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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Waterman B. Editorial Commentary: Buttoning Up After Recurrent Anterior Shoulder Instability: The Eden-Hybinette Procedure Is an Effective Salvage After Failed Latarjet. Arthroscopy 2022; 38:1134-1136. [PMID: 35369916 DOI: 10.1016/j.arthro.2021.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 02/02/2023]
Abstract
Operative management of anterior glenohumeral dislocation can confer significant improvements in subjective shoulder function, pain, and overall stability. Although the coracoid-based Latarjet procedure has long been considered the ultimate treatment for complex anterior shoulder instability with glenoid or bipolar bone loss, few authors have considered the unimaginable question: what do you do when a patient fails Latarjet? A modified arthroscopic technique of the Eden-Hybinette procedure allows for revision anterior glenoid augmentation of critical glenoid bone loss with autologous tricortical iliac crest, while suture button fixation may obviate hardware complications previously seen with bicortical screw fixation. Although distal tibial allograft provides excellent congruity, viable articular cartilage, and no harvest site morbidity, financial costs and graft availability must also be considered. With favorable patient-reported outcomes, excellent rates of radiographic union, and reliable return to sport, the Eden-Hybinette procedure with suture button-based construct offers a viable alternative for patients with advanced glenoid bone loss (>20%) or revision scenarios.
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Gilat R, Haunschild ED, Lavoie-Gagne OZ, Tauro TM, Knapik DM, Fu MC, Cole BJ. Outcomes of the Latarjet Procedure Versus Free Bone Block Procedures for Anterior Shoulder Instability: A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:805-816. [PMID: 32795174 DOI: 10.1177/0363546520925833] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Free bone block (FBB) procedures for anterior shoulder instability have been proposed as an alternative to or bail-out for the Latarjet procedure. However, studies comparing the outcomes of these treatment modalities are limited. PURPOSE To systematically review and perform a meta-analysis comparing the clinical outcomes of patients undergoing anterior shoulder stabilization with a Latarjet or FBB procedure. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS PubMed, Embase, and the Cochrane Library databases were systematically searched from inception to 2019 for human-participants studies published in the English language. The search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement including studies reporting clinical outcomes of patients undergoing Latarjet or FBB procedures for anterior shoulder instability with minimum 2-year follow-up. Case reports and technique articles were excluded. Data were synthesized, and a random effects meta-analysis was performed to determine the proportions of recurrent instability, other complications, progression of osteoarthritis, return to sports, and patient-reported outcome (PRO) improvement. RESULTS A total of 2007 studies were screened; of these, 70 studies met the inclusion criteria and were included in the meta-analysis. These studies reported outcomes on a total of 4540 shoulders, of which 3917 were treated with a Latarjet procedure and 623 were treated with an FBB stabilization procedure. Weighted mean follow-up was 75.8 months (range, 24-420 months) for the Latarjet group and 92.3 months (range, 24-444 months) for the FBB group. No significant differences were found between the Latarjet and the FBB groups in the overall random pooled summary estimate of the rate of recurrent instability (5% vs 3%, respectively; P = .09), other complications (4% vs 5%, respectively; P = .892), progression of osteoarthritis (12% vs 4%, respectively; P = .077), and return to sports (73% vs 88%; respectively, P = .066). American Shoulder and Elbow Surgeons scores improved after both Latarjet and FBB, with a significantly greater increase after FBB procedures (10.44 for Latarjet vs 32.86 for FBB; P = .006). Other recorded PRO scores improved in all studies, with no significant difference between groups. CONCLUSION Current evidence supports the safety and efficacy of both the Latarjet and FBB procedures for anterior shoulder stabilization in the presence of glenoid bone loss. We found no significant differences between the procedures in rates of recurrent instability, other complications, osteoarthritis progression, and return to sports. Significant improvement in PROs was demonstrated for both groups. Significant heterogeneity existed between studies on outcomes of the Latarjet and FBB procedures, warranting future high-quality, comparative studies.
