Effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation for recurrent anterior shoulder dislocation with massive glenoid bone defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Yueming ¹ , DENG Ting ² ^△ , TANG Qi ¹ , LIU Qian ¹ , ZHOU Ding ¹ , TANG Dezhou ³ , ZHAI Longxiang ¹ , XU Zhenmu ¹ ,  ZHU Weihong ¹

1. Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha Hunan, 410011, P. R. China;
2. Clinical Nursing Teaching and Research Section, the Second Xiangya Hospital, Central South University, Changsha Hunan, 410011, P. R. China;
3. Department of Orthopedics, the Hospital of Qingdao Binhai University, Qingdao Shandong, 266000, P. R. China;

Corresponding author：

ZHU Weihong, Email: zhuweihong@csu.edu.cn

Keywords：

Recurrent anterior shoulder dislocation; glenoid bone defect; iliac bone grafting; Latarjet procedure; arthroscopy

DOI：

10.7507/1002-1892.202303102

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Objective To investigate the effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation in treatment of recurrent anterior shoulder dislocation combined with massive glenoid bone defects. Methods Between January 2018 and December 2021, 16 male patients with recurrent anterior shoulder dislocation combined with massive glenoid bone defects were treated with arthroscopic autogenous iliac bone grafting and double-row elastic fixation. The patients were 14-29 years old at the time of the first dislocation, with an average age of 18.4 years. The causes of the first dislocation included falling injury in 5 cases and sports injury in 11 cases. The shoulders dislocated 4-15 times, with an average of 8.3 times. The patients were 17-37 years old at the time of admission, with an average age of 25.1 years. There were 5 left shoulders and 11 right shoulders. The preoperative instability severity index (ISIS) score of the shoulder joint was 5.8±2.1, and the Beighton score was 4.3±2.6. The University of California Los Angeles (UCLA) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score were used to evaluate shoulder function, and the degree of the glenoid bone defect repair was observed based on CT after operation. Results All incisions healed by first intention, and no complication such as incision infection or neurovascular injury occurred. The patients were followed up 12 months. At 12 months after operation, UCLA score, Constant score, ASES score, and Rowe score all significantly improved when compared with the scores before operation (P<0.05). CT imaging showed the degree of glenoid bone defect was significantly smaller at immediate, 6 and 12 months after operation when compared with that before operation (P<0.05), and the bone blocks healed with the scapula, and bone fusion had occurred at 12 months. Conclusion Arthroscopic autologous iliac bone grafting with double-row elastic fixation is a safe treatment for recurrent anterior shoulder dislocation combined with massive glenoid bone defects, with good short-term effectiveness.

Citation： CHEN Yueming, DENG Ting, TANG Qi, LIU Qian, ZHOU Ding, TANG Dezhou, ZHAI Longxiang, XU Zhenmu, ZHU Weihong. Effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation for recurrent anterior shoulder dislocation with massive glenoid bone defect. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(5): 533-537. doi: 10.7507/1002-1892.202303102 Copy

