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Erschienen in: Current Reviews in Musculoskeletal Medicine 4/2017

09.10.2017 | Management of Anterior Shoulder Instability (X Li, section editor)

Management of Glenoid Bone Loss with Anterior Shoulder Instability: Indications and Outcomes

verfasst von: Justin Rabinowitz, Richard Friedman, Josef K. Eichinger

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 4/2017

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Abstract

Purpose of Review

Glenoid Bone Loss is a commonly encountered problem in anterior shoulder instability. In this article, we review current techniques for diagnosis, indications and management of glenoid bone loss.

Recent Findings

Multiple bone grafting techniques are available depending on the glenoid defect size including the coracoid, distal clavicle, iliac crest, and allograft distal tibia. Advancement in imaging methods allows for more accurate quantification of bone loss. Indications and techniques are continuing to evolve, and emerging evidence suggests that smaller degrees of bone loss “subcritical” may be best treated with bone grafting.

Summary

Future directions for innovation and investigation include improved arthroscopic techniques and a refinement of indications for the type of bone grafts and when to indicate a patient of arthroscopic repair versus glenoid bone grafting for smaller degrees of bone loss to ensure successful outcome.
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Zurück zum Zitat • Montgomery SR, Katthagen JC, Mikula JD, Marchetti DC, Tahal DS, Dornan GJ, et al. Anatomic and biomechanical comparison of the classic and congruent-arc techniques of the Latarjet procedure. Am J Sports Med. 2017;45(6):1252–60. https://doi.org/10.1177/0363546516685318. In this cadaveric study, a 30% anterior glenoid defect was created in 20 pairs of shoulders which were then randomized to treatment with either a classic or congruent-arc technique of the Latarjet procedure. Biomechanical testing revealed that classic technique provides a broader surface for bone healing and demonstrates a higher load to failure for coracoid fixation, while the congruent-arc technique allowed for restoration of a larger glenoid defect. PubMedCrossRef • Montgomery SR, Katthagen JC, Mikula JD, Marchetti DC, Tahal DS, Dornan GJ, et al. Anatomic and biomechanical comparison of the classic and congruent-arc techniques of the Latarjet procedure. Am J Sports Med. 2017;45(6):1252–60. https://​doi.​org/​10.​1177/​0363546516685318​. In this cadaveric study, a 30% anterior glenoid defect was created in 20 pairs of shoulders which were then randomized to treatment with either a classic or congruent-arc technique of the Latarjet procedure. Biomechanical testing revealed that classic technique provides a broader surface for bone healing and demonstrates a higher load to failure for coracoid fixation, while the congruent-arc technique allowed for restoration of a larger glenoid defect. PubMedCrossRef
56.
Zurück zum Zitat Matton D, Van Looy F, Geens S. Recurrent anterior dislocations of the shoulder joint treated by the Bristow-Latarjet procedure. Historical review, operative technique and results. Acta Orthop Belg. 1992;58(1):16–22.PubMed Matton D, Van Looy F, Geens S. Recurrent anterior dislocations of the shoulder joint treated by the Bristow-Latarjet procedure. Historical review, operative technique and results. Acta Orthop Belg. 1992;58(1):16–22.PubMed
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Zurück zum Zitat • Mook WR, Petri M, Greenspoon JA, Horan MP, Dornan GJ, Millett PJ. Clinical and anatomic predictors of outcomes after the latarjet procedure for the treatment of anterior glenohumeral instability with combined glenoid and humeral bone defects. Am J Sports Med. 2016;44(6):1407–16. https://doi.org/10.1177/0363546516634089. This is a retrospective review of 38 patients who underwent the Latarjet procedure for shoulder instability. Anatomic characteristics such as width of the coracoid and the on-track or off-track classification of the glenoid track were measured radiographically. Patients with off-track lesions were four times more likely to experience postoperative instability, and greater width of the coracoid was associated with greater stability after surgery. Findings indicate native coracoid size, glenoid width, and the width of the Hill-Sachs lesion may impact surgical outcomes and should be considered in planning. PubMedCrossRef • Mook WR, Petri M, Greenspoon JA, Horan MP, Dornan GJ, Millett PJ. Clinical and anatomic predictors of outcomes after the latarjet procedure for the treatment of anterior glenohumeral instability with combined glenoid and humeral bone defects. Am J Sports Med. 2016;44(6):1407–16. https://​doi.