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Arthroscopic Autologous Iliac Crest Grafting Results in Similar Outcomes and Low Recurrence compared to Remplissage plus Bankart Repair for Anterior Shoulder Instability with Bipolar Bone Defects

  • Di Wu
    Affiliations
    Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200030, China
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  • Zhekun Zhou
    Affiliations
    Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200030, China
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  • Wei Song
    Affiliations
    Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200030, China
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  • Daoyun Chen
    Affiliations
    Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200030, China
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  • Zhenlong Bai
    Affiliations
    Department of Orthopaedics, Jinshan Branch of Shanghai Sixth People’s Hospital affiliated to Shanghai University of Medicine & Health Sciences, 147 Jiankang Road, Shanghai 201503, China
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  • Xiaofeng Zhang
    Affiliations
    Department of Orthopaedics, Jinshan Branch of Shanghai Sixth People’s Hospital affiliated to Shanghai University of Medicine & Health Sciences, 147 Jiankang Road, Shanghai 201503, China
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  • Weilin Yu
    Correspondence
    Address correspondence to Weilin Yu, MD, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, China (). Telephone: +86 021-64369181
    Affiliations
    Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200030, China
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  • Yaohua He
    Correspondence
    Address correspondence to Yaohua He, MD, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, China ().
    Affiliations
    Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200030, China
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Published:January 24, 2023DOI:https://doi.org/10.1016/j.arthro.2022.12.039

      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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