scholarly journals Arthroscopic Distal Tibial Allograft for Posterior Glenoid Reconstruction

2021 ◽  
Vol 1 (4) ◽  
pp. 263502542110067
Author(s):  
Benjamin W. Hoyt ◽  
Cory A. Riccio ◽  
Lance E. LeClere ◽  
Kelly G. Kilcoyne ◽  
Jonathan F. Dickens
Keyword(s):  
Bone Loss ◽  
Distal Tibia ◽  
Glenoid Bone Loss ◽  
Labral Repair ◽  
Anatomic Reconstruction ◽  
Joint Surface ◽  
Bone Block ◽  
Posterior Instability ◽  
Invasive Approach ◽  
Glenoid Reconstruction

Background: Posterior glenoid bone loss occurs in more than two-thirds of patients with posterior glenohumeral instability, with 14% to 22% having greater than subcritical bone loss (13.5%), a marker for potential need for bony augmentation versus soft tissue-only procedures. Several techniques are described to augment either the version or volume of the glenoid surface including osteotomies, autograft transfers, and allograft tibia transfers. Indications: Arthroscopic-assisted allograft distal tibia bone block augmentation to the posterior glenoid is indicated for revision posterior instability procedures with posterior bone loss and in primary cases of posterior instability with critical bone loss. Technique Description: Arthroscopic posterior glenoid reconstruction with allograft distal tibia and posterior labral repair in the lateral position is presented. This technique uses standard instrument sets and requires no patient repositioning. The preplanned tibial bone block is prepared on a back table either prior to, or concurrently with, arthroscopic procedure. After creation of high posterior portal and standard anterior portal, a sucker-shaver and burr are used to create a perpendicular edge for apposition of the allograft tibia. The bone block is introduced through a longitudinal incision and underdelivered to the prepared surface under the liberated labrum. The articular surface of the graft and glenoid are aligned and cannulated screws are used to compress the bone block against the native glenoid. The posterior labral tissue is then mobilized over the graft and repaired to the native glenoid. Results: Arthroscopic distal tibial allograft augmentation for posterior bone loss restored stability and function in a small cohort of patients. Patients reported improved stability in the immediate postoperative course, with restoration of motion by 2 months. Push-ups, pull-ups, and return to full active duty without restrictions is allowed at 6 months postoperatively. Imaging at 3 months postoperatively has shown excellent graft healing. Discussion: The benefits of allograft tibia augmentation for posterior instability with glenoid bone loss include an anatomic joint surface restoration including articular cartilage, lack of donor site morbidity, and a minimally invasive approach. When performed arthroscopically, this technique permits concurrent posterior labral repair and anatomic reconstruction.

Glenoid Bone Loss in Posterior Shoulder Instability: Prevalence and Outcomes in Arthroscopic Treatment

2018 ◽  
Vol 46 (5) ◽  
pp. 1053-1057 ◽  
Author(s):  
Adam Hines ◽  
Jay B. Cook ◽  
James S. Shaha ◽  
Kevin Krul ◽  
Steve H. Shaha ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Patient Reported Outcomes ◽  
Glenoid Bone Loss ◽  
Labral Repair ◽  
Arthroscopic Stabilization ◽  
Posterior Instability ◽  
Glenohumeral Instability ◽  
Patient Reported ◽  
Return To Duty

Background: Glenoid bone loss is a well-accepted risk factor for failure after arthroscopic stabilization of anterior glenohumeral instability. Glenoid bone loss in posterior instability has been noted relative to its existence in posterior instability surgery. Its effect on outcomes after arthroscopic stabilization has not been specifically evaluated and reported. Purpose: The purpose was to evaluate the presence of posterior glenoid bone loss in a series of patients who had undergone arthroscopic isolated stabilization of the posterior labrum. Bone loss was then correlated to return-to-duty rates, complications, and validated patient-reported outcomes. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review was conducted at a single military treatment facility over a 4-year period (2010-2013). Patients with primary posterior instability who underwent arthroscopic isolated posterior labral repair were included. Preoperative magnetic resonance imaging was used to calculate posterior glenoid bone loss using a standardized “perfect circle” technique. Demographics, return to duty, complications, and reoperations, as well as outcomes scores including the Single Assessment Numeric Evaluation and the Western Ontario Shoulder Instability Index (WOSI) scores, were obtained. Outcomes were analyzed across all patients based on percentage of posterior glenoid bone loss. Bone loss was then categorized as below or above the subcritical threshold of 13.5% to determine if bone loss effected outcomes similar to what has been shown in anterior instability. Results: There were 43 consecutive patients with primary, isolated posterior instability, and 32 (74.4%) completed WOSI scoring. Mean follow-up was 53.7 months (range, 25-82 months) The mean posterior glenoid bone loss was 7.3% (0%-21.5%). Ten of 32 patients (31%) had no appreciable bone loss. Bone loss exceeded 13.5% in 7 of 32 patients (22%), and 2 patients (6%) exceeded 20% bone loss. Return to full duty or activity was nearly 90% overall. However, those with >13.5%, subcritical glenoid bone loss, were statistically less likely to return to full duty (relative risk = 1.8), but outcomes scores, complications, and revision rates were otherwise not different in those with no or minimal bone loss versus those with more significant amounts. Conclusion: Posterior glenoid bone loss has not previously been evaluated independently relative to patients with shoulder instability repairs. Sixty-nine percent of our patients had measurable bone loss, and 22% had greater than 13.5%, or above subcritical bone loss. While these patients were statistically less likely to return to full duty, the reoperation rate, complications, and patient-reported outcomes between groups were not different.

