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Wang D, Ni J, Wang D, Wei W, Li R, Feng M, Shi Z. Arthroscopic Autologous Iliac Bone Grafting With Double-Row Elastic Fixation and Double Antirotating Anchors for Recurrent Anterior Shoulder Dislocation With Massive Glenoid Bone Defect. Arthrosc Tech 2024; 13:102961. [PMID: 38835459 PMCID: PMC11144960 DOI: 10.1016/j.eats.2024.102961] [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: 10/31/2023] [Accepted: 01/16/2024] [Indexed: 06/06/2024] Open
Abstract
The management of recurrent anterior shoulder dislocations with massive glenoid bone defects typically involves arthroscopic intervention. Autologous iliac bone grafting with double-row elastic fixation reportedly yields excellent outcomes. In this article, we introduce a specialized technique for iliac bone grafting that uses double-row elastic fixation and double antirotating anchors. Implementation of this technique prevents the occurrence of iliac graft rotation.
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Affiliation(s)
- Dazhi Wang
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
| | - Jianlong Ni
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
| | - Dongjian Wang
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
| | - Wang Wei
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
| | - Ruiying Li
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
| | - Meng Feng
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
| | - Zhibin Shi
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Jiaotong University, Shaanxi, China
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Zhao L, Fu C, Lu M, He L, Shen Z, Xing J, Wang C, Hou S. Remodeling process and clinical outcomes following all-arthroscopic modified Eden-Hybinette procedure using iliac crest autograft and 1-tunnel double Endobutton fixation system. J Shoulder Elbow Surg 2023; 32:1825-1837. [PMID: 36907316 DOI: 10.1016/j.jse.2023.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Arthroscopically modified Eden-Hybinette procedures for glenohumeral stabilization have been used for a long time. With the advancement of arthroscopic techniques and the development of sophisticated instruments, a double Endobutton fixation system has been used clinically to secure bone graft to the glenoid rim placed through a specifically designed guide. The purpose of this report was to evaluate clinical outcomes and serial glenoid remodeling process following all-arthroscopic anatomical glenoid reconstruction using autologous iliac crest bone grafting technique through 1-tunnel fixation. METHODS Forty-six patients with recurrent anterior dislocations and significant glenoid defects greater than 20% underwent arthroscopic surgery with a modified Eden-Hybinette technique. Instead of firm fixation, autologous iliac bone graft was fixed to the glenoid by double Endobutton fixation system through 1-tunnel placed in the glenoid surface. Follow-up examinations were performed at 3, 6, 12, and 24 months. The patients were followed up for a minimum of two years using the Rowe score, the Constant score, the Subjective Shoulder Value, and the Walch-Duplay score; patient satisfaction with the procedure outcome was also rated. Graft positions, healing, and absorption were evaluated postoperatively with computed tomography imaging. RESULTS At a mean follow-up of 28 months, all patients were satisfied and had a stable shoulder. The Constant score improved from 82.9 to 88.9 points (P < .001), the Rowe score, improved from 25.3 to 89.1 points (P < .001), the Subjective Shoulder Value improved from 31% to 87% (P < .001), and the Walch-Duplay score improved from 52.5 to 85.7 points (P < .001). One donor-site fracture occurred during the follow-up period. All grafts were well-positioned and achieved optimal bone healing with zero excessive absorption. The preoperative glenoid surface (72.6% ± 4.5%) increased significantly immediately after surgery to 116.5% ± 9.6% (P < .001). After a physiological remodeling process, the glenoid surface remained significantly increased at the last follow-up (99.2% ± 7.1%) (P < .001). The glenoid surface area appeared to decrease serially when compared between the first 6 months and 12 months postoperatively, while there was no significant interval change between 12 and 24 months postoperatively. CONCLUSION Patient outcomes were satisfactory following the all-arthroscopic modified Eden-Hybinette procedure using an autologous iliac crest grafting technique through one-tunnel fixation system with double Endobutton. Graft absorption mostly occurred on the edge and outside the ''best-fit'' circle of the glenoid. Glenoid remodeling occurred within the first year after all-arthroscopic glenoid reconstruction with an auto iliac bone graft.
