Clinical and Radiological Long-term Results After Implant-Free,Autologous,Iliac Crest Bone Graft Procedure for the Treatment of Anterior Shoulder Instability

Abstract

Background:

The implant-free, autologous, iliac crest bone graft procedure (J-bone graft) for the treatment of anterior shoulder instability shows low rates of recurrent dislocations and moderate progression of instability arthropathy in the midterm follow-up.

Purpose:

To analyze the clinical and radiological long-term results of the J-bone graft procedure.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 46 patients (47 shoulders) with anterior shoulder instability and a relevant bony glenoid defect who received a J-bone graft between 1993 and 2000 and who were previously subjected to a midterm follow-up (mean, 8 years) were included. In total, 34 patients and 35 shoulders (74%) were clinically and radiologically assessed after a mean follow-up of 18 years (range, 15-23 years). Patients were assessed in terms of pain, bilateral active range of motion, and strength; in addition, the Western Ontario Shoulder Instability Index (WOSI), the Rowe Score, and the Subjective Shoulder Value (SSV) were obtained. Both an apprehension test and a relocation test were performed. Radiological imaging included bilateral radiographs (true anteroposterior and axillary view) to determine the grade of instability arthropathy.

Results:

At final follow-up, a mean WOSI score of 295 (range, 0-1765), Rowe Score of 94 (range, 55-100), SSV of 90% (range, 20%-100%), and pain level of 0.5 (range, 0-4) were noted. Slight differences were detected in active range of motion between the affected and the contralateral side: flexion 178° vs 179° (P = .325), abduction 177° vs 179° (P = .225), external rotation 63° vs 67° (P = .048), high external rotation 77° vs 82° (P = .007), internal rotation 8.8 vs 9.4 points (P = .017), and high internal rotation 70° vs 74° (P = .026). No significant strength deficit of the affected side was noticed. In 1 patient, a traumatic redislocation with fracture of the bone graft was observed 6 weeks after index surgery. No further recurrences were found during the follow-up period. Negative apprehension and relocation tests were confirmed in 77% of the shoulders, while 23% were positive. At final follow-up, 9 shoulders showed no signs of instability arthropathy (26%), mild arthropathy was revealed in 22 shoulders (63%), moderate arthropathy was noted in 3 shoulders (9%), and signs of severe arthropathy were found in 1 shoulder (3%) (collective instability arthropathy score, 0.9). The collective instability arthropathy score on the contralateral side was 0.4 ± 0.8 with no instability arthropathy in 24 shoulders (69%), mild arthropathy in 8 shoulders (23%), moderate signs of arthropathy in 2 shoulders (6%), and severe arthropathy in 1 shoulder (3%) at the time of follow-up examination (collective instability arthropathy score, 0.4). The overall difference between affected shoulders and contralateral shoulders was significant (P = .005).

Conclusion:

The J-bone graft procedure for the treatment of recurrent anterior shoulder instability shows excellent results regarding stability and function after a mean follow-up period of 18 years. However, the development of instability arthropathy of the affected shoulder is not prevented by this procedure.

Keywords

anterior shoulder instability significant bony glenoid defect J-bone graft procedure instability arthropathy long-term follow-up

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References

Aboalata

Plath

Seppel

Juretzko

Vogt

Imhoff

. Results of arthroscopic Bankart repair for anterior-inferior shoulder instability at 13-year follow-up. Am J Sports Med. 2017;45(4):782-787.

Allain

Goutallier

Glorion

. Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am. 1998;80(6):841-852.

Auffarth

Resch

Matis

, et al. Cartilage morphological and histological findings after reconstruction of the glenoid with an iliac crest bone graft. Am J Sports Med. 2018;46(5):1039-1045.

Auffarth

Schauer

Matis

Kofler

Hitzl

Resch

. The J-bone graft for anatomical glenoid reconstruction in recurrent posttraumatic anterior shoulder dislocation. Am J Sports Med. 2008;36(4):638-647.

Bankart

. Recurrent or habitual dislocation of the shoulder-joint. Br Med J. 1923;2(3285):1132-1133.

Bouju

Gadea

Stanovici

Moubarak

Favard

. Shoulder stabilization by modified Latarjet-Patte procedure: results at a minimum 10 years’ follow-up, and role in the prevention of osteoarthritis. Orthop Traumatol Surg Res. 2014;100(suppl 4):S213-S218.

