Advertisement

Arthroscopic Iliac Crest Bone Allograft Combined With Subscapularis Upper-Third Tenodesis Shows a Low Recurrence Rate in the Treatment of Recurrent Anterior Shoulder Instability Associated With Critical Bone Loss

Published:December 23, 2020DOI:https://doi.org/10.1016/j.arthro.2020.11.037

      Purpose

      To evaluate the clinical and radiologic outcomes of patients undergoing arthroscopic glenoid bone allograft combined with subscapularis upper-third tenodesis for anterior shoulder instability associated with clinically relevant bone loss and hyperlaxity.

      Methods

      Between January 2016 and December 2017, patients with recurrent anterior shoulder instability associated with bone loss and hyperlaxity were selected and treated with arthroscopic iliac crest bone graft combined with subscapularis upper-third tenodesis. The selection criteria were as follows: more than 5 dislocations; positive apprehension, anterior drawer, and Coudane-Walch test results; glenoid bone defect between 15% and 30% and humeral bone defect with an engaging Hill-Sachs lesion; and no previous shoulder surgery. All patients were followed up with the Constant score, University of California–Los Angeles (UCLA) rating, Rowe score, and visual analog scale evaluation. Assessments were performed with plain radiographs and a PICO computed tomography scan before surgery and at 2 years of follow-up.

      Results

      Nineteen patients were included in the study, with a mean follow-up duration of 34.6 months (range, 24-48 months). In 17 patients (89%), excellent clinical results were recorded according to the Rowe score. The Constant score improved from 82.9 (standard deviation [SD], 5.2) to 88.9 (SD, 4.3) (P = .002); Rowe score, from 25.3 (SD, 5.3) to 89.1 (SD, 21.8) (P < .001); UCLA score, from 23.7 (SD, 3) to 31.5 (SD, 4.8) (P < .001); and visual analog scale score, from 3.2 to 1.3 (P < .001). Patients met the minimal clinically important difference 94.7%, 89.5%, and 47.3% of the time for the Rowe score, UCLA score, and Constant score, respectively. Bone graft resorption was observed in all patients: partial in 9 and complete in 10. We recorded 2 recurrent traumatic dislocations (11%), with no case of persistent anterior apprehension or other complication.

      Conclusions

      An arthroscopic glenoid bone graft combined with subscapularis upper-third tenodesis may be a valid surgical option to treat recurrent anterior instability associated with both bone loss and hyperlaxity.

