Arthroscopic Glenoid Bone Augmentation Using Iliac Crest Autograft Is Safe and Effective for Anterior Shoulder Instability With Bone Loss

Abstract

Purpose: To establish a safety profile for an arthroscopic anatomic glenoid reconstruction using autologous iliac crest bone graft to treat shoulder instability with significant bone loss and to evaluate short-term clinical and radiological outcomes. Methods: A retrospective analysis of prospectively collected data was conducted for the patients who were treated for shoulder instability with bone loss using arthroscopic autologous iliac crest bone graft between November 2014 and June 2018. The safety profile was established by detective intraoperative or postoperative complications such as neurovascular injuries, infections, major bleeding, and subluxations. Short-term clinical and radiologic outcomes also were evaluated. Results: Thirteen patients were included in the study. A safety profile was observed, with no occurrence of intraoperative complications, neurovascular injuries, infection, or major bleeding. There were no dislocations or positive apprehension tests on clinical examination postoperatively. Postoperative Western Ontario Shoulder Instability (WOSI) scores were significantly greater than preoperative WOSI scores, with a mean improvement of 35.0 AE 20.2 (P < .001). Twelve patients (92.3%) received postoperative computed tomography scans, with 11 of 12 patients (91.7%) displaying complete graft union. Conclusions: Arthroscopic treatment of shoulder instability with bone loss via autologous iliac crest bone graft is shown to be a safe operative procedure that results in favourable short-term clinical and radiologic outcomes, with a significant improvement in WOSI scores and high rates of graft union. Although graft resorption was seen in most patients who had postoperative computed tomography imaging, there were no instances of clinical graft failure. Level of Evidence: Level IV, therapeutic case series.

Anterior shoulder dislocation: A bibliometric analysis in the past two decades (2003–2022)

“…This surgical procedure can be used as a revision after the failure of the Latarje and Bristow procedure or as a repair when the bone defect is huge. As for the choice of free bone graft, autogenous iliac crest is more common, but the complication rate is higher [ 23 , 24 ]. Meanwhile, studies using allograft distal tibia, autogenous distal clavicle, and autologous scapular spine as grafts have also been reported [ [25] , [26] , [27] ].…”

Morphometric and Biomechanical Comparison of the Scapular Spine and Coracoid Graft in Anterior Shoulder Instability

“…According to Wolff's law, 17 osteolysis and graft resorption might happen if the reconstructed glenoid is larger than its physiological size. 29 Therefore, the ability for glenoid restoration of the scapular spine is worth investigating. Rodriguez et al 36 found that the scapular spine was capable of achieving 28.2% glenoid restoration on average, compared with 31% in our results.…”