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Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Eric D Haunschild
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | | | - Tracy M Tauro
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Derrick M Knapik
- University Hospitals Cleveland Medical Center, Department of Orthopaedic Surgery, Cleveland, Ohio, USA
| | - Michael C Fu
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
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Uffmann WJ, Christensen GV, Yoo M, Nelson RE, Greis PE, Burks RT, Tashjian RZ, Chalmers PN. A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft. Orthop J Sports Med 2019; 7:2325967119882001. [PMID: 31799329 PMCID: PMC6873280 DOI: 10.1177/2325967119882001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: The optimal surgical treatment of anterior shoulder instability remains
controversial. Hypothesis: (1) Implants and facility-related costs are the primary drivers of variation
in direct costs between arthroscopic Bankart and Latarjet procedures, and
(2) distal tibial allograft (DTA) is more costly than Latarjet as a function
of the graft expense. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Intraoperative cost data were derived for all arthroscopic anterior
stabilizations and Latarjet and DTA procedures performed at a single
academic institution from January 2012 to September 2017. Cost comparisons
were made between those undergoing arthroscopic stabilization and Latarjet
and between Latarjet and DTA. Multivariate regressions were performed to
determine the difference in direct costs accounting for various patient- and
surgery-related factors. Results: A total of 87 arthroscopic stabilizations, 44 Latarjet procedures, and 5 DTA
procedures were performed during the study period. Arthroscopic Bankart
repair was found to be 17% more costly than Latarjet, with suture anchor
implant cost being the primary driver of cost. DTA was 2.9-fold more costly
than Latarjet, with greater costs across all domains. Multivariate analysis
also found the number of prior arthroscopic procedures performed
(P = .007) and whether the procedure was performed in
an ambulatory or inpatient setting (P < .0001) to be
significantly associated with higher direct costs. Conclusion: Latarjet is less costly than arthroscopic Bankart repair, largely because of
implant cost. Value-driven strategies to narrow the cost differential could
focus on performing these procedures in an outpatient setting in addition to
reducing overall implant cost for arthroscopic procedures. Perceived
potential benefits of DTA over Latarjet may be outweighed by higher
costs.
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Affiliation(s)
- William J Uffmann
- Sports Medicine and Orthopaedics, Essentia Health-Duluth Clinic, Duluth, Minnesota, USA
| | | | - Minkyoung Yoo
- Health Economics Core, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Richard E Nelson
- Health Economics Core, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Patrick E Greis
- Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Robert T Burks
- Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
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Provencher MT, Peebles LA, Aman ZS, Bernhardson AS, Murphy CP, Sanchez A, Dekker TJ, LaPrade RF, Di Giacomo G. Management of the Failed Latarjet Procedure: Outcomes of Revision Surgery With Fresh Distal Tibial Allograft. Am J Sports Med 2019; 47:2795-2802. [PMID: 31498688 DOI: 10.1177/0363546519871896] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with recurrent anterior glenohumeral instability after a failed Latarjet procedure remain a challenge to address. Complications related to this procedure include large amounts of bone loss, bone resorption, and issues with retained hardware that necessitate the need for revision surgery. PURPOSE To determine the outcomes of patients who underwent revision surgery for a recurrent shoulder instability after a failed Latarjet procedure with fresh distal tibial allograft. STUDY DESIGN Case series; Level of evidence, 4. METHODS All consecutive patients who underwent revision of a failed Latarjet procedure with distal tibial allograft were prospectively enrolled. Patients were included if they had physical examination findings consistent with recurrent anterior shoulder instability. Patients were excluded if they had prior neurologic injury, a seizure disorder, bone graft requirements to the humeral head, or findings of multidirectional or posterior instability. History of shoulder instability was documented, including initial dislocation history, duration of instability, number of prior surgeries, examination findings, plain radiographic and computed tomography (CT) data, and arthritis graded with Samilson and Prieto (SP) classification. All patients were treated with hardware removal, capsular release with subsequent repair, and fresh distal tibial allograft to the glenoid. Outcomes before and after revision were assessed according to the American Shoulder and Elbow Score (ASES), Single Assessment Numerical Evaluation (SANE), and Western Ontario Shoulder Index (WOSI) and statistically