Arthroscopic iliac crest bone grafting in recurrent anterior
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Bony glenoid defects frequently occur in patients with recurrent anterior shoulder instability, and numerous surgical techniques have been described to restore the pear-shaped anatomy and concavity of the glenoid. In general, free bone block procedures can be differentiated from the coracoid transfer. While the stabilizing effect of the non-anatomic Latarjet procedure is generated by the bone block acting as a mechanic barrier in combination with a sling effect of the conjoined tendons, free bone block procedures aim to restore the glenoid concavity and anatomy of the glenohumeral joint to re-establish stability.

A study was done to evaluate the clinical and radiologic mid- to long-term results of anatomic glenoid reconstruction using an all-arthroscopic, autologous tricortical iliac crest bone-grafting technique in patients with recurrent anterior shoulder instability. The hypothesis was that patients show good clinical results and a stable shoulder joint with an anatomic glenoid configuration after a minimum follow-up period of 5 years.

Fourteen patients were available after a follow-up period of 78.7 months. The SSV averaged 87%, CS 94 points, RS 89 points, WD 87 points, and WOSI 70%. The apprehension sign was positive in two patients (14%). One patient required an arthroscopic capsular plication due to a persisting feeling of instability, while the second patient experienced recurrent dislocations after a trauma, but refused revision surgery. CT imaging showed a significant increase of the glenoid index from preoperative 0.8 ± 0.04 to 1.0 ± 0.11 at the final follow-up.

In conclusion, arthroscopic reconstruction of anteroinferior glenoid defects using an autologous iliac crest bone-grafting technique yields satisfying clinical and radiologic results after a mid- to long-term follow-up period. Postoperative re-dislocation was experienced in one (7.1%) of the patients due to trauma and anatomic reconstruction of the pear-shaped glenoid configuration was observed.

Source: https://link.springer.com/article/10.1007/s00167-020-05986-7
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