​org/​10.​1177/​0363546516634089​. This is a retrospective review of 38 patients who underwent the Latarjet procedure for shoulder instability. Anatomic characteristics such as width of the coracoid and the on-track or off-track classification of the glenoid track were measured radiographically. Patients with off-track lesions were four times more likely to experience postoperative instability, and greater width of the coracoid was associated with greater stability after surgery. Findings indicate native coracoid size, glenoid width, and the width of the Hill-Sachs lesion may impact surgical outcomes and should be considered in planning. PubMedCrossRef
58.
Zurück zum Zitat • Cowling PD, Akhtar MA, Liow RY. What is a Bristow-Latarjet procedure? A review of the described operative techniques and outcomes. Bone Joint J. 2016;98-B(9):1208–14. https://doi.org/10.1302/0301-620X.98B9.37948. This systematic review compared various operative techniques of the Latarjet procedure (coracoid osteotomy site, subscapularis approach, orientation and position of coracoid graft and fixation method, and additional labral and capsular repair) and their effect on post-operative outcomes. There were no significant changes in post-operative outcomes with variations of the coracoid osteotomy site, fixation site on the scapular neck, fixation method, or whether a capsular repair was performed. External rotation may be better preserved when performing a horizontal split in the subscapularis tendon versus a tenotomy. PubMedCrossRef • Cowling PD, Akhtar MA, Liow RY. What is a Bristow-Latarjet procedure? A review of the described operative techniques and outcomes. Bone Joint J. 2016;98-B(9):1208–14. https://​doi.​org/​10.​1302/​0301-620X.​98B9.​37948. This systematic review compared various operative techniques of the Latarjet procedure (coracoid osteotomy site, subscapularis approach, orientation and position of coracoid graft and fixation method, and additional labral and capsular repair) and their effect on post-operative outcomes. There were no significant changes in post-operative outcomes with variations of the coracoid osteotomy site, fixation site on the scapular neck, fixation method, or whether a capsular repair was performed. External rotation may be better preserved when performing a horizontal split in the subscapularis tendon versus a tenotomy. PubMedCrossRef
61.
Zurück zum Zitat • Tokish JM, Fitzpatrick K, Cook JB, Mallon WJ. Arthroscopic distal clavicular autograft for treating shoulder instability with glenoid bone loss. Arthrosc Tech. 2014;3(4):e475–81. https://doi.org/10.1016/j.eats.2014.05.006. The authors present the advantages of utilizing the distal clavicle osteochondral autograft for bony augmentation in the case of significant anterior or posterior glenoid bone loss. This paper describes the surgical technique for the procedure and points to the need for long-term follow-up and clinical studies. PubMedPubMedCentralCrossRef • Tokish JM, Fitzpatrick K, Cook JB, Mallon WJ. Arthroscopic distal clavicular autograft for treating shoulder instability with glenoid bone loss. Arthrosc Tech. 2014;3(4):e475–81. https://​doi.​org/​10.​1016/​j.​eats.​2014.​05.​006. The authors present the advantages of utilizing the distal clavicle osteochondral autograft for bony augmentation in the case of significant anterior or posterior glenoid bone loss. This paper describes the surgical technique for the procedure and points to the need for long-term follow-up and clinical studies. PubMedPubMedCentralCrossRef
62.
Zurück zum Zitat • Petersen SA, Bernard JA, Langdale ER, Belkoff SM. Autologous distal clavicle versus autologous coracoid bone grafts for restoration of anterior-inferior glenoid bone loss: a biomechanical comparison. J Shoulder Elb Surg. 2016;25(6):960–6. https://doi.org/10.1016/j.jse.2015.10.023. This is a comparative biomechanical study conducted in 13 frozen cadaveric shoulders with a vertical anterior glenoid defect approximately 25% that was experimentally created. One centimeter of both distal clavicle and coracoid were harvested and utilized to reconstruct the glenoid. While the coracoid graft provided the greater contact area for all testing positions, the differences did not reach statistical significance. CrossRef • Petersen SA, Bernard JA, Langdale ER, Belkoff SM. Autologous distal clavicle versus autologous coracoid bone grafts for restoration of anterior-inferior glenoid bone loss: a biomechanical comparison. J Shoulder Elb Surg. 2016;25(6):960–6. https://​doi.​org/​10.​1016/​j.​jse.​2015.​10.​023. This is a comparative biomechanical study conducted in 13 frozen cadaveric shoulders with a vertical anterior glenoid defect approximately 25% that was experimentally created. One centimeter of both distal clavicle and coracoid were harvested and utilized to reconstruct the glenoid. While the coracoid graft provided the greater contact area for all testing positions, the differences did not reach statistical significance. CrossRef