compared. All patients underwent a CT scan of the distal tibial allograft at a minimum 4 months after surgery. RESULTS There were 31 patients enrolled (all males), with a mean age of 25.5 years (range, 19-38 years) and a mean follow-up time of 47 months (range, 36-60 months) after revision with distal tibial allograft. Before distal tibial allograft augmentation, the mean percentage glenoid bone loss was 30.3% (range, 25%-49%). All patients after their Latarjet stabilization had recurrent shoulder dislocation (11/31, 35.5%) or subluxation (20/31, 64.5%), and all patients had symptoms consistent with recurrent shoulder instability upon physical examination. Radiographs demonstrated 2 fixation screws in all cases, mean SP grade was 0.5 (range, 0-3), and CT scans revealed that a mean 78% of the Latarjet coracoid graft had resorbed (range, 37%-100%). Patient-reported outcome scores improved significantly pre- to postoperatively for ASES (40 to 92, P = .001), SANE (44 to 91, P = .001), and WOSI (1300 to 310, P = .001). There were no cases of recurrence, and a final CT scan of the distal tibial revision demonstrated a complete union at the glenoid-distal tibial allograft interface in 92% of patients. CONCLUSION The majority of the failed Latarjet procedures included in this study had near-complete resorption of the coracoid graft and hardware complications. At a minimum follow-up time of 36 months, patients who underwent revision treatment for a failed Latarjet procedure with a fresh distal tibial allograft demonstrated excellent clinical outcomes and near-complete osseous union at the glenoid-allograft interface. Although patients evaluated with recurrent anterior shoulder instability after a failed Latarjet procedure remain a challenge to address, fresh distal tibial allograft augmentation is a viable and highly effective revision procedure to treat this patient population.
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Affiliation(s)
- Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Liam A Peebles
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Zachary S Aman
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Colin P Murphy
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Giovanni Di Giacomo
- Department of Shoulder Surgery, Concordia Hospital for Special Surgery, Rome, Italy
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Parada SA, Shaw KA, Moreland C, Adams DR, Chabak MS, Provencher MT. Variations in the Anatomic Morphology of the Lateral Distal Tibia: Surgical Implications for Distal Tibial Allograft Glenoid Reconstruction. Am J Sports Med 2018; 46:2990-2995. [PMID: 30169114 DOI: 10.1177/0363546518793880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Distal tibial allograft glenoid augmentation has been introduced as a viable treatment approach for glenoid bone loss in conjunction with shoulder instability. No previous study, however, has assessed the morphologic variation of the distal tibia at the incisura as it relates to graft dimensions for glenoid augmentation. Increased concavity at the lateral distal tibia necessitates removal of the lateral cortex to obtain a flat surface, which may have implications for the strength of surgical fixation. PURPOSE To assess the morphologic variation of the distal tibia at the incisura as it relates to graft dimensions for glenoid augmentation. STUDY DESIGN Descriptive laboratory study. METHODS Magnetic resonance images of the ankle were reviewed for morphology assessment of the appearance and depth of the distal tibia. A classification system was created reflecting the suitability for glenoid augmentation. Type A tibias contained a flat contour of the lateral tibia at the articular surface, indicative of an ideal graft. Type B tibias had slight concavity with a central depth <5 mm and were deemed acceptable grafts. Type C tibias had deep concavity with a central depth >5 mm and were deemed unacceptable. Statistical analysis was performed via univariate analyses to compare patient demographics against acceptable morphology for glenoid augmentation. RESULTS Eighty-five study patients met inclusion criteria (53 male, 32 female; mean age ± SD, 35.1 ± 10.3 years). Overall, 12 patients (14.1%) demonstrated type A morphology, with 61 patients (71.8%) having type B morphology for a total of 85.9% of acceptable grafts for glenoid augmentation. The interrater reliability was moderate to strong between observers (kappa value = 0.841). On univariate analysis, sex was the only variable significantly associated with an acceptable graft, with 100% of female patients having acceptable morphology, as compared with 77% of male patients ( P = .004). CONCLUSION Variable morphology of the distal tibia at the incisura was found: 14.1% of patients demonstrated an ideal morphology for glenoid augmentation; an additional 71.8% were deemed suitable for graft usage; and 14.1% of tibias had unacceptable morphology. Sex was a significant factor for predicting acceptable grafts. CLINICAL RELEVANCE This information will assist surgeons in accepting or rejecting grafts based on the epidemiology of the distal tibial morphology as it relates to glenoid augmentation.
