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Posterior Glenoid Augmentation With Extra-articular Iliac Crest Autograft for Recurrent Posterior Shoulder Instability.

ABSTRACT: Several techniques have been described for bone block augmentation as a treatment for posterior shoulder instability, including intra-articular distal tibial allograft and extra-articular iliac crest autograft. Although indications are not yet well defined, these bone augmentation procedures are considered in patients with glenoid bone loss, increased glenoid retroversion, previous failed posterior soft-tissue repair, and insufficient posterior capsulolabral tissue. In patients with posterior glenoid bone loss, the senior author (P.J.M.) recommends intra-articular glenoid reconstruction with a fresh distal tibial osteoarticular allograft. In patients with insufficient posterior capsulolabral tissue, the senior author prefers an extra-articular iliac crest autograft to buttress the posterior soft-tissue restraints. This technique guide outlines extra-articular iliac crest autograft treatment for recurrent posterior shoulder instability in patients with insufficient posterior soft tissues due to prior failed surgery. After an open capsulolabral repair is performed using suture anchors, the bone block is placed extra-articularly on the posterior glenoid neck.

SUBMITTER: Arner JW

PROVIDER: S-EPMC7528205 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Arthroscopic Glenoid Bone Augmentation Using Iliac Crest Autograft Is Safe and Effective for Anterior Shoulder Instability With Bone Loss.

Project description:PurposeTo establish a safety profile for an arthroscopic anatomic glenoid reconstruction using autologous iliac crest bone graft to treat shoulder instability with significant bone loss and to evaluate short-term clinical and radiological outcomes.MethodsA retrospective analysis of prospectively collected data was conducted for the patients who were treated for shoulder instability with bone loss using arthroscopic autologous iliac crest bone graft between November 2014 and June 2018. The safety profile was established by detective intraoperative or postoperative complications such as neurovascular injuries, infections, major bleeding, and subluxations. Short-term clinical and radiologic outcomes also were evaluated.ResultsThirteen patients were included in the study. A safety profile was observed, with no occurrence of intraoperative complications, neurovascular injuries, infection, or major bleeding. There were no dislocations or positive apprehension tests on clinical examination postoperatively. Postoperative Western Ontario Shoulder Instability (WOSI) scores were significantly greater than preoperative WOSI scores, with a mean improvement of 35.0 ± 20.2 (P < .001). Twelve patients (92.3%) received postoperative computed tomography scans, with 11 of 12 patients (91.7%) displaying complete graft union.ConclusionsArthroscopic treatment of shoulder instability with bone loss via autologous iliac crest bone graft is shown to be a safe operative procedure that results in favourable short-term clinical and radiologic outcomes, with a significant improvement in WOSI scores and high rates of graft union. Although graft resorption was seen in most patients who had postoperative computed tomography imaging, there were no instances of clinical graft failure.Level of evidenceLevel IV, therapeutic case series.

| S-EPMC8689205 | biostudies-literature

Arthroscopic Iliac Crest Bone Graft Augmentation Using All-Suture Anchors for Shoulder Instability Caused by Glenoid Bone Loss.

Project description:Augmentation of the anterior glenoid with bone graft is an established treatment for recurrent anterior instability due to critical glenoid bone loss. Both open and arthroscopic techniques have been described. Fixation with metal screws through an open approach is the most common technique, but the risk of metal screw-related complications remains a concern. A variety of arthroscopic techniques using suspensory fixation or suture anchors have been described in the literature. However, they all require a posterior incision to insert a targeting device or to manage sutures. We describe a technique for arthroscopic bone grafting of the anterior glenoid via a purely anterior approach with 2 linked knotless suture anchors, thereby avoiding posterior suture management and glenoid metalwork complications.

| S-EPMC8719134 | biostudies-literature

Arthroscopic distal tibial allograft augmentation for posterior shoulder instability with glenoid bone loss.

Project description:Glenoid bone loss is commonly associated with recurrent shoulder instability. Failure to recognize and appropriately address it can lead to poor outcomes. Numerous studies have found anterior-inferior glenoid bone loss in the setting of recurrent anterior instability. Though much less common, posterior shoulder instability can be seen in the setting of acute trauma, epilepsy, electrocution, and alcoholism. Heightened awareness has led to recognition in collision athletes as well. Posterior glenoid bone loss must be addressed in a similar fashion to anterior glenoid bone loss to prevent recurrent instability. Open bone augmentation procedures have been described with successful results. In this technical note, we describe an arthroscopic technique using fresh distal tibial allograft for posterior glenoid augmentation. In addition, a current review regarding the diagnosis and management of recurrent posterior shoulder instability is provided.

| S-EPMC3882716 | biostudies-literature

Posterior Shoulder Instability but Not Anterior Shoulder Instability Is Related to Glenoid Version.

