Distal clavicle autograft for anterior-inferior glenoid augmentation: A comparative cadaveric anatomic study

Abstract

Introduction The aim of this study was to anatomically compare distal clavicle and coracoid autografts and their potential to augment anterior-inferior glenoid bone loss. Methods Ten millimeters of distal clavicle and 20 mm of coracoid were harvested bilaterally from 32 cadavers. Length, weight, and height were measured and surface area and density were calculated. For each graft, ipsilateral measurements were compared and the ability to restore corresponding glenoid bone loss was calculated. Results Distal clavicle grafts were larger than coracoid grafts with respect to length (22.3 mm versus 17.7 mm; p < 0.001), height (12.49 mm versus 9.65 mm; p < 0.001), mass (2.72 g versus 2.45 g; p = 0.0437), and volume (2.36 cm3 versus 1.96 cm3; p = 0.002). Coracoid grafts had larger widths (14.56 mm versus 10.52 mm; p < 0.001) and greater density (1.24 g/cm3 versus 1.18 g/cm3; p < 0.001). Distal clavicle surface area was greater on both the articular (2.93 cm2 versus 1.5 cm2; p < 0.001) and superior surfaces (2.76 cm2 versus 1.5 cm2; p < 0.001) when compared to lateral coracoid surface area. Discussion Distal clavicle grafts were larger and restored larger bony defects but had greater variability and lower density than coracoid grafts. Clinical studies are needed to compare these graft options.

Distal Clavicle Autograft Versus Traditional and Congruent Arc Latarjet Procedures: A Comparison of Surface Area and Glenoid Apposition With 3-Dimensional Computed Tomography and 3-Dimensional Magnetic Resonance Imaging

“…19,26 Our study found that the distal clavicle autograft (DCP and DCR) provided a slightly larger surface area than the SLJ (309.25 vs 302.84 mm 2 , respectively), consistent with the literature. Hudson et al 10 found that the distal clavicle yielded significantly more graft than the coracoid. The surface area of the articular distal clavicle and the superior distal clavicle were nearly twice that of the lateral coracoid, allowing the grafted distal clavicle to potentially fill larger glenoid defects—particularly defects >25% of the glenoid—and restore a more native glenoid articular surface compared with coracoid transfer.…”

“…8 The distal clavicle autograft is gaining further attention as a graft source. 10,19,25 Biomechanical studies have shown the distal clavicle to be comparable with the coracoid in terms of contact area and mean and peak pressure. 19 Resection of 1 cm medial to the distal end of the clavicle has been shown to be sufficient to reconstruct a 25% vertical glenoid defect.…”

“…27 A reported 78% to 91% of recurrent anterior shoulder dislocations involve some degree of glenoid bone loss, which often necessitates bony augmentation when the size of the lesion exceeds a threshold of 21% of the glenoid width. 10 Significant glenoid bone loss is one of the most significant risk factors for recurrence and failure after arthroscopic stabilization of the shoulder. 2 Several autologous and allograft options for glenoid reconstruction have been described.…”

“…19 Resection of 1 cm medial to the distal end of the clavicle has been shown to be sufficient to reconstruct a 25% vertical glenoid defect. 10 Studies have also suggested that a distal clavicle graft may provide a larger radius of restoration than a coracoid graft. 10,11 Despite the potential advantages of using a distal clavicle autograft compared with a coracoid graft, there remain limited studies quantifying and comparing the dimensions between the different graft options.…”

Current concepts in anterior glenohumeral instability: diagnosis and treatment

“…Distal clavicle has a broader radius of reconstruction than that of a coracoid graft [ 66 ] but, on the other hand, had greater variability and lower density than coracoid grafts [ 67 ].…”