Advertisement

Distal Tibia Allograft Glenoid Reconstruction in Recurrent Anterior Shoulder Instability: Clinical and Radiographic Outcomes

Published:December 22, 2016DOI:https://doi.org/10.1016/j.arthro.2016.09.029

      Purpose

      To assess the clinical and radiographic outcomes of patients with recurrent anterior shoulder instability treated with fresh distal tibia allograft (DTA) glenoid reconstruction.

      Methods

      Consecutive patients with a minimum 15% anterior glenoid bone loss associated with recurrent anterior instability who underwent stabilization with DTA glenoid reconstruction were retrospectively reviewed. Patients were evaluated with the American Shoulder and Elbow Society score, Western Ontario shoulder instability index, and single numerical assessment evaluation score at a minimum 2 years after surgery. All patients also underwent postoperative imaging evaluation with computed tomography where graft incorporation and allograft angle were measured. Statistical analysis was performed with paired t-tests, with P < .05 considered significant.

      Results

      A total of 27 patients (100% male) with an average age of 31 ± 5 years and an average follow-up of 45 months (range, 30-66) were included. There were significant improvements in preoperative to postoperative American Shoulder and Elbow Society score (63-91, P < .01), Western Ontario shoulder instability index (46% to 11% of normal, P < .01), and single numerical assessment evaluation score (50-90.5, P < .01) outcomes. Analysis of computed tomography data at an average 1.4 years postoperatively (available for 25 patients) showed an allograft healing rate of 89% (range, 80% to 100%), average allograft angle of 14.9° (range, 6.6° to 29.3°), and average allograft lysis of 3% (range, 0% to 25%). Grafts with lesser allograft angles (<15°) were better opposed to the anterior glenoid, showing superior healing and graft incorporation. There were no cases of recurrent instability.

      Conclusions

      At an average follow-up of 45 months, fresh DTA reconstruction for recurrent anterior shoulder instability results in a clinically stable joint with excellent clinical outcomes and minimal graft resorption. Optimal allograft placement resulted in superior bony incorporation with the native glenoid.