Project description:PurposeTo assess and compare glenoid version in patients with anterior shoulder instability (ASI), posterior shoulder instability (PSI), and a control group.MethodsThe operative notes of all patients that had undergone arthroscopic shoulder instability repair between January 2017 and May 2022 were retrospectively reviewed. Magnetic resonance imaging scans were then analyzed, and glenoid version was measured by a single blinded observer. A P value <.05 was considered statistically significant.ResultsThere were 100 patients included in the ASI group, 65 in PSI group, and 100 in the control group. The mean glenoid versions for the ASI group were -16°, -9.1°, and -9.2° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean glenoid versions for the PSI group were -21°, -13.4°, and -16.6° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean versions for the control group were -17.8°, -9.5°, and -9.8° for the vault version, simplified vault version and chondrolabral version, respectively. ANOVA testing and post hoc comparisons revealed the PSI group to be significantly more retroverted than both other groups P < .001. The ASI group's degree of glenoid version was not significantly different to that of the control P = .009.ConclusionPatients with PSI have a higher degree of retroversion in comparison to those with ASI and control. There is no significant difference in glenoid version among patients with ASI when compared with control.Level of evidenceLevel III, retrospective comparative study.

| S-EPMC10497783 | biostudies-literature

Distal Tibial Allograft Augmentation for Posterior Shoulder Instability Associated With Glenoid Bony Deficiency: A Case Series.

Project description:PurposeTo report the clinical history and preliminary outcomes of patients who underwent posterior glenoid reconstruction using a distal tibial allograft (DTA) for the management of posterior shoulder instability with glenoid bone loss.MethodsPatients who underwent posterior shoulder stabilization with a DTA in our institution between 2011 and 2019 were retrospectively reviewed. Demographic characteristics, operative reports, and clinical and functional outcomes were recorded. Outcomes included postoperative range of motion (ROM), recurrent instability, complications, and revision surgery. All patients underwent at least 1 year of follow-up, except 2 patients who underwent revision surgery. Preoperative and postoperative ROM was compared using the 2-tailed Student t test for paired samples.ResultsTen patients who underwent DTA augmentation for posterior instability were included, comprising 2 female and 8 male patients with an average age of 24 years (range, 17-35 years). Five patients had a prior sports-related traumatic event, and 2 patients had a seizure disorder. Seven patients had undergone a prior stabilization procedure. The average reverse bony Bankart lesion was 26% of the glenoid diameter. Concomitant procedures included 4 capsular repairs, 2 labral repairs, 2 capsular plications, and 1 repair for humeral avulsion of the glenohumeral ligament. One patient reported recurrent instability after surgery. Two patients underwent revision surgery, with one removal of symptomatic hardware and one early revision owing to screw penetration into the glenoid. There was no significant difference in preoperative versus postoperative ROM.ConclusionsPosterior shoulder instability with significant bony deficiency can be managed using DTA augmentation with good outcomes and a reasonable complication rate in these challenging cases.Level of evidenceLevel IV, case series.

| S-EPMC7754527 | biostudies-literature

Arthroscopic distal clavicular autograft for treating shoulder instability with glenoid bone loss.

Project description:Glenoid bone loss is a significant risk factor for failure after arthroscopic shoulder stabilization. Multiple options are available to reconstruct this bone loss, including coracoid transfer, iliac crest bone graft, and osteoarticular allograft. Each technique has strengths and weaknesses. Coracoid grafts are limited to anterior augmentation and, along with iliac crest, do not provide an osteochondral reconstruction. Osteochondral allografts do provide a cartilage source but are challenged by the potential for graft rejection, infection, cost, and availability. We describe the use of a distal clavicular osteochondral autograft for bony augmentation in cases of glenohumeral instability with significant bone loss. This graft has the advantages of being readily available and cost-effective, it provides an autologous osteochondral transplant with minimal donor-site morbidity, and it can be used in both anterior and posterior bone loss cases. The rationale and technical aspects of arthroscopic performance will be discussed. Clinical studies are warranted to determine the outcomes of the use of the distal clavicle as a graft in shoulder instability.

| S-EPMC4175166 | biostudies-literature

Use of tricortical iliac crest strut autograft in comminuted posterior wall acetabular fractures: A case series.

