Arthroscopic Iliac Crest Bone Allograft Combined With Subscapularis Upper-Third Tenodesis Shows a Low Recurrence Rate in the Treatment of Recurrent Anterior Shoulder Instability Associated With Critical Bone Loss
| Autor: | Stefano Viglione, Raffaele Russo, Giuseppe Della Rotonda, Marco Maiotti, Andrea Cozzolino, Antonio Guastafierro, Carlo Massoni |
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| Přispěvatelé: | Russo, Raffaele, Maiotti, Marco, Cozzolino, Andrea, Della Rotonda, Giuseppe, Guastafierro, Antonio, Massoni, Carlo, Viglione, Stefano |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Joint Instability Male medicine.medical_specialty Shoulder Shoulder surgery Visual analogue scale medicine.medical_treatment Tenodesis Iliac crest Follow-Up Studie Ilium 03 medical and health sciences Arthroscopy Rotator Cuff Young Adult 0302 clinical medicine Allograft Retrospective Studie Recurrence Medicine Humans Transplantation Homologous Orthopedics and Sports Medicine Tenodesi Bone Resorption Transplantation Homologou Retrospective Studies 030222 orthopedics Bone allograft Bone Transplantation business.industry Shoulder Joint Shoulder Dislocation Retrospective cohort study 030229 sport sciences Anterior shoulder Allografts Surgery Transplantation Scapula medicine.anatomical_structure Female Upper third business Human Follow-Up Studies |
| Zdroj: | Arthroscopy : the journal of arthroscopicrelated surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 37(3) |
| ISSN: | 1526-3231 |
| Popis: | Purpose: To evaluate the clinical and radiologic outcomes of patients undergoing arthroscopic glenoid bone allograft combined with subscapularis upper-third tenodesis for anterior shoulder instability associated with clinically relevant bone loss and hyperlaxity. Methods: Between January 2016 and December 2017, patients with recurrent anterior shoulder instability associated with bone loss and hyperlaxity were selected and treated with arthroscopic iliac crest bone graft combined with subscapularis upper-third tenodesis. The selection criteria were as follows: more than 5 dislocations; positive apprehension, anterior drawer, and Coudane-Walch test results; glenoid bone defect between 15% and 30% and humeral bone defect with an engaging Hill-Sachs lesion; and no previous shoulder surgery. All patients were followed up with the Constant score, University of California-Los Angeles (UCLA) rating, Rowe score, and visual analog scale evaluation. Assessments were performed with plain radiographs and a PICO computed tomography scan before surgery and at 2 years of follow-up. Results: Nineteen patients were included in the study, with a mean follow-up duration of 34.6 months (range, 24-48 months). In 17 patients (89%), excellent clinical results were recorded according to the Rowe score. The Constant score improved from 82.9 (standard deviation [SD], 5.2) to 88.9 (SD, 4.3) (P = .002); Rowe score, from 25.3 (SD, 5.3) to 89.1 (SD, 21.8) (P < .001); UCLA score, from 23.7 (SD, 3) to 31.5 (SD, 4.8) (P < .001); and visual analog scale score, from 3.2 to 1.3 (P < .001). Patients met the minimal clinically important difference 94.7%, 89.5%, and 47.3% of the time for the Rowe score, UCLA score, and Constant score, respectively. Bone graft resorption was observed in all patients: partial in 9 and complete in 10. We recorded 2 recurrent traumatic dislocations (11%), with no case of persistent anterior apprehension or other complication. Conclusions: An arthroscopic glenoid bone graft combined with subscapularis upper-third tenodesis may be a valid surgical option to treat recurrent anterior instability associated with both bone loss and hyperlaxity. Level of evidence: Level IV, case series. |
| Databáze: | OpenAIRE |
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