      Level of Evidence

      Level IV, therapeutic case series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Provencher M.T.
        • Bhatia S.
        • Ghodadra N.S.
        • et al.
        Recurrent shoulder instability: Current concepts for evaluation and management of glenoid bone loss.
        J Bone Joint Surg Am. 2010; 92: 133-151
        • Piasecki D.P.
        • Verma N.N.
        • Romeo A.A.
        • Levine W.N.
        • Bach Jr., B.R.
        • Provencher M.T.
        Glenoid bone deficiency in recurrent anterior shoulder instability: Diagnosis and management.
        J Am Acad Orthop Surg. 2009; 17: 482-493
        • Di Giacomo G.
        • Costantini A.
        • de Gasperis N.
        • et al.
        Coracoid graft osteolysis after the Latarjet procedure for anteroinferior shoulder instability: A computed tomography scan study of twenty-six patients.
        J Shoulder Elbow Surg. 2011; 20: 989-995
        • Di Giacomo G.
        • de Gasperis N.
        • Costantini A.
        • De Vita A.
        • Beccaglia M.A.
        • Pouliart N.
        Does the presence of glenoid bone loss influence coracoid bone graft osteolysis after the Latarjet procedure? A computed tomography scan study in 2 groups of patients with and without glenoid bone loss.
        J Shoulder Elbow Surg. 2014; 23: 514-518
        • Provencher M.T.
        • Ghodadra N.
        • LeClere L.
        • Solomon D.J.
        • Romeo A.A.
        Anatomic osteochondral glenoid reconstruction for recurrent glenohumeral instability with glenoid deficiency using a distal tibia allograft.
        Arthroscopy. 2009; 25: 446-452
        • Provencher M.T.
        • LeClere L.E.
        • Ghodadra N.
        • Solomon D.J.
        Postsurgical glenohumeral anchor arthropathy treated with a fresh distal tibia allograft to the glenoid and a fresh allograft to the humeral head.
        J Shoulder Elbow Surg. 2010; 19: e6-e11
        • Frank R.M.
        • Shin J.
        • Saccomanno M.F.
        • et al.
        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: 2574-2582
        • Ghodadra N.
        • Gupta A.
        • Romeo A.A.
        • et al.
        Normalization of glenohumeral articular contact pressures after Latarjet or iliac crest bone-grafting.
        J Bone Joint Surg Am. 2010; 92: 1478-1489
        • Bhatia S.
        • Van Thiel G.S.
        • Gupta D.
        • et al.
        Comparison of glenohumeral contact pressures and contact areas after glenoid reconstruction with Latarjet or distal tibial osteochondral allografts.
        Am J Sports Med. 2013; 41: 1900-1908
        • Altan E.
        • Ozbaydar M.U.
        • Tonbul M.
        • Yalcin L.
        Comparison of two different measurement methods to determine glenoid bone defects: Area or width?.
        J Shoulder Elbow Surg. 2014; 23: 1215-1222
        • Bishop J.Y.
        • Jones G.L.
        • Rerko M.A.
        • Donaldson C.
        • Group M.S.
        3-D CT is the most reliable imaging modality when quantifying glenoid bone loss.
        Clin Orthop Relat Res. 2013; 471: 1251-1256
        • Bois A.J.
        • Fening S.D.
        • Polster J.
        • Jones M.H.
        • Miniaci A.
        Quantifying glenoid bone loss in anterior shoulder instability: Reliability and accuracy of 2-dimensional and 3-dimensional computed tomography measurement techniques.
        Am J Sports Med. 2012; 40: 2569-2577
        • Chuang T.Y.
        • Adams C.R.
        • Burkhart S.S.
        Use of preoperative three-dimensional computed tomography to quantify glenoid bone loss in shoulder instability.
        Arthroscopy. 2008; 24: 376-382
        • Sugaya H.
        • Moriishi J.
        • Dohi M.
        • Kon Y.
        • Tsuchiya A.
        Glenoid rim morphology in recurrent anterior glenohumeral instability.
        J Bone Joint Surg Am. 2003; 85: 878-884
      1. Frank RM, Romeo AA, Provencher MT. Glenoid reconstruction with distal tibia allograft for recurrent anterior shoulder instability [published online October 13, 2016]. Orthopedics. doi:10.3928/01477447-20161006-06.

