Arthroscopic Pushlock anchor fixation with iliac creast bone autograft in the treatment of recurrent anterior shoulder instability with critical bone defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 AN Baijing ¹ , WANG Yaoting ¹ , WANG Mingxin ¹ , ZHANG Haochong ² , XING Gengyan ³

1. Department of Sports Medicine, Senior Department of Orthopedics, the Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, P. R. China;
2. Department of Joint Surgery, Senior Department of Orthopedics, the Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, P. R. China;
3. Department of Orthopedics, the Third Medical Centre of Chinese PLA General Hospital, Beijing, 100039, P. R. China;

Corresponding author：

AN Baijing, Email: anbaijing1983@163.com

Keywords：

Arthroscopy; autologous iliac bone grafting; anterior shoulder instability

DOI：

10.7507/1002-1892.202109044

Video：

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Objective To evaluate the effectiveness of arthroscopic Pushlock anchor fixation with iliac creast bone autograft in the treatment of recurrent anterior shoulder instability with critical bone defect. Methods The clinical data of 80 patients with recurrent anterior shoulder instability with critical bone defect treated by arthroscopic Pushlock anchor fixation with iliac creast bone autograft between January 2016 and January 2019 were retrospectively analyzed. The patients were all male; they were 18-45 years old at the surgery, with an average of 25 years old. The disease duration ranged from 3 months to 5 years, with an average of 2 years. The shoulder joint dislocated 3-50 times, with an average of 8 times. X-ray films, MRI, CT scans and three-dimensional reconstruction of the shoulder were performed before operation. The area of the anterior glenoid defect was 25%-45%, with an average of 27.3%. The shoulder mobility (forward flexion and external rotation in abduction at 90°), the Constant-Murley score, and the Rowe score were used to evaluate the shoulder function before operation and at last follow-up. Results Patients were followed up 1-3 years, with an average of 2 years. No shoulder dislocation occurred again during follow-up. All partial graft absorption occurred after operation, CT scan showed that the graft absorption ratio was less than 30% at 1 week and 3 months after operation. CT three-dimensional reconstruction at 1 year after operation showed that all grafts had healed to the glenoid. The anterior glenoid bone defect was less than 5% (from 0 to 5%, with an average of 3.2%). At last follow-up, the shoulder mobility (forward flexion and external rotation in abduction at 90°), the Constant-Murley score, and the Rowe score significantly improved when compared with preoperative ones (P<0.05). The shoulder mobility of external rotation in abduction at 90° of the affected side limited when compared with the healthy side [(6.7±5.1)°]. Conclusion Arthroscopic Pushlock anchor fixation with iliac creast bone autograft has a good effectiveness in the treatment of recurrent anterior shoulder instability with critical bone defect. The method is relatively simple and the learning curve is short.

Citation： AN Baijing, WANG Yaoting, WANG Mingxin, ZHANG Haochong, XING Gengyan. Arthroscopic Pushlock anchor fixation with iliac creast bone autograft in the treatment of recurrent anterior shoulder instability with critical bone defect. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(2): 143-148. doi: 10.7507/1002-1892.202109044 Copy