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Affiliation(s)
- Stephen A Parada
- Department of Orthopaedics, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - K Aaron Shaw
- Eisenhower Army Medical Center, Orthopaedic Surgery, Fort Gordon, Georgia, USA
| | - Colleen Moreland
- Eisenhower Army Medical Center, Orthopaedic Surgery, Fort Gordon, Georgia, USA
| | - Douglas R Adams
- Evans Army Community Hospital, Orthopaedic Surgery, Fort Carson, Colorado, USA
| | - Mickey S Chabak
- Eisenhower Army Medical Center, Orthopaedic Surgery, Fort Gordon, Georgia, USA
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7
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Wong IH, King JP, Boyd G, Mitchell M, Coady C. Radiographic Analysis of Glenoid Size and Shape After Arthroscopic Coracoid Autograft Versus Distal Tibial Allograft in the Treatment of Anterior Shoulder Instability. Am J Sports Med 2018; 46:2717-2724. [PMID: 30095986 DOI: 10.1177/0363546518789348] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Latarjet procedure for autograft transposition of the coracoid to the anterior rim of the glenoid remains the most common procedure for reconstruction of the glenoid after shoulder instability. The anatomic glenoid reconstruction using distal tibial allograft has gained popularity and is suggested to better match the normal glenoid size and shape. However, concerns about decreased healing and increased resorption arise when an allograft bone is used. PURPOSE To use radiological findings to evaluate the arthroscopic reconstruction of the glenoid with respect to the size, shape, healing, and resorption of coracoid autograft versus distal tibial allograft. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective review was performed of 48 consecutive patients who had an arthroscopic bony reconstruction of the glenoid (12 coracoid autograft, 36 distal tibial allograft), diagnosed anterior shoulder instability, and computed tomography (CT)-confirmed glenoid bone loss more than 20%. Coracoid autograft was performed only when tibial allograft was not accessible from a bone bank. Two fellowship-trained musculoskeletal radiologists reviewed pre- and postoperative CT scans at a minimum follow-up of 6 months for the following: graft position, glenoid concavity, cross-sectional area, width, version, total area, osseous union, and graft resorption. Clinical outcome was noted in terms of instability, subluxation, and dislocation at a minimum follow-up of 2 years. Simple logistic regression, 2-tailed independent-sample t tests, paired t tests, and Fisher exact tests were performed. RESULTS Graft union was seen in 9 of the 12 patients (75%) who had coracoid autograft and 34 of the 36 patients (94%) who had tibial allograft (odds ratio, 5.66; 95% CI, 0.81-39.20; P = .08). The odds ratio comparing allograft to coracoid for overall resorption was 7.00 (95% CI, 1.65-29.66; P = .008). Graft resorption ≥50% was seen in 3 (8%) of the patients who had tibial allograft and none of the patients who had coracoid autograft. Graft resorption less than 50% was seen in the majority of patients in both groups: 27 (73%) patients with tibial allograft and 5 (42%) patients with coracoid autograft. No statistically significant difference was found between the 2 procedures regarding anteroposterior diameter of graft ( P = .81) or graft cross-sectional area ( P = .93). However, a significant difference was observed in step formation between the 2 procedures ( P < .001). Two patients experienced subluxations in the coracoid group (16%) as well as 2 patients in the tibial allograft group (6%) with a P value of .25. CONCLUSION Arthroscopic anatomic glenoid reconstruction via distal tibial allograft showed similar bony union but higher resorption compared with coracoid autograft. Even so, no statistically significant difference was found between the 2 procedures regarding final graft surface area, the size of grafts, and the anteroposterior dimensions of the reconstructed glenoids. These short-term results suggest that distal tibial allografts can be used as an alternative to coracoid autograft in the recreation of glenoid bony morphologic features.