        • Boileau P.
        • Mercier N.
        • Roussanne Y.
        • Thelu C.E.
        • Old J.
        Arthroscopic Bankart-Bristow-Latarjet procedure: The development and early results of a safe and reproducible technique.
        Arthroscopy. 2010; 26: 1434-1450
        • Lewandrowski K.U.
        • Rebmann V.
        • Passler M.
        • et al.
        Immune response to perforated and partially demineralized bone allografts.
        J Orthop Sci. 2001; 6: 545-555
        • Detterline A.J.
        • Goldberg S.
        • Bach Jr., B.R.
        • Cole B.J.
        Treatment options for articular cartilage defects of the knee.
        Orthop Nurs. 2005; 24 (quiz 367-368): 361-366
        • Sayegh E.T.
        • Mascarenhas R.
        • Chalmers P.N.
        • Cole B.J.
        • Verma N.N.
        • Romeo A.A.
        Allograft reconstruction for glenoid bone loss in glenohumeral instability: A systematic review.
        Arthroscopy. 2014; 30: 1642-1649
        • Gupta A.K.
        • Chalmers P.N.
        • Klosterman E.
        • Harris J.D.
        • Provencher M.T.
        • Romeo A.A.
        Arthroscopic distal tibial allograft augmentation for posterior shoulder instability with glenoid bone loss.
        Arthrosc Tech. 2013; 2: e405-e411
        • Millett P.J.
        • Schoenahl J.Y.
        • Register B.
        • Gaskill T.R.
        • van Deurzen D.F.
        • Martetschlager F.
        Reconstruction of posterior glenoid deficiency using distal tibial osteoarticular allograft.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 445-449
        • Waterman B.R.
        • Chandler P.J.
        • Teague E.
        • Provencher M.T.
        • Tokish J.M.
        • Pallis M.P.
        Short-term outcomes of glenoid bone block augmentation for complex anterior shoulder instability in a high-risk population.
        Arthroscopy. 2016; 32: 1784-1790
        • Hovelius L.
        • Vikerfors O.
        • Olofsson A.
        • Svensson O.
        • Rahme H.
        Bristow-Latarjet and Bankart: A comparative study of shoulder stabilization in 185 shoulders during a seventeen-year follow-up.
        J Shoulder Elbow Surg. 2011; 20: 1095-1101
        • Hovelius L.
        • Sandstrom B.
        • Sundgren K.
        • Saebo M.
        One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: Study I—Clinical results.
        J Shoulder Elbow Surg. 2004; 13: 509-516
        • Hovelius L.
        • Sandstrom B.
        • Saebo M.
        One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: Study II—The evolution of dislocation arthropathy.
        J Shoulder Elbow Surg. 2006; 15: 279-289
        • Flinkkila T.
        • Sirnio K.
        Open Latarjet procedure for failed arthroscopic Bankart repair.
        Orthop Traumatol Surg Res. 2015; 101: 35-38
        • Balg F.
        • Boileau P.
        The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation.
        J Bone Joint Surg Br. 2007; 89: 1470-1477
        • Bessiere C.
        • Trojani C.
        • Carles M.
        • Mehta S.S.
        • Boileau P.
        The open Latarjet procedure is more reliable in terms of shoulder stability than arthroscopic Bankart repair.
        Clin Orthop Relat Res. 2014; 472: 2345-2351
        • Boileau P.
        • Gendre P.
        • Baba M.
        • et al.
        A guided surgical approach and novel fixation method for arthroscopic Latarjet.
        J Shoulder Elbow Surg. 2016; 25: 78-89
        • Bhatia S.
        • Frank R.M.
        • Ghodadra N.S.
        • et al.
        The outcomes and surgical techniques of the Latarjet procedure.
        Arthroscopy. 2014; 30: 227-235
        • Dehaan A.
        • Munch J.
        • Durkan M.
        • Yoo J.
        • Crawford D.
        Reconstruction of a bony Bankart lesion: Best fit based on radius of curvature.
        Am J Sports Med. 2013; 41: 1140-1145
        • McCarty E.C.
        • Fader R.R.
        • Mitchell J.J.
        • Glenn Jr., R.E.
        • Potter H.G.
        • Spindler K.P.
        Fresh osteochondral allograft versus autograft: Twelve-month results in isolated canine knee defects.
        Am J Sports Med. 2016; 44: 2354-2365
        • Giles J.W.
        • Puskas G.
        • Welsh M.
        • Johnson J.A.
        • Athwal G.S.
        Do the traditional and modified Latarjet techniques produce equivalent reconstruction stability and strength?.
        Am J Sports Med. 2012; 40: 2801-2807

      Linked Article

      • Erratum
        ArthroscopyVol. 34Issue 3
        • Preview
          In the article “Distal Tibia Allograft Glenoid Reconstruction in Recurrent Anterior Shoulder Instability: Clinical and Radiographic Outcomes,” published in the May 2017 issue (Arthroscopy 2017;33:891-897), the senior authors of the paper were cited incorrectly in several places. In the “Participants” section on page 892, the term “senior authors” was followed only by the initials of author Anthony A. Romeo, M.D. The article featured four senior authors, and the text should therefore have shown the initials of authors Anthony A.
        • Full-Text
        • PDF