      Level of Evidence

      Level IV, 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

        • Yamamoto N.
        • Muraki T.
        • Sperling J.W.
        • et al.
        Stabilizing mechanism in bone-grafting of a large glenoid defect.
        J Bone Joint Surg Am. 2010; 92: 2059-2066
        • Burkhart S.S.
        • De Beer J.F.
        Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion.
        Arthroscopy. 2000; 16: 677-694
        • Glazebrook H.
        • Miller B.
        • Wong I.
        Anterior shoulder instability: A systematic review of the quality and quantity of the current literature for surgical treatment.
        Orthop J Sports Med. 2018; 6 (2325967118805983)
        • Shaha J.S.
        • Cook J.B.
        • Song D.J.
        • et al.
        Redefining “critical” bone loss in shoulder instability: Functional outcome worsen with “subcritical” bone loss.
        Am J Sports Med. 2015; 43: 1719-1725
        • Di Giacomo G.
        • Peebles L.A.
        • Pugliese M.
        • et al.
        Glenoid track instability management score: Radiographic modification of the Instability Severity Index Score.
        Arthroscopy. 2020; 36: 56-67
        • 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
        • Olds M.
        • Donaldson K.
        • Ellis R.
        • Kersten P.
        In children 18 years and under, what promotes recurrent shoulder instability after traumatic anterior shoulder dislocation? A systematic review and meta-analysis of risk factors.
        Br J Sports Med. 2016; 50: 1135-1141
        • Su F.
        • Kowalczuk M.
        • Ikpe S.
        • Lee H.
        • Sabzevari S.
        • Lin A.
        Risk factors for failure of arthroscopic revision anterior shoulder stabilization.
        J Bone Joint Surg Am. 2018; 100: 1319-1325
        • Murphy A.I.
        • Hurley E.T.
        • Hurley D.J.
        • Pauzenberger L.
        • Mullett H.
        Long-term outcomes of the arthroscopic Bankart repair: A systematic review of studies at 10-year follow-up.
        J Shoulder Elbow Surg. 2019; 28: 2084-2089
        • Purchase R.J.
        • Wolf E.M.
        • Hobgood E.R.
        • Pollock M.E.
        • Smalley C.C.
        Hill-Sachs “remplissage”: An arthroscopic solution for the engaging Hill-Sachs lesion.
        Arthroscopy. 2008; 24: 723-726
        • Maiotti M.
        • Massoni C.
        • Russo R.
        • Schroter S.
        • Zanini A.
        • Bianchedi D.
        Arthroscopic subscapularis augmentation of Bankart repair in chronic anterior shoulder instability with bone loss less than 25% and capsular deficiency: Clinical multicenter study.
        Arthroscopy. 2017; 33: 902-909
        • Williams H.L.M.
        • Evans J.P.
        • Furness N.D.
        • Smith C.D.
        It's not all about redislocation: A systematic review of complications after anterior shoulder stabilization surgery.
        Am J Sports Med. 2019; 47: 3277-3283
        • Hurley E.T.
        • Lim Fat D.
        • Farrington S.K.
        • Mullett H.
        Open versus arthroscopic Latarjet procedure for anterior shoulder instability: A systematic review and meta-analysis.
        Am J Sports Med. 2019; 47: 1248-1253
        • Griesser M.J.
        • Harris J.D.
        • McCoy B.W.
        • et al.
        Complications and re-operations after Bristow-Latarjet shoulder stabilization: A systematic review.
        J Shoulder Elbow Surg. 2013; 22: 286-292
        • Magarelli N.
        • Milano G.
        • Sergio P.
        • Santagada D.A.
        • Fabbriciani C.
        • Bonomo L.
        Intra-observer and interobserver reliability of the 'Pico' computed tomography method for quantification of glenoid bone defect in anterior shoulder instability.
        Skeletal Radiol. 2009; 38: 1071-1075
        • Russo R.
        • Maiotti M.
        • Taverna E.
        • Rao C.
        Arthroscopic bone graft procedure combined with arthroscopic subscapularis augmentation for recurrent anterior instability with glenoid bone defect.
        Arthrosc Tech. 2018; 7: e623-e632
        • Maiotti M.
        • Massoni C.
        Arthroscopic augmentation with subscapularis tendon in anterior shoulder instability with capsulolabral deficiency.
        Arthrosc Tech. 2013; 2: e303-e310
        • Neyton L.
        • Barth J.
        • Nourissat G.
        • et al.
        Arthroscopic Latarjet techniques: Graft and fixation positioning assessed with 2-dimensional computed tomography is not equivalent with standard open technique.
        Arthroscopy. 2018; 34: 2032-2040
        • Park I.
        • Oh M.J.
        • Shin S.J.
        Minimal clinically important differences and correlating factors for the Rowe score and the American Shoulder and Elbow Surgeons score after arthroscopic stabilization surgery for anterior shoulder instability.
        Arthroscopy. 2019; 35: 54-59
        • Cvetanovich G.L.
        • Gowd A.K.
        • Liu J.N.
        • et al.
