Arthroscopic bone block stabilisation procedures for glenoid bone loss in anterior glenohumeral instability: A systematic review of clinical and radiological outcomes

Tahir, Mohd Faizal Mat; Malik, Shahbaz S.; Jordan, Robert W.; Kronberga, Madara; D’Alessandro, Peter; Saithna, Adnan

doi:10.1016/j.otsr.2021.102949

Cited by 12 publications

(18 citation statements)

References 48 publications

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“…Second, an iliac crest allograft was used for the FBB procedure in the current study, and the efficacy and reliability of other graft options remain to be further investigated, such as a distal tibial allograft or iliac crest autograft. 60 Third, although young male patients account for the majority of ASI cases, 45 the inclusion of only 6 female patients in this study might result in sex bias because female sex has been identified as a risk factor for clinical failure after the Latarjet procedure. 25 Finally, the follow-up duration in this study was short term to midterm, and a long-term clinical and radiological follow-up should focus on donor site morbidity of the LHBT and the degenerative progression in the shoulder joint.…”

Section: Discussionmentioning

confidence: 97%

“…Bone resorption during the graft remodeling phase weakens the bone-mediated biomechanical effect on anterior shoulder stability, especially with allografts. 57,60 In 2 recent studies using iliac crest bone allografts, Boehm et al 9 reported nearly complete bone resorption in all patients with only a 2.2% glenoid defect decrease at 1-year follow-up, and Russo et al 56 observed that 10 of 19 patients had complete bone resorption. In the current study, although the mean glenoid defect area was significantly decreased from 18.1% to 4.9%, partial bone resorption was still observed in 35 of 59 patients.…”

Section: Discussionmentioning

confidence: 99%

“…32 Although the FBB procedure may result in comparable clinical and radiological outcomes, 32,50 biomechanical investigations have reported better stability with the Latarjet procedure because of its additional tendon sling effect. 67 In addition, bone resorption during the remodeling process would attenuate the bone block effect, 9,33,57,60 which might further highlight the time-zero biomechanical inferiority of the FBB procedure and result in a lower return-to-sports rate in an active population compared with the Latarjet procedure. 62,65,66 Furthermore, dynamic anterior stabilization (DAS) has been recently proposed to provide a similar tendon sling effect as the Latarjet procedure by transferring the long head of the biceps tendon (LHBT) through a subscapularis split onto the anterior glenoid rim.…”

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confidence: 99%

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Clinical and Radiological Outcomes in Patients With Anterior Shoulder Instability and Glenoid Bone Loss after Arthroscopic Free Bone Block Combined With Dynamic Anterior Stabilization

Fang

et al. 2022

Am J Sports Med

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Background: As an alternative to the Latarjet procedure, the arthroscopic free bone block (FBB) procedure combined with dynamic anterior stabilization (DAS) has been recently proposed to provide both glenoid augmentation and a tendon sling effect for treating anterior shoulder instability (ASI) with glenoid bone loss. Purpose: To evaluate the clinical and radiological outcomes of FBB-DAS for ASI with glenoid bone loss. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent arthroscopic FBB-DAS for ASI with >15% glenoid bone loss between February 2017 and March 2020 were screened and enrolled in this study. Clinical outcome measures were assessed preoperatively and at a minimum 2-year follow-up, including recurrence, complications, shoulder functional scores, range of motion, and return to sports. Postoperative computed tomography and magnetic resonance imaging were also performed. Results: Of a total of 65 patients with a mean follow-up of 46.1 ± 13.1 months, no patients experienced a recurrent dislocation or subluxation postoperatively, while 2 had a positive anterior apprehension test (3.1%). Additionally, 2 patients (3.1%) experienced complications of hematoma and shoulder stiffness, respectively. The mean visual analog scale score, American Shoulder and Elbow Surgeons score, Rowe score, and Oxford Shoulder Instability Score all improved significantly from 3.2 ± 2.4, 75.0 ± 18.9, 43.6 ± 27.3, and 33.8 ± 9.0 preoperatively to 1.3 ± 0.8, 95.1 ± 8.0, 95.5 ± 7.8, and 14.8 ± 3.5 at final follow-up, respectively (all P < .001). No difference was detected in range of motion except for 8.1° and 7.5° external rotation limitations in adduction and abduction, respectively. There were 62 patients (95.4%) who returned to sports, and 54 patients (83.1%) returned to the preinjury level. The transferred biceps tendon was intact in all 59 patients who completed radiological examination at the latest follow-up. Good bone healing was achieved in 98.3% of patients, and the glenoid bone defect decreased from 18.1% to 4.9%. Osseous and labral glenoids were significantly enlarged in width and depth on the latest magnetic resonance imaging (all P < .001). Conclusion: Arthroscopic FBB-DAS provided satisfactory clinical and radiological outcomes for ASI with glenoid bone loss. Despite slight external rotation restrictions, it achieved low recurrence and complication rates, excellent shoulder functional scores, a high return-to-sports rate, and favorable graft healing and remodeling.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical and Radiological Outcomes in Patients With Anterior Shoulder Instability and Glenoid Bone Loss after Arthroscopic Free Bone Block Combined With Dynamic Anterior Stabilization

