Anatomic Glenoid Reconstruction Offers Better Stability

All-arthroscopic anatomic glenoid reconstruction techniques offer better bony and soft tissue stability, according to researchers.

In the study, “Arthroscopic Anatomic Glenoid Reconstruction Using Distal Tibial Allograft for Recurrent Anterior Shoulder Instability: Clinical and Radiographic Outcomes,” published online in The American Journal of Sports Medicine, the researchers found that the anatomic glenoid reconstruction technique using a distal tibial allograft avoids damage to the subscapularis muscle and allows repair of the capsulolabral tissue.

Their analysis is based off the clinicoradiologic outcomes of patients who underwent this procedure to treat anterior shoulder instability with glenoid bone loss with a minimum 2-year follow-up.

Data on 73 patients (52 male and 21 female) were collected over 6 years. Each patient underwent arthroscopic stabilization with capsulolabral Bankert repair and bony allograft augmentation of the glenoid for recurrent instability with significant bone loss. Both pre- and postoperative patient-reported functional assessment was performed using questionnaires, the Western Ontario Shoulder Instability Index (WOSI) and the Disabilities of the Arm, Shoulder and Hand. Radiological assessment was performed using radiographs and CT scans preoperative and 1 year later.

Over a follow-up of almost 5 years, mean pre-and postoperative WOSI scores were 71.1 ±17.5 and 25.6 ±21.9, respectively (p < .001). None of the patients had a recurrence of dislocation, but one patient had symptoms of subluxation. Five patients did have hardware complications where a screw had to be removed.

The graft union rate was 100%. Graft resorption was less than 50% in 86% of patients. Eighteen patients had no resorption, 39 had less than 50% and 9 had 50% or higher.

None of the patients experienced any symptoms of instability. The mean alpha angle of the screw between the screw shaft axis and the native glenoid axis was 18.3 ± 5.7⁰. Both graft positioning and vertical positioning were good in the majority of the patients.

The researchers wrote, “Arthroscopic stabilization using distal tibial allograft augmentation resulted in excellent clinicoradiologic outcomes at a 2-year follow-up. This procedure has the advantages of being an anatomic reconstruction that addresses bony and soft tissue instability. However, long-term follow-up studies are necessary for better assessment of outcomes.”