Project description:PurposeThe results for fixation of comminuted posterior wall acetabular fractures are not very promising with reported complications in terms of osteoarthritis, nonunion and malunion which subsequently require conversion to total hip arthroplasty. The conversion to total hip arthroplasty is possible in patients over 50 years of age but not in younger patients. So this requires new methods for salvage of the native hip in young patients.MethodsThere were six patients in our series with highly comminuted posterior wall acetabular fractures where the fragments were excised and the gap filled with tricortical anterior iliac-crest strut autograft, fixed with screws and plate.ResultsGood results were achieved in four out of six patients analyzed clinically using the Merle d'Aubinge score modified by Matta and radiologically by Matta scoring. These patients have returned to original work and are walking independently. The good result in one patient deteriorated from good to poor between one and two years. One patient developed infection and excision arthroplasty was done. The graft incorporated well in five out of six patients.ConclusionThe use of iliac crest autograft is a better, advanced and promising technique as it provides a new wall to the weight bearing dome of the acetabulum for articulation with the femoral head. The rates of nonunion, malunion, post traumatic osteoarthritis are less as compared to the fixation of the comminuted fragments. The need for conversion to total hip arthroplasty is also less.

| S-EPMC6114123 | biostudies-literature

Arthroscopic Iliac Crest Bone Grafting to the Anterior Glenoid.

Project description:Failed arthroscopic soft-tissue stabilization and anterior glenoid bone loss have been shown to have high failure rates after standard arthroscopic stabilization techniques. For patients with recurrent glenohumeral instability, the Bristow-Latarjet procedure is currently the standard of care. It is predominantly performed through an open deltopectoral approach but has recently been described arthroscopically. Although providing excellent clinical outcomes, the Bristow-Latarjet procedure violates the subscapularis muscle, has a steep learning curve with a high complication rate, and permanently changes the anterior shoulder anatomy, making any future revision surgery more challenging. We describe a technique for arthroscopic anterior glenoid augmentation using iliac crest bone graft that does not violate the subscapularis, by creating a far anterior-medial portal that traverses superior to the subscapularis and lateral to the conjoint tendon. The graft is passed through this portal and secured with rigid fixation. An arthroscopic Bankart capsulolabral repair is then performed, making the graft extra-articular. A remplissage can easily be added as indicated, allowing this procedure to arthroscopically address all 3 major components of structural instability: glenoid bone loss, capsulolabral tearing, and humeral bone loss.

| S-EPMC5040521 | biostudies-literature

The "Sublabral Window" in Arthroscopic Posterior Shoulder Instability Surgery: Description of a Technique for Safe Posterior Glenoid Preparation.

Project description:Arthroscopic posterior labral repairs for posterior shoulder instability can be challenging. Preparation of the capsulolabral tissue and glenoid bony surface is critical. Iatrogenic injury to the articular cartilage and unwarranted truncation of the capsulolabral tissue are concerns during preparation. As a result, several techniques have been described to potentially avoid these complications. We describe an additional technique for improving access and preparing the capsulolabral tissue and glenoid surface through a "sublabral window." This technique approaches the posterior labrum and glenoid through an already established posterior portal and mitigates iatrogenic injury to the labrum and articular cartilage. The technique is rather simple and easily adaptable.

| S-EPMC5020424 | biostudies-literature

Arthroscopic Anterior and Posterior Glenoid Bone Augmentation With Capsular Plication for Ehlers-Danlos Syndrome With Multidirectional Instability.

Project description:Recurrent multidirectional shoulder instability is a difficult clinical problem. This can be compounded in patients with connective tissue diseases such as Ehlers-Danlos syndrome. We present an all-arthroscopic technique involving extra-articular anterior and posterior glenoid bone grafting to augment a capsular repair in a patient with Ehlers-Danlos syndrome and recurrent multidirectional shoulder instability. Graft options include either distal tibial allograft or iliac crest autograft. Anterior graft placement uses a dilated far medial portal using an inside-out technique. The posterior graft is placed through a dilated posterior portal. A 1-mm edge of anterior and posterior glenoid rim is denuded of cartilage for later capsular repair, and grafts are secured flush to the osseous surface. A capsular plication is then completed and repaired to the prepared native glenoid surface, using the grafts as extra-articular osseous bumpers.

| S-EPMC5984445 | biostudies-literature

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