Fang

et al. 2022

Am J Sports Med

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“…This anterior glenoid defect model was radiologically confirmed to result in approximately 24% loss of the glenoid diameter based on the method reported by Sugaya et al 42 (Figure 2B), which was consistent with the clinical standard (.20%) that requires bony augmentation (Appendix Table A1, available in the online version of this article). 15,43 After anesthetization with pentobarbital (3%; 30 mg/kg), rabbits were positioned in the lateral decubitus position, and the unilateral shoulder was rotated externally. After identifying and mobilizing all tissue layers via a longitudinal incision to gain a good overview of the depth, we retained the supraspinatus and subscapularis tendons using two 2-0 Ethibond sutures (Ethicon), taking care to preserve sufficient stumps for reconnection.…”

Section: Glenoid Defect Modelmentioning

confidence: 99%

“…14,37,43 Traditionally, rigid fixation of an FBB onto the deficient glenoid neck using screws has been considered the standard because of its advantage in reliable mechanical fixation, particularly in the early postoperative rehabilitation period. 29,43 Similarly, hardware complications are huge concerns in these rigid fixation techniques using either metal or biodegradable screws, including impingement, soft tissue irritation, and graft osteolysis. 4,29,43 More importantly, hardware failure or irritation, one of the most common complications to compromise the results of FBB procedures, has shown a high propensity for revision surgery.…”

mentioning

confidence: 99%

Radiological and Histological Analyses of Nonrigid Versus Rigid Fixation for Free Bone Block Procedures in a Rabbit Model of Glenoid Defects

Han

et al. 2023

Am J Sports Med

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Background: Nonrigid fixation techniques have been recently introduced in free bone block (FBB) procedures to treat substantial glenoid bone loss in patients with anterior shoulder instability. However, the radiological and histological effectiveness of nonrigid fixation versus conventional rigid fixation have not been comprehensively understood in vivo. Purpose: To (1) explore the radiological and histological characteristics of nonrigid fixation for FBB procedures in a rabbit model of glenoid defects and (2) further compare them with those of conventional rigid fixation. Study Design: Controlled laboratory study. Methods: Unilateral shoulder glenoid defects were created in 36 mature New Zealand White rabbits, of which 24 underwent FBB procedures using allogenic iliac crest bone and were randomly divided into rigid fixation (RF) and nonrigid fixation (N-RF) groups, with the remaining divided into 2 control groups: 6 with sham surgery for glenoid defects (GD group) and 6 native glenoids (normal group). In the RF and N-RF groups, 6 rabbits were sacrificed at 6 or 12 weeks postoperatively for radiological and histological analyses of the reconstructed glenoid, and all rabbits in the GD and normal groups were sacrificed at 12 weeks. The radiological glenoid morphology was evaluated via micro–computed tomography. Moreover, the graft-glenoid healing and graft remodeling processes were determined using histological staining. Results: At 6 weeks, both the N-RF and RF groups had similarly improved radiological axial radian and en face area of the glenoid compared with the GD group, but the N-RF group showed superiority in restoration of the glenoid radian and area compared with the RF group at 12 weeks, with the native glenoid as the baseline. Histologically, the bone graft in both groups was substantively integrated into the deficient glenoid neck at 6 and 12 weeks, showing similar osseous healing processes at the graft-glenoid junction. Moreover, the bone graft histologically presented similar regenerated vascular density, total graft bone, and integrated graft bone in both groups. In contrast, the N-RF group had a different remodeling profile on radiological and histological analyses regarding regional bone resorption, mineralization, and fibrous tissue replacement during osseointegration. Conclusion: Compared with rigid fixation, nonrigid fixation resulted in superior reconstructed glenoid morphology radiologically and similar graft-glenoid osseous healing histologically, showing different graft remodeling profiles of regional bone resorption, mineralization, and fibrous tissue replacement. Clinical Relevance: The nonrigid fixation technique can be feasible for FBB procedures to treat glenoid bone loss in anterior shoulder instability. More clinical evidence is required to determine its pros and cons compared with conventional rigid fixation.

