Abstract
Purpose
To compare the functional outcomes, range of motion (ROM), recurrence rates, and complication
rates of arthroscopic autologous iliac crest grafting (AICG) and remplissage plus
Bankart repair (RB) for anterior shoulder instability with bipolar bone defects.
Methods
This study enrolled patients undergoing arthroscopic AICG or RB with 13.5% - 25% glenoid
bone defect combined with Hill-Sachs lesion between January 2013 and April 2020 who
had a minimum 2-year follow-up. Patient-reported outcomes were evaluated by Subjective
Shoulder Value (SSV), Oxford Shoulder Instability Score (OSIS), Rowe score, Constant
score, and visual analog scale (VAS) for pain. Active ROM, return to sports, recurrence,
self-reported apprehension, and complications were recorded.
Results
This study included 60 patients, including 28 AICG (Group A) and 32 RB (Group R).
Mean glenoid bone defect was similar (17.7%±3.1% vs 16.6%±2.4%, P=0.122). Both groups showed significant postoperative improvement in Rowe score, SSV,
OSIS, and Constant score. No significant difference was found in postoperative Rowe
Score (87.7 vs 85.2, P=0.198). A total of 20/28 (71.4%) patients in Group A versus 26/32 (81.3%) patients
in Group R met the Patient Acceptable Symptomatic State determined by VAS pain score
(P=0.370). Both groups showed high return-to-sports rates (67.8% vs 71.8%, P=0.735) and slightly decreased ROM. There were two cases of recurrence in Group A
versus one in Group R (P=0.594). Group R had insignificantly higher positive self-reported apprehension rate
(40.6% vs 17.9%, P=0.055).
Conclusion
For anterior shoulder instability with bipolar bone defects, both arthroscopic AICG
and RB can result in satisfactory clinical outcomes, good postoperative ROM, and low
recurrence and complication rates.
Level of evidence
Level III; retrospective cohort study
Keywords
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Article info
Publication history
Accepted:
December 30,
2022
Received in revised form:
December 29,
2022
Received:
June 22,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
All authors meet authorship based on the following contributions:
Di Wu: Design/data interpretation, manuscript pre and revision, final approval, and accountable for all aspects of work
Zhekun Zhou: Data acquisition, manuscript revision, final approval, and accountable for all aspects of work
Wei Song: Data acquisition, final approval, and accountable for all aspects of work
Daoyun Chen: Final approval, and accountable for all aspects of work
Zhenlong Bai: Data acquisition, final approval, and accountable for all aspects of work
Xiaofeng Zhang: Data acquisition, final approval, and accountable for all aspects of work
Weilin Yu: Design/data interpretation, manuscript pre and revision, final approval, and accountable for all aspects of work
Yaohua He: Design/data interpretation, manuscript revision, final approval, and accountable for all aspects of work
Acknowledgments:
The study was supported by the clinical project of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital (ynhg202101, ynts202002) and the clinical project of Shanghai Health Committee (20214Y0155).
IRB approval:
The study was approved by the ethics committee of Shanghai Sixth People’s Hospital (No. 2021-KY-62(K)).
Identification
Copyright
© 2023 Published by Elsevier on behalf of the Arthroscopy Association of North America
