This study demonstrated that limited medial meniscal RD was present preoperatively but increased by 2 mm after scaffold implantation. Lateral RD was also present preoperatively but did not increase after scaffold implantation. Importantly, a strong negative correlation was found between the rim and postoperative medial RD; a thicker rim limited RD. However, in the lateral compartment, rim thickness did not correlate with RD because RD was already strongly present preoperatively. Finally, no correlations were observed between scaffold RD and clinical outcome scores, either preoperatively or postoperatively.
Graft non-union resulting in recurrent instability was the main indication for open revision surgery after Bristow or Latarjet procedure, followed by resorption, malpositioning, and graft fracture in this retrospective case series. Revision surgery consisted of a structural iliac crest bone graft in the majority of cases. Clinical and radiographic outcomes are predictably variable in this population of multioperated patients.
Recurrent anterior shoulder instability is associated with glenohumeral bone loss. Glenoid deficiency compromises the concavity-compression mechanism. Medial Hill-Sachs lesions can result in an off-track humeral position. Anterior glenoid reconstruction or augmentation prevents recurrence by addressing the pathomechanics. In Bristow and Latarjet procedures, the coracoid process is harvested for conjoint tendon transfer, capsular reinforcement, and glenoid rim restoration. Complications and the nonanatomic nature of the procedure have spurred research on graft sources. The iliac crest is preferred for autogenous structural grafts. Tricortical, bicortical, and J-bone grafts have shown promising results despite the historical association of Eden-Hybinette procedures with early degenerative joint disease. Allogeneic osteochondral grafts may minimize the risk of arthropathy and donor site morbidity. Tibial plafond and glenoid allografts more closely match the native glenoid geometry and restore the articular chondral environment, compared with conventional grafts. Graft availability, cost, risk of disease transmission, and low chondrocyte viability have slowed the acceptance of osteochondral allografts.
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