Shoulder and Elbow Surgery, Schulthess Clinic Zurich, Zurich, Switzerland.
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Lin D, Cai B, Wang L, Cai L, Wang Z, Xie J, Lv QX, Yuan Y, Liu C, Shen SGF. A viscoelastic PEGylated poly(glycerol sebacate)-based bilayer scaffold for cartilage regeneration in full-thickness osteochondral defect. Biomaterials 2020; 253:120095. [DOI: 10.1016/j.biomaterials.2020.120095] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
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Sigrist B, Ferguson S, Boehm E, Jung C, Scheibel M, Moroder P. The Biomechanical Effect of Bone Grafting and Bone Graft Remodeling in Patients With Anterior Shoulder Instability. Am J Sports Med 2020; 48:1857-1864. [PMID: 32437213 DOI: 10.1177/0363546520919958] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Individual constitutional differences in glenoid shape and bone remodeling require a patient-specific and longitudinal approach to evaluate the biomechanical effects of glenoid bone grafting in patients with anterior shoulder instability. PURPOSE To quantify the longitudinal, in vivo, biomechanical effects of bone grafting, bone graft remodeling, and glenoid shape in patients with anterior shoulder instability by means of patient-specific finite element models. STUDY DESIGN Descriptive laboratory study. METHODS In total, 25 shoulders of 24 patients with anterior shoulder instability and anterior glenoid bone loss underwent an arthroscopic iliac crest bone graft transfer (ICBGT) procedure with either autologous or allogenic bone. Patient-specific finite element simulations based on preoperative, postoperative, and follow-up computed tomography scans were used to quantify the bone-mediated stability ratio (SR) and the distance to dislocation. Additionally, the relationship between glenoid morphological parameters and the SR was assessed. RESULTS The ICBGT procedure significantly increased the SR and distance to dislocation in the 2-, 3-, and 4-o'clock directions immediately after the surgical intervention (P < .01) in both the autograft and the allograft groups. Although the SR and distance to dislocation decreased subsequently, autografts showed long-term effects on SR and dislocation distance in the 3-o'clock direction (P < .01) and on SR in the 4-o'clock direction (P < .01). Allografts showed no significant effect on SR and dislocation distance in long-term follow-up (P > .05). Overall, glenoid retroversion as well as cavity depth predicted stability in all 4 dislocation directions, with glenoid cavity depth showing the highest correlation coefficients (R = 0.71, 0.8, 0.73, and 0.7 for 2-, 3-, 4-, and 5-o'clock, respectively). CONCLUSION The autologous ICBGT procedure biomechanically improved anterior shoulder stability in long-term follow-up, whereas the use of allografts did not show any bone-mediated biomechanical effect at follow-up due to resorption. Furthermore, in addition to measurements of defect extent, the glenoid depth and version seem to be useful parameters to determine the biomechanical effect and need for glenoid bone grafting in patients with shoulder instability. CLINICAL RELEVANCE This study proposes the use of autologous bone grafts for a successful long-term stabilization effect. Additionally, this study proposes additional glenoid morphological measures to predict shoulder stability.
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Affiliation(s)
- Bastian Sigrist
- Laboratory for Orthopaedic Technology, ETH Zürich, Zürich, Switzerland
| | - Stephen Ferguson
- Laboratory for Orthopaedic Technology, ETH Zürich, Zürich, Switzerland.,Department of Shoulder and Elbow Surgery, Schulthess Clinic Zürich, Zürich, Switzerland
| | - Elisabeth Boehm
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Christian Jung
- Department of Shoulder and Elbow Surgery, Schulthess Clinic Zürich, Zürich, Switzerland
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Schulthess Clinic Zürich, Zürich, Switzerland.,Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Philipp Moroder
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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Haeni DL, Lafosse T, Haggerty C, Plath J, Kida Y, Sanchez-Brass M, Wolf F, Calvo E, Müller AM, Barbero A, Lafosse L. Tissue on the Transferred Coracoid Graft After Latarjet Procedure: Histological and Morphological Findings. Am J Sports Med 2019; 47:704-712. [PMID: 30716278 DOI: 10.1177/0363546518819825] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior shoulder instability is a debilitating condition that can require stabilization via a Latarjet procedure. PURPOSE The aim of this study was to characterize the histological composition of the articular-sided surface of the coracoid bone graft after Latarjet procedure. Specific features of cells isolated from the coracoid and graft tissues were assessed. STUDY DESIGN Case series; Level of evidence, 4. METHODS Tissue samples were harvested from 9 consecutive patients undergoing arthroscopic debridement and screw removal after arthroscopic or open Latarjet procedure. Tissues were processed histologically. In 2 patients, the samples were analyzed to assess specific cellular properties. RESULTS Safranin O staining indicated that glenoid tissues contained variable amounts of glycosaminoglycan (GAG) and round chondrocytic cells mainly organized in clusters. Graft tissues contained less GAG and were more cellular but were not organized in clusters and had variable morphological features. An association appeared to exist between the cartilage quality of glenoid tissues and that of the graft tissues. Cells isolated from glenoid and graft tissues exhibited similar proliferation capacity. CONCLUSION The results of our analysis show that cells located at the articular-sided surface of transferred coracoid grafts demonstrate fibrocartilaginous properties and may have the capacity for chondral proliferation. Further studies are needed to confirm this observation and future application.