1.	Shields E, Mirabelli M, Amsdell S, et al. Functional and imaging outcomes of arthroscopic simultaneous rotator cuff repair and bankart repair after shoulder dislocations. Am J Sports Med, 2014, 42(11): 2614-2620.
2.	Willemot LB, Elhassan BT, Verborgt O. Bony reconstruction of the anterior glenoid rim. J Am Acad Orthop Surg, 2018, 26(10): e207-e218.
3.	Fedorka CJ, Mulcahey MK. Recurrent anterior shoulder instability: a review of the Latarjet procedure and its postoperative rehabilitation. Phys Sportsmed, 2015, 43(1): 73-79.
4.	Flinkkilä T, Sirniö K. Open Latarjet procedure for failed arthroscopic Bankart repair. Orthop Traumatol Surg Res, 2015, 101(1): 35-38.
5.	Argintar E, Heckmann N, Wang L, et al. The biomechanical effect of shoulder remplissage combined with Bankart repair for the treatment of engaging Hill-Sachs lesions. Knee Surg Sports Traumatol Arthrosc, 2016, 24(2): 585-592.
6.	Malahias MA, Chytas D, Raoulis V, et al. Iliac crest bone grafting for the management of anterior shoulder instability in patients with glenoid bone loss: a systematic review of contemporary literature. Sports Med Open, 2020, 6(1): 12. doi: 10.1186/s40798-020-0240-x.
7.	Anderl W, Pauzenberger L, Laky B, et al. Arthroscopic implant-free bone grafting for shoulder instability with glenoid bone loss: clinical and radiological outcome at a minimum 2-year follow-up. Am J Sports Med, 2016, 44(5): 1137-1145.
8.	Shibata H, Go toh M, Mitsui Y, et al. Risk factors for shoulder re-dislocation after arthroscopic Bankart repair. J Orthop Surg Res, 2014, 9: 53. doi: 10.1186/s13018-014-0053-z.
9.	Neoral P, Holibka R, Kalina R, et al. Arthroscopic stabilisation of the shoulder. Risk factors for its failure. Acta Chir Orthop Traumatol Cech, 2014, 81(1): 51-56.
10.	Klungsøyr PJ, Guldal F, Vagstad T, et al. A new subscapular sling operation to stabilize the shoulder. A cadaver study. J Exp Orthop, 2015, 2(1): 12. doi: 10.1186/s40634-015-0028-y.
11.	Maiotti M, Massoni C. Arthroscopic augmentation with subscapularis tendon in anterior shoulder instability with capsulolabral deficiency. Arthrosc Tech, 2013, 2(3): e303-e310.
12.	Taverna E, D’Ambrosi R, Perfetti C, et al. Arthroscopic bone graft procedure for anterior inferior glenohumeral instability. Arthrosc Tech, 2014, 3(6): e653-e660.
13.	Waterman BR, Chandler PJ, Teague E, et al. Short-term outcomes of glenoid bone block augmentation for complex anterior shoulder instability in a high-risk population. Arthroscopy, 2016, 32(9): 1784-1790.
14.	Moroder P, Plachel F, Becker J, et al. Clinical and radiological long-term results after implant-free, autologous, iliac crest bone graft procedure for the treatment of anterior shoulder instability. Am J Sports Med, 2018, 46(12): 2975-2980.
15.	Giannakos A, Vezeridis PS, Schwartz DG, et al. All-arthroscopic revision eden-hybinette procedure for failed instability surgery: Technique and preliminary results. Arthroscopy, 2017, 33(1): 39-48.
16.	Gendre P, Thélu CE, d’Ollonne T, et al. Coracoid bone block fixation with cortical buttons: An alternative to screw fixation? Orthop Traumatol Surg Res, 2016, 102(8): 983-987.
17.	Metais P, Clavert P, Barth J, et al. Erratum to “Preliminary clinical outcomes of Latarjet-Patte coracoid transfer by arthroscopy vs. open surgery: Prospective multicentre study of 390 cases” [Orthop. Traumatol. Surg. Res. 102(2016)S271-S276]. Orthop Traumatol Surg Res, 2017, 103(3): 475. doi: 10.1016/j.otsr.2017.01.001.
18.	Domos P, Lunini E, Walch G. Contraindications and complications of the Latarjet procedure. Shoulder Elbow, 2018, 10(1): 15-24.
19.	Jeong JY, Yoo YS, Kim T. Arthroscopic iliac bone block augmentation for glenoid reconstruction: Transglenoid fixation technique using an all-suture anchor. Arthrosc Tech, 2020, 9(3): e351-e356.
20.	Moroder P, Schulz E, Wierer G, et al. Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss:a prospective randomized trial. J Shoulder Elbow Surg, 2019, 28(7): 1298-1307.
21.	Nzeako O, Bakti N, Bawale R, et al. Bone block procedures for glenohumeral joint instability. J Clin Orthop Trauma, 2019, 10(2): 231-235.
22.	Ranalletta M, Tanoira I, Bertona A, et al. Autologous tricortical iliac bone graft for failed latarjet procedures. Arthrosc Tech, 2019, 8(3): e283-e289.
23.	Hurley ET, Jamal MS, Ali ZS, et al. Long-term outcomes of the Latarjet procedure for anterior shoulder instability: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg, 2019, 28(2): e33-e39.
24.	Avramidis G, Kokkineli S, Trellopoulos A, et al. Excellent clinical and radiological midterm outcomes for the management of recurrent anterior shoulder instability by all-arthroscopic modified eden-hybinette procedure using iliac crest autograft and double-pair button fixation system: 3-year clinical case series with no loss to follow-up. Arthroscopy, 2021, 37(3): 795-803.
25.	Taverna E, Garavaglia G, Perfetti C, et al. An arthroscopic bone block procedure is effective in restoring stability, allowing return to sports in cases of glenohumeral instability with glenoid bone deficiency. Knee Surg Sports Traumatol Arthrosc, 2018, 26(12): 3780-3787.
26.	Di Giacomo G, Costantini A, de Gasperis N, et al. Coracoid graft osteolysis after the Latarjet procedure for anteroinferior shoulder instability: a computed tomography scan study of twenty-six patients. J Shoulder Elbow Surg, 2011, 20(6): 989-995.
27.	Griesser MJ, Harris JD, McCoy BW, et al. Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review. J Shoulder Elbow Surg, 2013, 22(2): 286-292.

