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Autologous Tricortical Iliac Bone Graft for Failed Latarjet Procedures.

ABSTRACT: The high recurrence rates seen in open and arthroscopic Bankart repair in the presence of significant glenoid bone loss, Hill-Sachs lesions, or combined bony deficiencies have led many surgeons to choose bony reconstructions to manage these injuries. Although the Latarjet procedure has proved to be reliable to manage recurrent anterior shoulder instability, there have been concerns of a higher surgical complication rate associated with this procedure. Moreover, some of the complications reported with this procedure such as symptomatic implants, fracture or nonunion of the coracoid graft, and recurrence of instability could need a revision surgery to be solved. The autologous tricortical iliac bone graft is an excellent option for failed bony reconstructions. However, as with any successful surgery, each step requires planning and precise application to limit risks and avoid pitfalls. This Technical Note provides a detailed description of the autologous tricortical iliac bone graft for failed Latarjet procedures.

SUBMITTER: Ranalletta M

PROVIDER: S-EPMC6471327 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Autologous Tricortical Iliac Bone Graft for Failed Latarjet Procedures.

Ranalletta Maximiliano M Tanoira Ignacio I Bertona Agustin A Maignon Gaston G Bongiovanni Santiago S Rossi Luciano A LA

Arthroscopy techniques 20190218 3

The high recurrence rates seen in open and arthroscopic Bankart repair in the presence of significant glenoid bone loss, Hill-Sachs lesions, or combined bony deficiencies have led many surgeons to choose bony reconstructions to manage these injuries. Although the Latarjet procedure has proved to be reliable to manage recurrent anterior shoulder instability, there have been concerns of a higher surgical complication rate associated with this procedure. Moreover, some of the complications reported ...[more]

PMID: 31019886

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Project description:BackgroundAutogenous Iliac Crest Bone Graft (ICBG) has been the "gold standard" for spinal fusion. However, bone graft harvest may lead to complications, such as chronic pain, numbness, and poor cosmesis. The long-term impact of these complications on patient function and well-being has not been established but is critical in determining the value of expensive bone graft substitutes such as recombinant bone morphogenic protein. We thus aimed to investigate the long-term complications of ICBG. Our second aim was to evaluate the psychometric properties of a new measure of ICBG morbidity that would be useful for appropriately gauging spinal surgery outcomes.MethodsProspective study of patients undergoing spinal fusion surgery with autologous ICBG. The SF-36v2, Oswestry Disability Index, and a new 14-item follow-up questionnaire addressing persistent pain, functional limitation, and cosmesis were administered with an 83% response rate. Multiple regression analyses examined the independent effect of ICBG complications on physical and mental health and disability.ResultsThe study population included 170 patients with a mean age of 51.1 years (SD = 12.2) and balanced gender (48% male). Lumbar fusion patients predominated (lumbar = 148; cervical n = 22). At 3.5 years mean follow-up, 5% of patients reported being bothered by harvest site scar appearance, 24% reported harvest site numbness, and 13% reported the numbness as bothersome. Harvest site pain resulted in difficulty with household chores (19%), recreational activity (18%), walking (16%), sexual activity (16%), work activity (10%), and irritation from clothing (9%). Multivariate regression analyses revealed that persistent ICBG complications 3.5 years post-surgery were associated with significantly worse disability and showed a trend association with worse physical health, after adjusting for age, workers' compensation status, surgical site pain, and arm or leg pain. There was no association between ICBG complications and mental health in the multivariate model.ConclusionChronic ICBG harvest site pain and discomfort is reported by a significant percentage of patients undergoing this procedure more than three years following surgery, and these complications are associated with worse patient-reported disability. Future studies should consider employing a control group that does not include autologous bone graft harvest, e.g., a group utilizing rhBMP, to determine whether eliminating harvest-site morbidity does indeed lead to observable improvement in clinical outcome sufficient to justify the increased cost of bone graft substitutes.