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High correlation between inner and outer glenoid circle diameters and its clinical relevance

Arenas-Miquelez

Karargyris

Hertel

2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThe majority of methods for measuring glenoid bone loss in shoulder instability use the best‐fit circle following the inferior glenoid rim. However, there is no precise method on how to draw this circle, particularly in case of a missing rim segment. Defining the radius is a source of substantial error. It was hypothesized that there is a relationship between the best‐fit inferior circle (inner circle), defined by Sugaya, and the circle tangent to the supra‐ and infra‐glenoid tubercles (outer circle), defined by Itoi, thus allowing a more consistent appreciation of the paleo‐glenoid. MethodsNinety‐five normal dry scapulae were examined. The specimens were digitally photographed obtaining perpendicular images of the glenoid cavity. Using HOROS® imaging software, a best‐fit inferior circle (inner circle) and a second circle fitting the most inferior and superior points of the glenoid (outer circle) were drawn by two investigators. The diameters and areas of the circles were recorded. Two‐way random‐effects intra‐class correlation coefficients (ICC) were used to measure intra‐ and inter‐observer agreement. A Bayesian measurement‐error regression model was used to determine the relationship between outer and inner circle measurements. ResultsThe mean glenoid height was 35.1 mm and the glenoid width 25.6 mm.The mean diameter of the outer circle was 35.7 ± 4.2 mm and the mean diameter of the inner circle was 26.8 ± 3.2 mm. ICC showed excellent inter‐ and intra‐observer agreement for both the outer circle diameter (ICC ≥ 0.95) and inner circle diameter (ICC ≥ 0.93). The two diameters demonstrated a very strong significant Pearson correlation (0.92, p < 0.001) and the regression showed excellent model fit R2 = 0.87. The areas of the two circles were also highly and significantly correlated (r = 0.94; p < 0.001). The ratio of inner circle to outer diameters was 0.74. ConclusionThere is a strong correlation between the inner and outer glenoid circle diameters. This study sets the base for the use the combined outer and inner circle and its ratio to better appreciate the paleo‐glenoid morphology and thus obtain a more reliable bone loss estimation. Application of this method aids in a more reliable estimation bone loss with potential benefit in surgical decision‐making.

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Arthroscopic bone block stabilisation procedures for glenoid bone loss in anterior glenohumeral instability: A systematic review of clinical and radiological outcomes

Cited by 12 publications

References 48 publications

Clinical and Radiological Outcomes in Patients With Anterior Shoulder Instability and Glenoid Bone Loss after Arthroscopic Free Bone Block Combined With Dynamic Anterior Stabilization

Clinical and Radiological Outcomes in Patients With Anterior Shoulder Instability and Glenoid Bone Loss after Arthroscopic Free Bone Block Combined With Dynamic Anterior Stabilization

Radiological and Histological Analyses of Nonrigid Versus Rigid Fixation for Free Bone Block Procedures in a Rabbit Model of Glenoid Defects

High correlation between inner and outer glenoid circle diameters and its clinical relevance

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