Effect of Posterior Glenoid Bone Loss and Retroversion on Arthroscopic Posterior Glenohumeral Stabilization

2020 ◽  
Vol 48 (11) ◽  
pp. 2621-2627
Author(s):  
Jared A. Wolfe ◽  
Michael Elsenbeck ◽  
Kyle Nappo ◽  
Daniel Christensen ◽  
Robert Waltz ◽  
...  
Keyword(s):  
Bone Loss ◽  
Circle Method ◽  
Glenoid Bone Loss ◽  
Labral Repair ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Bone Deficiency ◽  
Posterior Shoulder ◽  
Deficiency Group ◽  
Glenoid Retroversion

Background: Posterior glenohumeral instability is an increasingly recognized cause of shoulder instability, but little is known about the incidence or effect of posterior glenoid bone loss. Purpose: To determine the incidence, characteristics, and failure rate of posterior glenoid deficiency in shoulders undergoing isolated arthroscopic posterior shoulder stabilization. Study Design: Cohort study; Level of evidence, 3. Methods: All patients undergoing isolated posterior labral repair and glenoid-based capsulorrhaphy with suture anchors between 2008 and 2016 at a single institution were identified. Posterior bone deficiency was calculated per the best-fit circle method along the inferior two-thirds of the glenoid by 2 independent observers. Patients were divided into 2 groups: minimal (0%-13.5%) and moderate (>13.5%) posterior bone loss. The primary outcome was reoperation for any reason. The secondary outcomes were military separation and placement on permanent restricted duty attributed to the operative shoulder. Results: A total of 66 shoulders met the inclusion criteria, with 10 going on to reoperation after a median follow-up of 16 months (range, 14-144 months). Of the total shoulders, 86% (57/66) had ≤13.5% bone loss and 14% (9/66) had >13.5%. Patients with moderate posterior glenoid bone loss had significantly greater retroversion (−11.5° vs −4.3°; P = .01). Clinical failure requiring reoperation was seen in 10.5% of patients in the minimal bone deficiency group and 44.4% in the moderate group ( P = .024). There was no difference between groups in rate of military separation or restricted duty. Patients with moderate posterior glenoid bone deficiency were more likely to be experiencing instability instead of pain on initial presentation ( P < .001), were more likely to have a positive Jerk test result ( P = .05), and had increased glenoid retroversion ( P = .01). Conclusion: In shoulders with moderate glenoid bone deficiency (>13.5%) and increased glenoid retroversion, posterior capsulolabral repair alone may result in higher reoperation rates than in shoulders without bone deficiency.

scholarly journals Arthroscopic Bone Block Cerclage: A Fixation Method for Glenoid Bone Loss Reconstruction Without Metal Implants

2019 ◽  
Vol 8 (12) ◽  
pp. e1591-e1597 ◽  
Author(s):  
Abdul-Ilah Hachem ◽  
Marcos Del Carmen ◽  
Iñigo Verdalet ◽  
Javier Rius
Keyword(s):  
Bone Loss ◽  
Glenoid Bone Loss ◽  
Fixation Method ◽  
Bone Block ◽  
Metal Implants

scholarly journals Use of a Cutting Instrument for Fresh Osteochondral Distal Tibia Allograft Preparation: Treatment of Glenoid Bone Loss

2017 ◽  
Vol 6 (2) ◽  
pp. e363-e368 ◽  
Author(s):  
Marcio B. Ferrari ◽  
Anthony Sanchez ◽  
George Sanchez ◽  
Ramesses Akamefula ◽  
Bradley M. Kruckeberg ◽  
...  
Keyword(s):  
Bone Loss ◽  
Distal Tibia ◽  
Glenoid Bone Loss

scholarly journals Arthroscopic Treatment of Shoulder Instability with Glenoid Bone Loss Using Distal Tibia Allograft Augmentation

2017 ◽  
Vol 5 (7_suppl6) ◽  
pp. 2325967117S0025
Author(s):  
Ivan Wong ◽  
Eyal Amar ◽  
Catherine M. Coady ◽  
Ben Smith ◽  
Mark Glazebrook ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Distal Tibia ◽  
Arthroscopic Treatment ◽  
Glenoid Bone Loss

scholarly journals Critical Glenoid Bone Loss in Posterior Shoulder Instability

2018 ◽  
Vol 46 (5) ◽  
pp. 1058-1063 ◽  
Author(s):  
Christopher Nacca ◽  
Joseph A. Gil ◽  
Rohit Badida ◽  
Joseph J. Crisco ◽  
Brett D. Owens
Keyword(s):  
Bone Loss ◽  
Lateral Displacement ◽  
Peak Force ◽  
Glenoid Bone Loss ◽  
Bankart Lesion ◽  
Bankart Repair ◽  
Labral Repair ◽  
Glenoid Defect ◽  
The Mean ◽  
Osseous Defect