1. Shields E, Mirabelli M, Amsdell S, et al. Functional and imaging outcomes of arthroscopic simultaneous rotator cuff repair and bankart repair after shoulder dislocations. Am J Sports Med, 2014, 42(11): 2614-2620.
2. Willemot LB, Elhassan BT, Verborgt O. Bony reconstruction of the anterior glenoid rim. J Am Acad Orthop Surg, 2018, 26(10): e207-e218.
3. Fedorka CJ, Mulcahey MK. Recurrent anterior shoulder instability: a review of the Latarjet procedure and its postoperative rehabilitation. Phys Sportsmed, 2015, 43(1): 73-79.
4. Flinkkilä T, Sirniö K. Open Latarjet procedure for failed arthroscopic Bankart repair. Orthop Traumatol Surg Res, 2015, 101(1): 35-38.
5. Argintar E, Heckmann N, Wang L, et al. The biomechanical effect of shoulder remplissage combined with Bankart repair for the treatment of engaging Hill-Sachs lesions. Knee Surg Sports Traumatol Arthrosc, 2016, 24(2): 585-592.
6. Malahias MA, Chytas D, Raoulis V, et al. Iliac crest bone grafting for the management of anterior shoulder instability in patients with glenoid bone loss: a systematic review of contemporary literature. Sports Med Open, 2020, 6(1): 12. doi: 10.1186/s40798-020-0240-x.
7. Anderl W, Pauzenberger L, Laky B, et al. Arthroscopic implant-free bone grafting for shoulder instability with glenoid bone loss: clinical and radiological outcome at a minimum 2-year follow-up. Am J Sports Med, 2016, 44(5): 1137-1145.
8. Shibata H, Go toh M, Mitsui Y, et al. Risk factors for shoulder re-dislocation after arthroscopic Bankart repair. J Orthop Surg Res, 2014, 9: 53. doi: 10.1186/s13018-014-0053-z.
9. Neoral P, Holibka R, Kalina R, et al. Arthroscopic stabilisation of the shoulder. Risk factors for its failure. Acta Chir Orthop Traumatol Cech, 2014, 81(1): 51-56.
10. Klungsøyr PJ, Guldal F, Vagstad T, et al. A new subscapular sling operation to stabilize the shoulder. A cadaver study. J Exp Orthop, 2015, 2(1): 12. doi: 10.1186/s40634-015-0028-y.
11. Maiotti M, Massoni C. Arthroscopic augmentation with subscapularis tendon in anterior shoulder instability with capsulolabral deficiency. Arthrosc Tech, 2013, 2(3): e303-e310.
12. Taverna E, D’Ambrosi R, Perfetti C, et al. Arthroscopic bone graft procedure for anterior inferior glenohumeral instability. Arthrosc Tech, 2014, 3(6): e653-e660.
13. Waterman BR, Chandler PJ, Teague E, et al. Short-term outcomes of glenoid bone block augmentation for complex anterior shoulder instability in a high-risk population. Arthroscopy, 2016, 32(9): 1784-1790.
14. Moroder P, Plachel F, Becker J, et al. Clinical and radiological long-term results after implant-free, autologous, iliac crest bone graft procedure for the treatment of anterior shoulder instability. Am J Sports Med, 2018, 46(12): 2975-2980.
15. Giannakos A, Vezeridis PS, Schwartz DG, et al. All-arthroscopic revision eden-hybinette procedure for failed instability surgery: Technique and preliminary results. Arthroscopy, 2017, 33(1): 39-48.