Burkhart

De Beer

. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16(7):677-694.

Bushnell

Creighton

Herring

. Bony instability of the shoulder. Arthroscopy. 2008;24(9):1061-1073.

Deml

Kaiser

van Leeuwen

Zitterl

Euler

. The J-shaped bone graft for anatomic glenoid reconstruction: a 10-year clinical follow-up and computed tomography-osteoabsorptiometry study. Am J Sports Med. 2016;44(11):2778-2783.

10.

Gilbart

Gerber

. Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg. 2007;16(6):717-721.

11.

Gordins

Hovelius

Sandstrom

Rahme

Bergstrom

. Risk of arthropathy after the Bristow-Latarjet repair: a radiologic and clinical thirty-three to thirty-five years of follow-up of thirty-one shoulders. J Shoulder Elbow Surg. 2015;24(5):691-699.

12.

Griffith

Antonio

Yung

, et al. Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. AJR Am J Roentgenol. 2008;190(5):1247-1254.

13.

Hovelius

Saeboe

. Neer Award 2008: Arthropathy after primary anterior shoulder dislocation—223 shoulders prospectively followed up for twenty-five years. J Shoulder Elbow Surg. 2009;18(3):339-347.

14.

Hovelius

Sandstrom

Olofsson

Svensson

Rahme

. The effect of capsular repair, bone block healing, and position on the results of the Bristow-Latarjet procedure (study III): long-term follow-up in 319 shoulders. J Shoulder Elbow Surg. 2012;21(5):647-660.

15.

Kirkley

Griffin

McLintock

. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med. 1998;26(6):764-772.

16.

Latarjet

. Treatment of recurrent dislocation of the shoulder [in French]. Lyon Chir. 1954;49(8):994-997.

17.

Nonweiler

Woolfrey

Litchfield

Kirkley

. An evaluation of the apprehension, relocation, and surprise tests for anterior shoulder instability. Am J Sports Med. 2004;32(2):301-307.

18.

Mizuno

Denard

Raiss

Melis

Walch

. Long-term results of the Latarjet procedure for anterior instability of the shoulder. J Shoulder Elbow Surg. 2014;23(11):1691-1699.

19.

Moroder

Hirzinger

Lederer

, et al. Restoration of anterior glenoid bone defects in posttraumatic recurrent anterior shoulder instability using the J-bone graft shows anatomic graft remodeling. Am J Sports Med. 2012;40(7):1544-1550.

20.

Moroder

Hitzl

Tauber

Hoffelner

Resch

Auffarth

. Effect of anatomic bone grafting in post-traumatic recurrent anterior shoulder instability on glenoid morphology. J Shoulder Elbow Surg. 2013;22(11):1522-1529.

21.

Moroder

Odorizzi

Pizzinini

Demetz

Resch

Moroder

. Open Bankart repair for the treatment of anterior shoulder instability without substantial osseous glenoid defects: results after a minimum follow-up of twenty years. J Bone Joint Surg Am. 2015;97(17):1398-1405.

22.

Plath

Aboalata

Seppel

, et al. Prevalence of and risk factors for dislocation arthropathy: radiological long-term outcome of arthroscopic Bankart repair in 100 shoulders at an average 13-year follow-up. Am J Sports Med. 2015;43(5):1084-1090.

23.

Provencher

Frank

Golijanin

, et al. Distal tibia allograft glenoid reconstruction in recurrent anterior shoulder instability: clinical and radiographic outcomes. Arthroscopy. 2017;33(5):891-897.

24.

Rowe

Patel

Southmayd

. The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am. 1978;60(1):1-16.

25.

Samilson

Prieto

. Dislocation arthropathy of the shoulder. J Bone Joint Surg Am. 1983;65(4):456-460.

26.

Schroder

Provencher

Mologne

Muldoon

Cox

. The modified Bristow procedure for anterior shoulder instability: 26-year outcomes in Naval Academy midshipmen. Am J Sports Med. 2006;34(5):778-786.

27.

Singer

Kirkland

Emery

. Coracoid transposition for recurrent anterior instability of the shoulder: a 20-year follow-up study. J Bone Joint Surg Br. 1995;77(1):73-76.

28.

Tauber

Resch

Forstner

Raffl

Schauer

. Reasons for failure after surgical repair of anterior shoulder instability. J Shoulder Elbow Surg. 2004;13(3):279-285.