Abstract
Objectives:
To compare clinical and radiographic outcomes between patients undergoing glenoid reconstruction with frozen DTA and a matched cohort of patients with fresh DTA
Methods:
A retrospective review was performed of consecutive patients with a minimum of 5% anterior glenoid bone loss (GBL) associated with recurrent anterior shoulder instability who underwent stabilization with either open or arthroscopic DTA glenoid reconstruction and had a minimum of two-year follow up. Consecutive patients undergoing frozen DTA were matched in a 1-to-1 format to patients undergoing fresh DTA by age, body mass index and number of previous shoulder operations. Patients were evaluated postoperatively with the Western Ontario shoulder instability index (WOSI) score, pain relief, and for episodes of recurrent instability. All patients also underwent postoperative imaging evaluation with computed tomography (CT) in which graft incorporation and allograft angle were measured. Statistical analyses were performed using Mann-Whitney U tests and Chi-square tests, respectively, to compare continuous outcomes and categorical variables.
Results:
A total of 100 patients (50 fresh open DTA, 50 frozen arthroscopic DTA) with a median ± IQR age of 32.0 ± 6.7 and 27.9 ± 15.9 years respectively, were analyzed at minimum 2 years follow-up. There were significantly more males (98% vs 70%, p<0.01) in the fresh DTA group and also had significantly greater glenoid bone loss defects (25% ± 6% vs 21% ± 11, p<0.01). Patients in both groups experienced significant WOSI score improvement (p < 0.05) Both groups demonstrated similar clinical outcomes regarding improvement postoperatively (p=0.61), pain relief (p=0.09), and recurrence rates (p=0.31). There was only one case of recurrent instability among the groups in the open fresh DTA cohort. Analysis of CT data at an average of 15 months postoperatively showed no significant difference between fresh versus frozen DTA groups for average Graft-glenoid interface healing rate, allograft angle, and final anterior-posterior dimensions (graft + glenoid).
Conclusions:
Open fresh and arthroscopic frozen DTA for anatomic glenoid reconstruction in patients with recurrent anterior shoulder instability results in a clinically stable joint with comparable outcomes and solid allograft healing rates. Additional long-term studies are needed to determine if these results are maintained over time.