16. Gendre P, Thélu CE, d’Ollonne T, et al. Coracoid bone block fixation with cortical buttons: An alternative to screw fixation? Orthop Traumatol Surg Res, 2016, 102(8): 983-987.
17. Metais P, Clavert P, Barth J, et al. Erratum to “Preliminary clinical outcomes of Latarjet-Patte coracoid transfer by arthroscopy vs. open surgery: Prospective multicentre study of 390 cases” [Orthop. Traumatol. Surg. Res. 102(2016)S271-S276]. Orthop Traumatol Surg Res, 2017, 103(3): 475. doi: 10.1016/j.otsr.2017.01.001.
18. Domos P, Lunini E, Walch G. Contraindications and complications of the Latarjet procedure. Shoulder Elbow, 2018, 10(1): 15-24.
19. Jeong JY, Yoo YS, Kim T. Arthroscopic iliac bone block augmentation for glenoid reconstruction: Transglenoid fixation technique using an all-suture anchor. Arthrosc Tech, 2020, 9(3): e351-e356.
20. Moroder P, Schulz E, Wierer G, et al. Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss:a prospective randomized trial. J Shoulder Elbow Surg, 2019, 28(7): 1298-1307.
21. Nzeako O, Bakti N, Bawale R, et al. Bone block procedures for glenohumeral joint instability. J Clin Orthop Trauma, 2019, 10(2): 231-235.
22. Ranalletta M, Tanoira I, Bertona A, et al. Autologous tricortical iliac bone graft for failed latarjet procedures. Arthrosc Tech, 2019, 8(3): e283-e289.
23. Hurley ET, Jamal MS, Ali ZS, et al. Long-term outcomes of the Latarjet procedure for anterior shoulder instability: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg, 2019, 28(2): e33-e39.
24. Avramidis G, Kokkineli S, Trellopoulos A, et al. Excellent clinical and radiological midterm outcomes for the management of recurrent anterior shoulder instability by all-arthroscopic modified eden-hybinette procedure using iliac crest autograft and double-pair button fixation system: 3-year clinical case series with no loss to follow-up. Arthroscopy, 2021, 37(3): 795-803.
25. Taverna E, Garavaglia G, Perfetti C, et al. An arthroscopic bone block procedure is effective in restoring stability, allowing return to sports in cases of glenohumeral instability with glenoid bone deficiency. Knee Surg Sports Traumatol Arthrosc, 2018, 26(12): 3780-3787.
26. Di Giacomo G, Costantini A, de Gasperis N, et al. Coracoid graft osteolysis after the Latarjet procedure for anteroinferior shoulder instability: a computed tomography scan study of twenty-six patients. J Shoulder Elbow Surg, 2011, 20(6): 989-995.
27. Griesser MJ, Harris JD, McCoy BW, et al. Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review. J Shoulder Elbow Surg, 2013, 22(2): 286-292.

Chinese Journal of Reparative and Reconstructive Surgery

Arthroscopic Pushlock anchor fixation with iliac creast bone autograft in the treatment of recurrent anterior shoulder instability with critical bone defect

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