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Graft Transfer Technique in Arthroscopic Posterior Glenoid Reconstruction With Distal Tibia Allograft.

ABSTRACT: Posterior glenoid reconstruction using distal tibia allograft is an available technique for the treatment of posterior shoulder instability with glenoid bone loss. A key aspect to this procedure relies on maintaining complete control of the graft during insertion and securement to the posterior glenoid. Although there are commercially available products to aid with graft control, we describe a novel graft transfer technique that is compatible with all cannulated systems for maintaining positive graft control. This technique allows the surgery to be performed in an arthroscopic manner using current instrumentation for open glenoid reconstruction.

SUBMITTER: Parada SA

PROVIDER: S-EPMC5797295 | biostudies-other | 2017 Oct

REPOSITORIES: biostudies-other

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Graft Transfer Technique in Arthroscopic Posterior Glenoid Reconstruction With Distal Tibia Allograft.

Parada Stephen A SA Shaw K Aaron KA

Arthroscopy techniques 20171016 5

Posterior glenoid reconstruction using distal tibia allograft is an available technique for the treatment of posterior shoulder instability with glenoid bone loss. A key aspect to this procedure relies on maintaining complete control of the graft during insertion and securement to the posterior glenoid. Although there are commercially available products to aid with graft control, we describe a novel graft transfer technique that is compatible with all cannulated systems for maintaining positive ...[more]

PMID: 29416976

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Project description:BackgroundDistal tibia allograft reconstruction of the glenoid in shoulder instability has garnered significant attention over the last decade. Prior studies demonstrate significant improvement in all reported patient outcomes albeit the approach is through a subscapularis split. There have not been prior studies evaluating outcomes after lesser tuberosity osteotomy which provides excellent exposure to the anterior glenoid.We hypothesize there is significant improvement in functional outcomes and no deleterious effects after lesser tuberosity osteotomy for distal tibia allograft reconstruction of the glenoid for shoulder instability.MethodsA retrospective review was performed from 2016 of 2019 of patients undergoing distal tibia allograft reconstruction of the glenoid through a lesser tuberosity osteotomy. Patients were indicated if they had recurrent anterior shoulder instability with >20% glenoid bone loss and evidence of an off-track lesion. Clinical, imaging, and operative data were evaluated. Objective follow-up data evaluated at minimum 2 years included radiographs, range of motion, DASH, SANE, VAS, SST, ASES, and Constant scores.ResultsA total of 12 patients were available with average follow-up 28 months, average age 26 years old, and average glenoid bone loss of 33%. The patients demonstrated significant improvement in their clinical outcomes at final follow-up: DASH 42.9-8.9 (P = .004), SANE 32.2-85 (P = .00005), VAS 4.6-1.1 (P = .003), SST 7-11.4 (P = .01), ASES 50.2-90.5 (P = .001), and Constant 37.6-86.2 (P = .01). Range of motion at final follow-up was forward flexion to 161.4° (135-170°), external rotation 49.5° (40-65°), and internal rotation to T12-L1 (T7-L2) vertebral body.ConclusionThe present study demonstrates the effectiveness of a lesser tuberosity osteotomy in exposure of the glenoid for reconstruction with a distal tibia allograft. The functional integrity of the subscapularis is maintained and the patient-reported outcomes are comparable with current literature.

Project description:PurposeThe purpose of this study was to compare the learning curves and radiographic variables between screw and suture button fixation of the allograft for surgeons learning the all-arthroscopic anatomic glenoid reconstruction (AAGR) technique for anterior shoulder instability. We compared the surgical times of these two fixation techniques, as well as the graft placement in the vertical and medial-lateral directions.MethodsThis was a retrospective review of patients who underwent AAGR for recurrent anterior shoulder instability. Start and end times were recorded for each procedure, and learning was assessed through the change in operative time over successive surgeries and by variability of operative time. Graft placement, in terms of vertical positioning, medial-lateral step formation, and obliquity of fixation (alpha angle), was evaluated using 3-dimensional CT scans at approximately 6 months postoperation.ResultsA total of 43 patients were included in our study. Twenty-seven had screw fixation, and 16 had suture button fixation. The surgical duration of the button fixation technique was comparable to that of screw fixation (P = .72), with no significant difference in the variability of surgical time in either cohort (P > .05). Both groups showed similarly optimal vertical positioning of the graft onto the lower third of the glenoid (P = .89). Desired obliquity of graft fixation was identified more frequently with button fixation (P < .001). Both fixation methods provided clinically acceptable medial-lateral step formations, with suture-button fixation being significantly larger (P = .03).ConclusionsSuture button fixation of the allograft is a potential alternative to screw fixation for the management of glenoid bone loss in recurrent anterior shoulder instability. The results of this study show that this method has a comparable learning curve, with a similar surgical duration, while not compromising the optimal accuracy of vertical and medial-lateral placement of the graft and achieves a superior alpha angle of fixation.Level of evidenceLevel III, retrospective cohort study.

Dataset Information

Graft Transfer Technique in Arthroscopic Posterior Glenoid Reconstruction With Distal Tibia Allograft.

Publications

Graft Transfer Technique in Arthroscopic Posterior Glenoid Reconstruction With Distal Tibia Allograft.

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