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Affiliation(s)
- Lilian Zhao
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China.
| | - Chuying Fu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingfeng Lu
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China; Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lilei He
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Zhaoxiong Shen
- 6th Department of Orthopaedics, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Jisi Xing
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Changbing Wang
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Senrong Hou
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
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Levin JM, Whitlock KG, Warren E, Klifto CS, Anakwenze O. Arthroscopic Distal Clavicle Bone Block Technique for Anteroinferior Instability With Critical Bone Loss. Arthrosc Tech 2023; 12:e787-e794. [PMID: 37424640 PMCID: PMC10323972 DOI: 10.1016/j.eats.2023.02.055] [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: 10/16/2022] [Accepted: 02/08/2023] [Indexed: 07/11/2023] Open
Abstract
Arthroscopic distal clavicle autograft represents a locally available source of autograft for bone block augmentation in patients with anterior shoulder instability with glenoid bone loss. Anatomic and biomechanical studies have supported distal clavicle autograft use as comparable to coracoid graft with regard to restoration of glenoid articular surface, with the theoretical advantage of minimizing complications associated with coracoid transfer procedures, such as neurologic injury and coracoid fracture. The current technique describes a modification of those previously described, including a mini-open approach for distal clavicle autograft harvest, orientation of the distal clavicle with the medial clavicle graft against the glenoid (congruent arc), an all-arthroscopic technique of graft passage, and graft placement and fixation using specialized drill guides and four suture buttons to reproducibly place and secure the graft with final capsulolabral advancement over the graft to render it extra-articular.
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Affiliation(s)
- Jay M. Levin
- Address correspondence to Jay M. Levin, M.D., M.B.A., Department of Orthopaedic Surgery, Duke University, School of Medicine, 3475 Erwin Rd., Durham, NC, 27705, U.S.A.
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Xu J, Wu C, Han K, Zhang X, Ye Z, Jiang J, Yan X, Su W, Zhao J. Radiological and Histological Analyses of Nonrigid Versus Rigid Fixation for Free Bone Block Procedures in a Rabbit Model of Glenoid Defects. Am J Sports Med 2023; 51:743-757. [PMID: 36752692 DOI: 10.1177/03635465221145695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Nonrigid fixation techniques have been recently introduced in free bone block (FBB) procedures to treat substantial glenoid bone loss in patients with anterior shoulder instability. However, the radiological and histological effectiveness of nonrigid fixation versus conventional rigid fixation have not been comprehensively understood in vivo. PURPOSE To (1) explore the radiological and histological characteristics of nonrigid fixation for FBB procedures in a rabbit model of glenoid defects and (2) further compare them with those of conventional rigid fixation. STUDY DESIGN Controlled laboratory study. METHODS Unilateral shoulder glenoid defects were created in 36 mature New Zealand White rabbits, of which 24 underwent FBB procedures using allogenic iliac crest bone and were randomly divided into rigid fixation (RF) and nonrigid fixation (N-RF) groups, with the remaining divided into 2 control groups: 6 with sham surgery for glenoid defects (GD group) and 6 native glenoids (normal group). In the RF and N-RF groups, 6 rabbits were sacrificed at 6 or 12 weeks postoperatively for radiological and histological analyses of the reconstructed glenoid, and all rabbits in the GD and normal groups were sacrificed at 12 weeks. The radiological glenoid morphology was evaluated via micro-computed tomography. Moreover, the graft-glenoid healing and graft remodeling processes were determined using histological staining. RESULTS At 6 weeks, both the N-RF and RF groups had similarly improved radiological axial radian and en face area of the glenoid compared with the GD group, but the N-RF group showed superiority in restoration of the glenoid radian and area compared with the RF group at 12 weeks, with the native glenoid as the baseline. Histologically, the bone graft in both groups was substantively integrated into the deficient glenoid neck at 6 and 12 weeks, showing similar osseous healing processes at the graft-glenoid junction. Moreover, the bone graft histologically presented similar regenerated vascular density, total graft bone, and integrated graft bone in both groups. In contrast, the N-RF group had a different remodeling profile on radiological and histological analyses regarding regional bone resorption, mineralization, and fibrous tissue replacement during osseointegration. CONCLUSION Compared with rigid fixation, nonrigid fixation resulted in superior reconstructed glenoid morphology radiologically and similar graft-glenoid osseous healing histologically, showing different graft remodeling profiles of regional bone resorption, mineralization, and fibrous tissue replacement. CLINICAL RELEVANCE The nonrigid fixation technique can be feasible for FBB procedures to treat glenoid bone loss in anterior shoulder instability. More clinical evidence is required to determine its pros and cons compared with conventional rigid fixation.
