Outcomes for intra-substance free coracoid graft in patients with antero-inferior instability and glenoid bone loss in a population of high-risk athletes at a minimum follow-up of 2 years

Abstract

Background: The aim of this retrospective case series study was to assess the outcomes of patients with recurrent anterior shoulder instability with antero-inferior glenoid bone loss treated with a specific open stabilization technique using intra-substance coracoid bone-grafting and Bankart repair. Methods: Over a 4-year period, 34 shoulders in all male patients of mean age 21 years were stabilized with this technique. Pre-and postoperative function, motion and stability were assessed as part of Rowe stability scoring, and American Shoulder and Elbow Surgeons (ASES) and Oxford Instability were recorded, with at least 2 years of follow-up in all patients. Union of the graft was determined by post-operative computed tomography (CT) of the affected shoulder. Results: For all cases, two redislocations (5.9%) and two subluxations occurred when continuing high-risk sport after 2 years. Post-operative scores [median, mean (SD): Rowe 77.5, 77.2 (19.5); ASES 94.2, 92 (7.7); Oxford 43, 41.2 (6)]. CT scans on 28 shoulders at a mean of 4.5 months after surgery showed non-union in three cases (10%).Conclusions: These results demonstrate a high rate of success in cases of glenoid bone loss in the young contact athlete with recurrent instability treated with open stabilization and bone grafting.

Radiographic Analysis of Glenoid Size and Shape After Arthroscopic Coracoid Autograft Versus Distal Tibial Allograft in the Treatment of Anterior Shoulder Instability

“…However, we can see a trend of increased non-union rate for the coracoid autograft group, which is supported by several other studies where non-union rates for coracoid graft were 6.5% to 47%. 2,5,7,10,16,17 Conversely, several studies have reported tibial allograft to have a union rate of 89% to 100%, supported by the findings of this study. 18,24,27…”

Outcomes of the Latarjet Procedure Versus Free Bone Block Procedures for Anterior Shoulder Instability: A Systematic Review and Meta-analysis

“…There were 16 case series, level 4 studies (n = 544 shoulders) ** ; 1 cohort, level 3 study (n = 50 shoulders) 40 ; and 1 randomized controlled, level 1 study (n = 29 shoulders). 66 There were 6 studies reporting on the use of allografts (2 distal tibial, 40,75 3 iliac crest, 2,90,108 and 1 femoral head allograft) 98 , and 12 studies reporting on the use of autografts (10 iliac crest †† and 2 free partial-thickness coracoid autograft 7,95 ). Studies are presented in detail with MINORS and NOS scores in the Appendix (available in the online version of this article).…”

“…No statistically significant difference was found in terms of recurrent instability between the 2 groups ( P = .09). Of note, the definition of recurrent instability varied across studies; some studies did not define recurrent instability, 2,60,94 whereas others defined recurrent instability as dislocation 95 ; dislocation and subluxation 7,27,40,83,89,90 ; or dislocation, subluxation, and apprehension. 6,8,59,73,96,98,108 More details can be found in Table 1 and in the online Appendix.…”

“…A total of 23 studies (9 FBB studies 6-8,59,66,67,90,95,96 and 14 Latarjet studies ‖‖ ) reported return to sports rates. Return to sports rates were 73% for Latarjet (95% CI, 66%-79%; I 2 = 81%) and 88% for FBB (95% CI, 76%-96%; I 2 = 76%) (Figure 4).…”

“…‖ Sources of autograft include iliac crest bone graft (ICBG), ¶ distal clavicle, 92 and free partial-thickness coracoid (leaving the conjoint tendon attached to the remaining anatomic coracoid and not transferred with the graft as performed during a Latarjet/Bristow procedure). 7,95 Sources of allograft include the distal tibia, 40,73,75 proximal tibia, 87 distal femur, 87 iliac crest, 2,90,108 and femoral head. 98 The use of autografts may be associated with donor site morbidity, including risk for infection, hematoma, sensory disturbances, and an additional scar.…”