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Affiliation(s)
- Ivan H Wong
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Paul King
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gordon Boyd
- Diagnostic Imaging, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Mitchell
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Catherine Coady
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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9
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Frank RM, Shin J, Saccomanno MF, Bhatia S, Shewman E, Bach BR, Wang VM, Cole BJ, Provencher MT, Verma NN, Romeo AA. Comparison of glenohumeral contact pressures and contact areas after posterior glenoid reconstruction with an iliac crest bone graft or distal tibial osteochondral allograft. Am J Sports Med 2014; 42:2574-82. [PMID: 25193887 DOI: 10.1177/0363546514545860] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posterior glenoid bone deficiency in the setting of posterior glenohumeral instability is typically addressed with bone block augmentation with iliac crest bone grafts (ICBGs). Reconstruction with fresh distal tibial allograft (DTA) is an alternative option, with the theoretical advantages of restoring the glenoid articular surface, improving joint congruity, and providing the biological restoration of articular cartilage loss. HYPOTHESIS Reconstruction with an ICBG and DTA would more effectively restore normal glenoid contact pressures, contact areas, and peak forces when compared with the deficient glenoid. STUDY DESIGN Controlled laboratory study. METHODS Eight fresh-frozen human cadaveric shoulders were tested in 4 conditions: (1) intact glenoid, (2) 20% posterior-inferior defect of the glenoid surface area, (3) 20% defect reconstructed with a flush ICBG, and (4) 20% defect reconstructed with a fresh DTA. For each condition, a 0.1 mm-thick dynamic pressure-sensitive pad was placed between the humeral head and glenoid. A compressive load of 440 N was applied for each condition in the following clinically relevant arm positions: (1) 30° of humeral abduction, (2) 60° of humeral abduction, and (3) 90° of flexion-45° of internal rotation (FIR). Glenohumeral contact pressures (kg/cm(2)), contact areas (cm(2)), and joint peak forces (N) were compared. RESULTS Glenoid reconstruction with DTA resulted in significantly higher contact areas than the 20% defect model at 30°, 60°, and FIR at the time of surgery (P < .01 in all cases). The intact state exhibited significantly higher contact areas than the defect in all positions, significantly higher contact areas than the ICBG in all positions, and significantly higher contact areas than the DTA at 30° (P < .05 in all cases). The intact state experienced significantly lower contact pressures than the defect at 60° and FIR, while reconstruction with both a DTA and ICBG resulted in significantly lower contact pressures than the defect at 60° (P < .05 in all cases). There were no differences in contact pressures when comparing both the DTA and ICBG to the intact glenoid (P > .05 in all cases). There were no differences in peak forces between the groups, for any of the conditions, in any of the positions (P > .05 in all cases). CONCLUSION Reconstruction of posterior glenoid bone defects with DTA conferred similar contact mechanics as reconstruction with ICBGs at the time of surgery. CLINICAL RELEVANCE This study supports posterior glenoid reconstruction with fresh DTA as a viable alternative solution, with the potential advantage of improving joint congruity via an anatomic reconstruction, resulting in a cartilaginous, congruent articulation with the humeral head. Further studies are required to determine potential clinical effects of the glenohumeral joint contact mechanics reported here.
