Restricted accessResearch articleFirst published online 2015-1
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
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.
BurkhartSSDe BeerJF. 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. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc2000; 16: 677–94.
2.
WolfEMArianjamA. Hill–Sachs remplissage, an arthroscopic solution for the engaging Hill–Sachs lesion: 2- to 10-year follow-up and incidence of recurrence. J Shoulder Elb Surg Am Shoulder Elb Surg Al2014; 23: 814–30.
3.
BiglianiLUNewtonPMSteinmannSPConnorPMMcllveenSJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med1998; 26: 41–5.
4.
BoileauPVillalbaMHéryJ-YBalgFAhrensPNeytonL. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am2006; 88: 1755–63.
5.
EdwardsTBBoulahiaAWalchG. Radiographic analysis of bone defects in chronic anterior shoulder instability. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc2003; 19: 732–9.
6.
HoveliusLLindBThorlingJ. Primary dislocation of the shoulder. Factors affecting the two-year prognosis. Clin Orthop1983; 176: 181–5.
7.
SugayaHMoriishiJDohiMKonYTsuchiyaA. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am2003; 85A: 878–84.
8.
YoungDCRockwoodCAJr. Complications of a failed Bristow procedure and their management. J Bone Joint Surg Am1991; 73: 969–81.
9.
ZuckermanJDMatsenFAIII. Complications about the glenohumeral joint related to the use of screws and staples. J Bone Joint Surg Am1984; 66: 175–80.
10.
ItoiELeeS-BAmramiKKWengerDEAnK-N. Quantitative assessment of classic anteroinferior bony Bankart lesions by radiography and computed tomography. Am J Sports Med2003; 31: 112–8.
11.
ItoiELeeSBBerglundLJBergeLLAnKN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am2000; 82: 35–46.
12.
Edwards TB, Walch G. The Latarjet procedure for recurrent anterior shoulder instability: rationale and technique. Oper Tech Sports Med. 2012;20(1):57–64. doi:10.1053/j.otsm.2012.03.007.
13.
HoveliusLKörnerLLundbergB. The coracoid transfer for recurrent dislocation of the shoulder. Technical aspects of the Bristow–Latarjet procedure. J Bone Joint Surg Am1983; 65: 926–34.
14.
MontgomeryWHJrWahlMHettrichCItoiELippittSBMatsenFAIII. Anteroinferior bone-grafting can restore stability in osseous glenoid defects. J Bone Joint Surg Am2005; 87: 1972–7.
15.
WarnerJJPGillTJO’hollerhanJDPathareNMillettPJ. Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with glenoid deficiency using an autogenous tricortical iliac crest bone graft. Am J Sports Med2006; 34: 205–12.
16.
WengP-WShenH-CLeeH-HWuS-SLeeC-H. Open reconstruction of large bony glenoid erosion with allogeneic bone graft for recurrent anterior shoulder dislocation. Am J Sports Med2009; 37: 1792–7.
17.
WellmannMPetersenWZantopT. Open shoulder repair of osseous glenoid defects: biomechanical effectiveness of the Latarjet procedure versus a contoured structural bone graft. Am J Sports Med2009; 37: 87–94.
18.
YamamotoNMurakiTAnK-N. The stabilizing mechanism of the Latarjet procedure: a cadaveric study. J Bone Joint Surg Am2013; 95: 1390–7.
19.
YamamotoNMurakiTSperlingJW. Stabilizing mechanism in bone-grafting of a large glenoid defect. J Bone Joint Surg Am2010; 92: 2059–66.
BhatiaSVan ThielGSGuptaD. Comparison of glenohumeral contact pressures and contact areas after glenoid reconstruction with latarjet or distal tibial osteochondral allografts. Am J Sports Med2013; 41: 1900–8.
22.
NorlinR. Intraarticular pathology in acute, first-time anterior shoulder dislocation: an arthroscopic study. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc1993; 9: 546–9.
23.
SingerGCKirklandPMEmeryRJ. Coracoid transposition for recurrent anterior instability of the shoulder. A 20-year follow-up study. J Bone Joint Surg Br1995; 77: 73–6.
24.
AllainJGoutallierDGlorionC. Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am1998; 80: 841–52.
25.
SymeonidesPP. The significance of the subscapularis muscle in the pathogenesis of recurrent anterior dislocation of the shoulder. J Bone Joint Surg Br1972; 54: 476–83.
26.
GoodCRMacGillivrayJD. Traumatic shoulder dislocation in the adolescent athlete: advances in surgical treatment. Curr Opin Pediatr2005; 17: 25–9.
27.
KerrZYCollinsCLPommeringTLFieldsSKComstockRD. Dislocation/separation injuries among US high school athletes in 9 selected sports: 2005–2009. Clin J Sport Med2011; 21: 101–8.
28.
MazzoccaAD. Arthroscopic anterior shoulder stabilization of collision and contact athletes. Am J Sports Med2005; 33: 52–60.
29.
RobertsSNTaylorDEBrownJNHayesMGSaiesA. Open and arthroscopic techniques for the treatment of traumatic anterior shoulder instability in Australian rules football players. J Shoulder Elb Surg Am Shoulder Elb Surg Al1999; 8: 403–9.
