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Editorial Commentary: Arthroscopic Shoulder Instability Surgery and Glenoid Bone Loss: A Paradigm Shift?

      Abstract

      The successful treatment of shoulder instability, particularly in the setting of glenoid bone loss, is a challenging problem. There are several surgical options that are available for patients who have this clinical entity. Of these options, bone block procedures have become increasing common over the past several years, both for primary and revision surgery, with the aim to restore the native glenoid anatomy. The arthroscopic Eden–Hybinette procedure is a viable arthroscopic treatment option in patients who have anterior shoulder instability with anterior glenoid insufficiency. This technique has some distinct advantages over other bone block procedures, specifically the ability to avoid damage to the subscapularis and to preserve the coracoid process. In addition, the use of autograft has benefits over glenoid reconstruction procedures that use allograft, specifically pertaining to cost and availability.
      Anterior shoulder instability is a common clinical problem, and its successful treatment can be challenging for the treating surgeon. Glenoid bone deficiency is frequently encountered even after a single glenohumeral dislocation event.
      • Dickens J.F.
      • Slaven S.E.
      • Cameron K.L.
      • et al.
      Prospective evaluation of glenoid bone loss after first-time and recurrent anterior glenohumeral instability events.
      The presence of glenoid bone loss is essential to recognize, as treatment strategies change in this setting. Bone block procedures that are designed to reconstruct the native glenoid anatomy include the Eden–Hybinette procedure,
      • Villatte G.
      • Spurr S.
      • Broden C.
      • Martins A.
      • Emery R.
      • Reilly P.
      The Eden-Hybbinette procedure is one hundred years old! A historical view of the concept and its evolutions.
      the Latarjet procedure,
      • Joshi M.A.
      • Young A.A.
      • Balestro J.C.
      • Walch G.
      The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes.
      the J-bone graft procedure,
      • Auffarth A.
      • Schauer J.
      • Matis N.
      • Kofler B.
      • Hitzl W.
      • Resch H.
      The J-bone graft for anatomical glenoid reconstruction in recurrent posttraumatic anterior shoulder dislocation.
      and distal tibial allograft reconstruction.
      • Provencher M.T.
      • Frank R.M.
      • Golijanin P.
      • et al.
      Distal tibia allograft glenoid reconstruction in recurrent anterior shoulder instability: Clinical and radiographic outcomes.
      First performed in 1917,
      • Eden R.
      Zur Operation der habituellen Schulter luxation unter Mitteilung eines neuen verfahrens bei Abri ß am inneren Pfannenrande.
      ,
      • Hybinette S.
      De la transplantation d’un fragment osseux pour remédier aux luxations récidivantes de l’epaule; constatations et résultats opératoires.
      the Eden–Hybinette procedure has evolved into an all-arthroscopic technique.
      • Giannakos A.
      • Vezeridis P.S.
      • Schwartz D.G.
      • Jany R.
      • Lafosse L.
      All-arthroscopic revision Eden-Hybinette procedure for failed instability surgery: Technique and preliminary results.
      • 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.
      • Kraus N.
      • Amphansap T.
      • Gerhardt C.
      • Scheibel M.
      Arthroscopic anatomic glenoid reconstruction using an autologous iliac crest bone grafting technique.
      This technique has some distinct advantages over other bone block procedures, specifically the ability to avoid damage to the subscapularis and to preserve the coracoid process. In addition, the use of autograft has benefits over glenoid reconstruction procedures that use allograft, specifically pertaining to cost and availability.
      I read the study by Drs. Avramidis, Kokkineli, Trellopoulos, Tsiogka, Natsika, Brilakis, and Antonogiannakis, entitled “Excellent Clinical and Radiological Mid-Term Outcomes for the Management of Recurrent Anterior Shoulder Instability by All-Arthroscopic Modified Eden-Hybinette Procedure Using Iliac Crest Autograft and Double Pair of Button Fixation System: 3-Year Clinical Case Series With No Loss to Follow-Up”
      • Avramidis G.
      • Kokkineli S.
      • Trellopoulos A.
      • et al.
      Excellent clinical and radiological mid-term outcomes for the management of recurrent anterior shoulder instability by all-arthroscopic modified Eden–Hybinette procedure using iliac crest autograft and double pair of button fixation system: 3-year clinical case series with no loss to follow-up.
      with great interest. In this well-executed investigation, the authors report on their experience using a modified all-arthroscopic Eden–Hybinette procedure for patients with anterior shoulder instability in the setting of glenoid bone loss. At 3 years postoperatively, they demonstrated no recurrence and only 1 patient with mild arthrosis in their series of 28 patients. In addition, computed tomography scans were performed at the 1-year postoperative time point in 82% of their patients, and these computed tomography scan data found no instances of complete bone graft resorption and only 2 cases of partial graft resorption. Taverna et al.
      • 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.
      had similar findings of bone block healing in 92% of patients in their cohort. In addition, this procedure has been successfully used in revision instability cases.
      • Giannakos A.
      • Vezeridis P.S.
      • Schwartz D.G.
      • Jany R.
      • Lafosse L.
      All-arthroscopic revision Eden-Hybinette procedure for failed instability surgery: Technique and preliminary results.
      ,
      • Boileau P.
      • Duysens C.
      • Saliken D.
      • Lemmex D.B.
      • Bonnevialle N.
      All-arthroscopic, guided Eden–Hybbinette procedure using suture-button fixation for revision of failed Latarjet.
      Avramidis et al.
      • Avramidis G.
      • Kokkineli S.
      • Trellopoulos A.
      • et al.
      Excellent clinical and radiological mid-term outcomes for the management of recurrent anterior shoulder instability by all-arthroscopic modified Eden–Hybinette procedure using iliac crest autograft and double pair of button fixation system: 3-year clinical case series with no loss to follow-up.
      have obtained thorough mid-term clinical and radiographic follow-up for the modified all-arthroscopic Eden–Hybinette procedure. Their results demonstrate that this technique can be performed safely and reliably, with minimal donor-site morbidity and a low complication rate. Furthermore, they found a low rate of shoulder stiffness and arthrosis.
      There are multiple bone block techniques available to reconstruct the anterior glenoid, and there are advantages and disadvantages associated with each technique. The modified all-arthroscopic Eden–Hybinette procedure uses a readily available source of autograft with little donor-site morbidity. It also avoids violation of the subscapularis. Although there is no perfect solution to anterior shoulder instability in the setting of glenoid bone loss, the arthroscopic Eden–Hybinette procedure serves as a viable option and can serve as a powerful tool in the shoulder surgeon’s armamentarium.

      Supplementary Data

      References

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