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Affiliation(s)
- Rachel M Frank
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, USA
| | - Jason Shin
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, USA
| | | | - Sanjeev Bhatia
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, USA
| | - Elizabeth Shewman
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, USA
| | - Bernard R Bach
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, USA
| | - Vincent M Wang
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, USA
| | - Brian J Cole
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, USA
| | - Matthew T Provencher
- Division of Sports Medicine and Surgery, Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Nikhil N Verma
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, USA
| | - Anthony A Romeo
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, USA
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Bhatia S, Van Thiel GS, Gupta D, Ghodadra N, Cole BJ, Bach BR, Shewman E, Wang VM, Romeo AA, Verma NN, Provencher MT. Comparison of glenohumeral contact pressures and contact areas after glenoid reconstruction with latarjet or distal tibial osteochondral allografts. Am J Sports Med 2013; 41:1900-8. [PMID: 23775244 DOI: 10.1177/0363546513490646] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Glenoid reconstruction with distal tibial allografts offers the theoretical advantage over Latarjet reconstruction of improved joint congruity and a cartilaginous articulation for the humeral head. Hypothesis/ PURPOSE To investigate changes in the magnitude and location of glenohumeral contact areas, contact pressures, and peak forces after (1) the creation of a 30% anterior glenoid defect and subsequent glenoid bone augmentation with (2) a flush Latarjet coracoid graft or (3) a distal tibial osteochondral allograft. It was hypothesized that the distal tibial bone graft would best normalize glenohumeral contact areas, contact pressures, and peak forces. STUDY DESIGN Controlled laboratory study. METHODS Eight cadaveric shoulder specimens were dissected free of all soft tissues and randomly tested in 3 static positions of humeral abduction with a 440-N compressive load: 30°, 60°, and 60° of abduction with 90° of external rotation (ABER). Glenohumeral contact area, contact pressure, and peak force were determined sequentially using a digital pressure mapping system for (1) the intact glenoid, (2) the glenoid with a 30% anterior bone defect, and (3) the glenoid after reconstruction with a distal tibial allograft or a Latarjet bone block. RESULTS Glenoid reconstruction with distal tibial allografts resulted in significantly higher glenohumeral contact areas than reconstruction with Latarjet bone blocks in 60° of abduction (4.87 vs. 3.93 cm2, respectively; P < .05) and the ABER position (3.98 vs. 2.81 cm2, respectively; P < .05). Distal tibial allograft reconstruction also demonstrated significantly lower peak forces than Latarjet reconstruction in the ABER position (2.39 vs. 2.61 N, respectively; P < .05). Regarding the bone loss model, distal tibial allograft reconstruction exhibited significantly higher contact areas and significantly lower contact pressures and peak forces than the 30% defect model at all 3 abduction positions. Latarjet reconstruction also followed this same pattern, but differences in contact areas and peak forces between the defect model and Latarjet reconstruction in the ABER position were not statistically significant (P > .05). CONCLUSION Reconstruction of anterior glenoid bone defects with a distal tibial allograft may allow for improved joint congruity and lower peak forces within the glenohumeral joint than Latarjet reconstruction at 60° of abduction and the ABER position. Although these mechanical properties may translate into clinical differences, further studies are needed to understand their effects. CLINICAL RELEVANCE Glenoid bone reconstruction with a distal tibial osteochondral allograft may result in significantly improved glenohumeral contact areas and significantly lower glenohumeral peak forces than reconstruction with a Latarjet bone block, which could play a role in improving postoperative outcomes after glenoid reconstruction.
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Affiliation(s)
- Sanjeev Bhatia
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, 1611 West Harrison St, Suite 400, Chicago, IL 60612, USA
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