        Establishing clinically significant outcome after arthroscopic rotator cuff repair.
        J Shoulder Elbow Surg. 2019; 28: 939-948
        • Xu S.
        • Chen J.Y.
        • Lie H.M.E.
        • Hao Y.
        • Lie D.T.T.
        Minimal clinically important difference of Oxford, Constant, and UCLA shoulder score for arthroscopic rotator cuff repair.
        J Orthop. 2019; 19: 21-27
        • Patte D.
        • Debeyre J.
        Luxations recidivantes de l’epaule.
        Encycl Med Chir. 1980; 44265: 44-52
        • Joshi M.A.
        • Young A.A.
        • Balestro J.C.
        • Walch G.
        The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes.
        Orthop Clin North Am. 2015; 46: 105-111
        • Samilson R.L.
        • Prieto V.
        Dislocation arthropathy of the shoulder.
        J Bone J Surg Am. 1983; 65: 456-460
        • Valsamis E.M.
        • Kany J.
        • Bonnevialle N.
        • et al.
        The arthroscopic Latarjet: A multisurgeon learning curve analysis.
        J Shoulder Elbow Surg. 2020; 29: 681-688
        • Leuzinger J.
        • Brzoska R.
        • Métais P.
        • et al.
        Learning curves in the arthroscopic Latarjet procedure: A multicenter analysis of the first 25 cases of 5 international surgeons.
        Arthroscopy. 2019; 35: 2304-2311
        • Boddapati V.
        • Fu M.C.
        • Schairer W.W.
        • et al.
        Increased shoulder arthroscopy time is associated with overnight hospital stay and surgical site infection.
        Arthroscopy. 2018; 34: 363-368
        • Hovelius L.
        • Sandström B.
        • Sundgren K.
        • Saebö 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
        • Zimmermann S.M.
        • Scheyerer M.J.
        • Farshad M.
        • et al.
        Long-term restoration of anterior shoulder stability: A retrospective analysis of arthroscopic Bankart repair versus open Latarjet procedure.
        J Bone Joint Surg Am. 2016; 98: 1954-1961
        • Valencia M.
        • Fernández-Bermejo G.
        • Martín-Ríos M.D.
        • et al.
        Subscapularis structural integrity and function after arthroscopic Latarjet procedure at a minimum 2-year follow-up.
        J Shoulder Elbow Surg. 2020; 29: 104-112
        • 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
        • Moroder P.
        • Schulz E.
        • Wierer G.
        • et al.
        Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: A prospective randomized trial.
        J Shoulder Elbow Surg. 2019; 28: 1298-1307
        • Bonnevialle N.
        • Azoulay V.
        • Faraud A.
        • Elia F.
        • Swider P.
        • Mansat P.
        Results of arthroscopic Bankart repair with Hill-Sachs remplissage for anterior shoulder instability.
        Int Orthop. 2017; 41: 2573-2580
        • 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
        • Boehm E.
        • Minkus M.
        • Moroder P.
        • Scheibel M.
        Massive graft resorption after iliac crest allograft reconstruction for glenoid bone loss in recurrent anterior shoulder instability.
        Arch Orthop Trauma Surg. 2020; 140: 895-903
        • Taverna E.
        • Garavaglia G.
        • Perfetti C.
        • Ufenast H.
        • Sconfienza L.M.
        • Guarrella V.
        An arthroscopic bone block procedure is effective in restoring stability, allowing return to sports in cases of glenohumeral instability with glenoid bone deficiency.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 3780-3787
        • Cautiero F.
        • Russo R.
        • Di Pietto F.
        • Sabino G.
        Computerized tomographic assessment and clinical evaluation in shoulder instability treated with the Latarjet-Patte procedure using one screw and washer.
        Muscles Ligaments Tendons J. 2017; 7: 26-33
        • Di Giacomo G.
        • Costantini A.
        • De Gasperis N.
        • et al.
        Coracoid graft osteolysis after the Latarjet procedure: A comparison study between two screws standard technique vs mini-plate fixation.
        Int J Shoulder Surg. 2013; 7: 1-6
        • Balestro J.C.
        • Young A.
        • Maccioni C.
        • Walch G.
        Graft osteolysis and recurrent instability after the Latarjet procedure performed with bioabsorbable screw fixation.
        J Shoulder Elbow Surg. 2015; 24: 711-718
        • LU Bigliani
        • Flatow E.L.
        • Kelkar R.
        • et al.
        The effect of anterior capsular tightening on shoulder kinematics and contact.
        J Shoulder Elbow Surg. 1994; 3: S65
        • Ahmad C.S.
        • Wang V.M.
        • Sugalski M.T.
        • et al.
        Biomechanics of shoulder capsulorrhaphy procedures.
        J Shoulder Elbow Surg. 2005; 14: S12-S18
        • Montgomery Jr., W.H.
        • Wahl M.
        • Hettrich C.
        • Itoi E.
        • Lippitt S.B.
        • Matsen III, F.A.
        Anteroinferior bone-grafting can restore stability in osseous glenoid defects.
        J Bone Joint Surg Am. 2005; 87: 1972-1977