Project description:BackgroundThe spine surgeons have been combining anterior and posterolateral fusion (circumferential fusion) as the final solution to treat spinal disorders and many have been using it to treat failed back surgery syndrome (FBSS). In present study, we analyzed and compared the clinical and radiological outcomes in patients with transpedicular screw fixation and intervertebral autogenous posterior iliac crest bone graft or in patients with transpedicular screw fixation and intervertebral B-Twin system for FBSS with a follow-up period of 10 years after the surgery.Materials and methodsThis study was a retrospective case study performed on 55 patients with FBSS. Clinical and radiological changes were compared between the two groups of patients on the basis of improvement of back pain, radicular pain, and work capacity. Outcome was measured in terms of Oswestry Low Back Pain Disability Index, and the changes in pain and function were documented every year from before surgery until 2012. We analyzed the evolution of 55 cases of FBSS those underwent segmental circumferential posterior fusions from June 2001 to February 2003, operated by a single surgeon and followed up during 10 years until February 2012. The patients were divided into 2 groups: In 25 patients, posterolateral fusions with Legacy™ (Medtronic, Inc. NYSE: MDT) screws and intersomatic autogenous posterior iliac crest bone graft was performed, and, in 30 patients, posterolateral fusions with the same screws and intersomatic fusion B-Twin (Biomet Spain Orthopaedics, S.L.) system was performed. In all cases, we used posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) approach for intervertebral graft, and the artrodesis was supplemented at intertransverse level with Autologus Growth Factor (AGF-MBA INCORPORADO, S.A.). The outcome was measured in terms of Oswestry Low Back Pain Disability Index, and the changes in pain and function were documented every year and compared from before surgery to the final follow-up visit. Preoperative and postoperative scores were available for all patients.ResultsThe average age of these patients was comparable in both groups (mean age 42.6 versus 50.2 years). The average follow-up period was 200.6 months in the first group (screws and intersomatic bone) and 184.4 months in the second group (screws and B-Twin). In the autologus bone graft group, the CT scan and Rx study revealed loss of height of intervertebral space between 25% and 45% of 24 h postoperative height of intervertebral operated disc, and the patients continued to lose the height until 20 months after the surgery. In the B Twin group, the CT scan and Rx study revealed a loss of height of the intervertebral level of 8-12% over a period of 9 months follow-up, followed by stability. A total of 31 patients (55%) had improved Oswestry Low Back Pain Disability Index >40% of the total possible points, although this did not reflect in PSI or return to work rate.ConclusionsThe patients with rigid fixation do well in terms of correction of lumbar lordosis, but they do not do well in terms of recurrence of pain. Furthermore, they need some kind of intervention to control pain after the first year after surgery. In patients in whom bone graft is used, although they do not maintain and sustain the lumbar lordosis in the long term, they have less recurrence of pain with less chances of intervention for pain control.

Project description:Background: Bone-graft substitutes are commonly used for the augmentation of traumatic bone defects in tibial plateau fractures. However, their clinical performance compared with that of autologous bone-grafting, the gold standard in bone defect reconstruction, still remains under debate. This study investigates the differences in quality of life, pain, and radiographic outcomes in the treatment of tibial plateau fracture-associated bone defects with either autologous bone grafts or a bioresorbable hydroxyapatite and calcium sulfate cement (CERAMENT BONE VOID FILLER [CBVF]; BONESUPPORT).Methods: In this study, 135 patients with acute depression and split-depression fractures of the proximal part of the tibia (OTA/AO types 41-B2 and 41-B3) were enrolled in a prospective, controlled, randomized, multicenter trial including 20 hospitals in Germany. Patients were randomized to receive either autologous iliac bone graft or CBVF for reconstruction of the bone defect. The primary outcome measures were the Short Form (SF)-12 version 2 Physical Component Summary (PCS) score at week 26 (the study was designed to show noninferiority of the CBVF with regard to the PCS with a prespecified margin of -5 points) and the pain level at 26 weeks postoperatively measured by a visual analog scale (VAS). The secondary outcomes were the SF-12 version 2 Mental Component Summary (MCS) and SF-12 PCS scores at weeks 1, 6, and 12 and bone-healing on radiographs.Results: Age, sex, fixation methods, and fracture pattern were comparable in both groups. There were no significant differences (p > 0.05) in the SF-12 PCS or VAS scores at postoperative week 26. There was a significant reduction of blood loss (p = 0.007) and pain levels (p = 0.008) at postoperative day 1 in the CBVF group. The rates of fracture-healing, defect remodeling, and articular subsidence were not significantly different (p > 0.05) in both groups.Conclusions: Bioresorbable CBVF was noninferior to autologous bone graft with regard to both patient-reported and radiographic outcomes in tibial plateau fractures of OTA/AO types 41-B2 and 41-B3.Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Autologous Tricortical Iliac Bone Graft for Failed Latarjet Procedures.

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Autologous Tricortical Iliac Bone Graft for Failed Latarjet Procedures.

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