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Affiliation(s)
- David L Haeni
- Orthopaedic Department, Children's Hospital, University of Basel, Basel, Switzerland
| | | | | | | | - Yoshikazu Kida
- Pioneer Peek Orthopedics, Palmer, Alaska, USA.,Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Françine Wolf
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Emilio Calvo
- Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Madrid, Spain
| | - Andreas M Müller
- Orthopaedic Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrea Barbero
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
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Moroder P, Plachel F, Becker J, Schulz E, Abdic S, Haas M, Resch H, Auffarth A. Clinical and Radiological Long-term Results After Implant-Free, Autologous, Iliac Crest Bone Graft Procedure for the Treatment of Anterior Shoulder Instability. Am J Sports Med 2018; 46:2975-2980. [PMID: 30207741 DOI: 10.1177/0363546518795165] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The implant-free, autologous, iliac crest bone graft procedure (J-bone graft) for the treatment of anterior shoulder instability shows low rates of recurrent dislocations and moderate progression of instability arthropathy in the midterm follow-up. PURPOSE To analyze the clinical and radiological long-term results of the J-bone graft procedure. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 46 patients (47 shoulders) with anterior shoulder instability and a relevant bony glenoid defect who received a J-bone graft between 1993 and 2000 and who were previously subjected to a midterm follow-up (mean, 8 years) were included. In total, 34 patients and 35 shoulders (74%) were clinically and radiologically assessed after a mean follow-up of 18 years (range, 15-23 years). Patients were assessed in terms of pain, bilateral active range of motion, and strength; in addition, the Western Ontario Shoulder Instability Index (WOSI), the Rowe Score, and the Subjective Shoulder Value (SSV) were obtained. Both an apprehension test and a relocation test were performed. Radiological imaging included bilateral radiographs (true anteroposterior and axillary view) to determine the grade of instability arthropathy. RESULTS At final follow-up, a mean WOSI score of 295 (range, 0-1765), Rowe Score of 94 (range, 55-100), SSV of 90% (range, 20%-100%), and pain level of 0.5 (range, 0-4) were noted. Slight differences were detected in active range of motion between the affected and the contralateral side: flexion 178° vs 179° ( P = .325), abduction 177° vs 179° ( P = .225), external rotation 63° vs 67° ( P = .048), high external rotation 77° vs 82° ( P = .007), internal rotation 8.8 vs 9.4 points ( P = .017), and high internal rotation 70° vs 74° ( P = .026). No significant strength deficit of the affected side was noticed. In 1 patient, a traumatic redislocation with fracture of the bone graft was observed 6 weeks after index surgery. No further recurrences were found during the follow-up period. Negative apprehension and relocation tests were confirmed in 77% of the shoulders, while 23% were positive. At final follow-up, 9 shoulders showed no signs of instability arthropathy (26%), mild arthropathy was revealed in 22 shoulders (63%), moderate arthropathy was noted in 3 shoulders (9%), and signs of severe arthropathy were found in 1 shoulder (3%) (collective instability arthropathy score, 0.9). The collective instability arthropathy score on the contralateral side was 0.4 ± 0.8 with no instability arthropathy in 24 shoulders (69%), mild arthropathy in 8 shoulders (23%), moderate signs of arthropathy in 2 shoulders (6%), and severe arthropathy in 1 shoulder (3%) at the time of follow-up examination (collective instability arthropathy score, 0.4). The overall difference between affected shoulders and contralateral shoulders was significant ( P = .005). CONCLUSION The J-bone graft procedure for the treatment of recurrent anterior shoulder instability shows excellent results regarding stability and function after a mean follow-up period of 18 years. However, the development of instability arthropathy of the affected shoulder is not prevented by this procedure.
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Affiliation(s)
- Philipp Moroder
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Germany
| | - Fabian Plachel
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Germany.,Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Johannes Becker
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Eva Schulz
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Shejla Abdic
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Maximilian Haas
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Herbert Resch
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Alexander Auffarth
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
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Anderl W, Heuberer P, Resch H, Ernstbrunner L. Authors' Response to the Editorial Commentary "Is Arthroscopic Bone Grafting Nearly Equivalent to Open Bone Grafting for Glenoid Bone Defects in Recurrent Anterior Shoulder Instability?" by Matthew T. Provencher. Arthroscopy 2018; 34:1752-1754. [PMID: 29804598 DOI: 10.1016/j.arthro.2018.04.002] [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: 03/07/2018] [Accepted: 04/04/2018] [Indexed: 02/02/2023]
Affiliation(s)
| | | | - Herbert Resch
- Paracelsus Medical University Salzburg, Salzburg, Austria
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