Background: There is currently no consensus regarding the amount of posterior glenoid bone loss that is considered critical. Critical bone loss is defined as the amount of bone loss that occurs in which an isolated labral repair will not sufficiently restore stability. Purpose: The purpose is to identify the critical size of the posterior defect. Study Design: Controlled laboratory study. Methods: Eleven cadaveric shoulders were tested. With the use of a custom robot device, a 50-N compressive force was applied to the glenohumeral joint, and the peak force that was required to translate the humeral head posteriorly and the lateral displacement that occurred with translation were measured. The defect size was measured as a percentage of the glenoid width. Testing was performed in 11 conditions: (1) intact glenoid and labrum, (2) simulated reverse Bankart lesion, (3) the reverse Bankart lesion repaired, (4) a 10% defect, (5) the reverse Bankart lesion repaired, (6) a 20% defect, (7) the reverse Bankart lesion repaired, (8) a 30% defect, (9) the reverse Bankart lesion repaired, (10) a 40% defect, and (11) the reverse Bankart repaired. Results: Force and displacement decreased as the size of the osseous defect increased. The mean peak force that occurred with posterior displacement in specimens with a glenoid defect ≥20% and a reverse Bankart repair (13 ± 9 N) was significantly lower than the peak force that occurred in specimens with an isolated reverse Bankart repair (22 ± 10 N) ( P = .0451). In addition, the mean lateral displacement was significantly less in the specimens with a 20% glenoid defect and a reverse Bankart repair (0.61 ± 0.57 mm) compared with the lateral displacement that occurred in specimens with an isolated reverse Bankart repair (1.6 ± 0.78 mm) ( P = .0058). Conclusion: An osseous defect that is ≥20% of the posterior glenoid width remains unstable after isolated reverse Bankart repair. Clinical Relevance: A bony restoration procedure of the glenoid may be necessary in shoulders with a posterior glenoid defect that is ≥20% of the glenoid width.

scholarly journals Open Posterior Glenoid Reconstruction Using a Distal Tibial Allograft

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110479
Author(s):  
Tracy M. Tauro ◽  
Nolan B. Condron ◽  
Ryan J. Quigley ◽  
Blake M. Bodendorfer ◽  
Brian J. Cole
Keyword(s):  
Bone Loss ◽  
Ct Scan ◽  
Glenohumeral Joint ◽  
Articular Surface ◽  
Case Series ◽  
Patient Reported Outcome Measures ◽  
Glenoid Bone Loss ◽  
Bony Union ◽  
Patient Reported ◽  
Glenoid Reconstruction

Background: Posterior instability is less common than anterior instability but can be seen in contact athletes and posttraumatically. Distal tibial allograft reconstruction for glenoid bone loss was first described by Provencher and colleagues in 2009 and an arthroscopic technique for posterior glenoid reconstruction using a distal tibial allograft was later described by Gupta et al in 2013. Indications: The primary indications for posterior distal tibial allograft include the failure of conservative management, recurrent instability after an arthroscopic stabilization, or glenoid bone loss > 20% to 25%. Technique Description: The patient is positioned in lateral decubitus, and examination under anesthesia is performed. Following arthroscopic evaluation, an incision is made medial to the posterolateral aspect of the acromion at the glenohumeral joint level. Electrocautery is carried to the deltoid, which is split in line with its fibers. A split between the infraspinatus and teres minor is performed. Vertical capsulotomy is performed, and deep retractors are placed. Attention is turned to the back table for graft preparation. The graft is measured, marked on the lateral aspect of the articular surface, and cut accordingly. Two 3.5-mm holes are drilled 1 cm apart, and the graft is thoroughly irrigated before being placed into the wound. A 2.5-mm drill is used in the 3.5-mm holes, and two 3.5-mm solid fully threaded screws are placed under power and tightened by hand. The wound is closed in the traditional fashion. Results: Graft nonunion and/or resorption are the primary concerns following posterior distal tibial allograft. Amar et al found no cases of nonunion or partial unions on 6-month computerized tomography (CT) scan, most patients having no or <50% resorption. Millet et al also found bony union by CT scan and improved patient-reported outcome measures. A case series by Gilat et al found 90% of patients reported restoration of stability. Discussion/Conclusion: Posterior distal tibial allograft is a successful surgical intervention for patients with recurrent posterior shoulder instability with glenoid bone loss.

scholarly journals The Sheffield bone block procedure: a new operation for the treatment of glenoid bone loss in patients with anterior traumatic shoulder instability

2015 ◽  
Vol 8 (2) ◽  
pp. 106-110 ◽  
Author(s):  
Santosh Venkatachalam ◽  
Phil Storey ◽  
Scott J Macinnes ◽  
Amjid Ali ◽  
David Potter
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Bone Block ◽  
Bone Block Procedure
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