64.
Zurück zum Zitat • Athwal GS, Meislin R, Getz C, Weinstein D, Favorito P. Short-term complications of the arthroscopic Latarjet procedure: a North American experience. Arthroscopy. 2016;32(10):1965–70. https://doi.org/10.1016/j.arthro.2016.02.022. This case series reported intraoperative and early postoperative complications and problems in 83 patients who underwent arthroscopic Latarjet procedures with a mean follow up of 17 months (range, 3 to 43 months). A problem was defined as a perioperative event that will not affect the outcome and a complication was defined as an event that will negatively affect outcome. In their series, 18% of patients experienced a problem and 10% of patients experienced a complication. Intraoperative fracture of the coracoid graft was the most common negative event (7%). Seven cases required secondary procedures. The overall adverse event rate was similar to the traditional open Latarjet procedure. PubMedCrossRef • Athwal GS, Meislin R, Getz C, Weinstein D, Favorito P. Short-term complications of the arthroscopic Latarjet procedure: a North American experience. Arthroscopy. 2016;32(10):1965–70. https://​doi.​org/​10.​1016/​j.​arthro.​2016.​02.​022. This case series reported intraoperative and early postoperative complications and problems in 83 patients who underwent arthroscopic Latarjet procedures with a mean follow up of 17 months (range, 3 to 43 months). A problem was defined as a perioperative event that will not affect the outcome and a complication was defined as an event that will negatively affect outcome. In their series, 18% of patients experienced a problem and 10% of patients experienced a complication. Intraoperative fracture of the coracoid graft was the most common negative event (7%). Seven cases required secondary procedures. The overall adverse event rate was similar to the traditional open Latarjet procedure. PubMedCrossRef
66.
Zurück zum Zitat • Nourissat G, Neyton L, Metais P, Clavert P, Villain B, Haeni D, et al. Functional outcomes after open versus arthroscopic Latarjet procedure: a prospective comparative study. Orthop Traumatol Surg Res. 2016;102(8S):S277–S9. https://doi.org/10.1016/j.otsr.2016.08.004. This prospective study compared post-operative clinical outcomes in patients undergoing arthroscopic Latarjet procedures and open Latarjet procedures. The study included a total of 184 patients (85 in the open group, 99 in the arthroscopy group). The arthroscopy group had higher functional outcome scores at 3 months, but both groups had similar functional outcome scores at 1 year. Both procedures significantly improve shoulder pain and function, but the arthroscopic Latarjet procedure has less immediate postoperative pain. PubMedCrossRef • Nourissat G, Neyton L, Metais P, Clavert P, Villain B, Haeni D, et al. Functional outcomes after open versus arthroscopic Latarjet procedure: a prospective comparative study. Orthop Traumatol Surg Res. 2016;102(8S):S277–S9. https://​doi.​org/​10.​1016/​j.​otsr.​2016.​08.​004. This prospective study compared post-operative clinical outcomes in patients undergoing arthroscopic Latarjet procedures and open Latarjet procedures. The study included a total of 184 patients (85 in the open group, 99 in the arthroscopy group). The arthroscopy group had higher functional outcome scores at 3 months, but both groups had similar functional outcome scores at 1 year. Both procedures significantly improve shoulder pain and function, but the arthroscopic Latarjet procedure has less immediate postoperative pain. PubMedCrossRef
Metadaten
Titel
Management of Glenoid Bone Loss with Anterior Shoulder Instability: Indications and Outcomes
verfasst von
Justin Rabinowitz
Richard Friedman
Josef K. Eichinger
Publikationsdatum
09.10.2017
Verlag
Springer US
Erschienen in
Current Reviews in Musculoskeletal Medicine / Ausgabe 4/2017
Elektronische ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-017-9439-y

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