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Affiliation(s)
- Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kang Han
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueying Zhang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyu Yan
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lubowitz JH, Brand JC, Rossi MJ. Early Treatment of Shoulder Pathology Is Necessary but Not Enough Is Being Performed. Arthroscopy 2022; 38:2943-2953. [PMID: 36344053 DOI: 10.1016/j.arthro.2022.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Delayed treatment of shoulder instability results in bone loss requiring more-complicated surgery, in turn resulting in less-optimal outcomes. Similarly, delayed treatment of repairable rotator cuff tears results in irreparable tears requiring more-complicated surgery and resulting in less-optimal outcomes. Delayed treatment of shoulder pathology is a problem. Solutions include education and research investigation.
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Rattier S, Druel T, Hirakawa Y, Gröger F, van Rooij F, Neyton L. Use of Cannulated Screws for Primary Latarjet Procedures. Orthop J Sports Med 2022; 10:23259671221117802. [PMID: 36051974 PMCID: PMC9425914 DOI: 10.1177/23259671221117802] [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: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background Rapid consolidation of the bone block is paramount for the success of the Latarjet procedure. Noncannulated screws have shown satisfactory long-term bone block fusion, while cannulated screws are challenged with inferior mechanical properties and fusion rates. Purpose To report outcomes of the Latarjet procedure using cannulated screws, notably bone block fusion and complication rates at 3 months, as well as clinical scores and return to sports at minimum 2 years postoperatively. Study Design Case series; Level of evidence, 4. Methods We reviewed the records of 124 consecutive patients (124 shoulders) who underwent primary Latarjet procedures using cannulated screws between 2015 and 2018. All patients underwent clinical examination at 3 months postoperatively, including range of motion and radiographs to assess graft fusion. The Walch-Duplay score, Rowe score, Subjective Shoulder Value, and visual analog scale for pain were collected at a minimum follow-up of 2 years. Results Overall, 9 patients (7%) required reoperation: 7 (6%) had screw removal for unexplained residual pain, 1 (0.8%) had lavage for deep infection, and 1 (0.8%) had evacuation to treat a hematoma. Furthermore, 3 patients (2.4%) had recurrent instability, none of whom underwent reoperation. At 3-month follow-up, all 124 shoulders showed complete radiographic graft fusion, and at 40 ± 11 months (mean ± SD; range, 24-64 months), 88% of patients had returned to sport (109/124), the Walch-Duplay score was 86 ± 14, Rowe was 84 ± 15, Subjective Shoulder Value was 88 ± 11, and visual analog scale for pain was 1 ± 1. Conclusion The clinical relevance of these findings is that 4.5-mm cannulated screws are safe and effective for primary Latarjet procedures and grant adequate graft healing, with low recurrence of instability and a high rate of return to sports.
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Affiliation(s)
- Simon Rattier
- Department of Orthopedic and Trauma Surgery, SOS Mains, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France
| | - Thibaut Druel
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France
| | - Yoshihiro Hirakawa
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Falk Gröger
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Ramsay Santé, Lyon, France
| | | | - Lionel Neyton
- Department of Orthopedic and Trauma Surgery, SOS Mains, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France
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