1.	Pickett A, Svoboda S. Anterior glenohumeral instability. Sports Med Arthrosc Rev, 2017, 25(3): 156-162.
2.	Saltzman BM. Editorial commentary: Arthroscopic Bankart repair with Remplissage, irrespective of glenoid bone loss, may be advantageous over Latarjet: Don’t widen the lane, just fill in the pothole! Arthroscopy, 2022, 38(10): 2806-2808.
3.	Vezeridis PS. Editorial commentary: Arthroscopic shoulder instability surgery and glenoid bone loss: A paradigm shift? Arthroscopy, 2021, 37(3): 804-805.
4.	Kurokawa D, Yamamoto N, Nagamoto H, et al. The prevalence of a large Hill-Sachs lesion that needs to be treated. J Shoulder Elbow Surg, 2013, 22(9): 1285-1289.
5.	Amar E, Konstantinidis G, Coady C, et al. Arthroscopic treatment of shoulder instability with glenoid bone loss using distal tibial allograft augmentation: Safety profile and short-term radiological outcomes. Orthop J Sports Med, 2018, 6(5): 2325967118774507. doi: 10.1177/2325967118774507.
6.	Hovelius L, Sandström B, Olofsson A, et al. The effect of capsular repair, bone block healing, and position on the results of the Bristow-Latarjet procedure (study Ⅲ): long-term follow-up in 319 shoulders. J Shoulder Elbow Surg, 2012, 21(5): 647-660.
7.	Shao Z, Song Q, Cheng X, et al. An arthroscopic “Inlay” Bristow procedure with suture button fixation for the treatment of recurrent anterior glenohumeral instability: 3-year follow-up. Am J Sports Med, 2020, 48(11): 2638-2649.
8.	Kraus N, Amphansap T, Gerhardt C, et al. Arthroscopic anatomic glenoid reconstruction using an autologous iliac crest bone grafting technique. J Shoulder Elbow Surg, 2014, 23(11): 1700-1708.
9.	Zhao J, Huangfu X, Yang X, et al. Arthroscopic glenoid bone grafting with nonrigid fixation for anterior shoulder instability: 52 patients with 2- to 5-year follow-up. Am J Sports Med, 2014, 42(4): 831-839.
10.	Danilkowicz RM, Crook B, Kim J, et al. Patient factors associated with increased risk for complications after the latarjet procedure. Orthop J Sports Med, 2022, 10(2): 23259671211062573. doi: 10.1177/23259671211062573.
11.	Hurley ET, Schwartz LB, Mojica ES, et al. Short-term complications of the Latarjet procedure: a systematic review. J Shoulder Elbow Surg, 2021, 30(7): 1693-1699.
12.	Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy, 2014, 30(1): 90-98.
13.	Pauzenberger L, Dyrna F, Obopilwe E, et al. Biomechanical evaluation of glenoid reconstruction with an implant-free J-bone graft for anterior glenoid bone loss. Am J Sports Med, 2017, 45(12): 2849-2857.
14.	Sigrist B, Ferguson S, Boehm E, et al. The biomechanical effect of bone grafting and bone graft remodeling in patients with anterior shoulder instability. Am J Sports Med, 2020, 48(8): 1857-1864.
15.	Sugaya H, Moriishi J, Dohi M, et al. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg (Am), 2003, 85(5): 878-884.
16.	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.
17.	Zhou P, Shao H, Zhao M, et al. Suspension fixation of iliac bone grafts under arthroscopy is an effective method for the treatment of unstable bony Bankart disease of the shoulder joint in patients with joint relaxation. Knee Surg Sports Traumatol Arthrosc, 2023, 31(5): 1925-1931.
18.	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.
19.	程念南, 潘剑英, 曾春. 关节镜下双袢固定自体髂骨修复合并严重骨缺损的Bankart损伤临床疗效分析. 中华肩肘外科电子杂志, 2021, 9(1): 55-62.
20.	邵振兴, 张淑涵, 蒋艳芳, 等. 关节镜下结合改良线袢固定的 “双嵌入式” 髂骨移植翻修术治疗肩关节复发性前脱位: 初期两年随访结果. 中国运动医学杂志, 2021, 40(7): 509-517.
21.	王东昕, 李盛海, 李靖年, 等. 关节镜下髂骨游离悬吊植骨治疗肩关节复发性脱位. 中国矫形外科杂志, 2021, 29(8): 735-737, 741.
22.	Ueda Y, Sugaya H, Takahashi N, et al. Arthroscopic iliac bone grafting for traumatic anterior shoulder instability with significant glenoid bone loss yields low recurrence and good outcome at a minimum of five-year follow-up. Arthroscopy, 2021, 37(8): 2399-2408.

1. Pickett A, Svoboda S. Anterior glenohumeral instability. Sports Med Arthrosc Rev, 2017, 25(3): 156-162.
2. Saltzman BM. Editorial commentary: Arthroscopic Bankart repair with Remplissage, irrespective of glenoid bone loss, may be advantageous over Latarjet: Don’t widen the lane, just fill in the pothole! Arthroscopy, 2022, 38(10): 2806-2808.
3. Vezeridis PS. Editorial commentary: Arthroscopic shoulder instability surgery and glenoid bone loss: A paradigm shift? Arthroscopy, 2021, 37(3): 804-805.
4. Kurokawa D, Yamamoto N, Nagamoto H, et al. The prevalence of a large Hill-Sachs lesion that needs to be treated. J Shoulder Elbow Surg, 2013, 22(9): 1285-1289.
5. Amar E, Konstantinidis G, Coady C, et al. Arthroscopic treatment of shoulder instability with glenoid bone loss using distal tibial allograft augmentation: Safety profile and short-term radiological outcomes. Orthop J Sports Med, 2018, 6(5): 2325967118774507. doi: 10.1177/2325967118774507.
6. Hovelius L, Sandström B, Olofsson A, et al. The effect of capsular repair, bone block healing, and position on the results of the Bristow-Latarjet procedure (study Ⅲ): long-term follow-up in 319 shoulders. J Shoulder Elbow Surg, 2012, 21(5): 647-660.
7. Shao Z, Song Q, Cheng X, et al. An arthroscopic “Inlay” Bristow procedure with suture button fixation for the treatment of recurrent anterior glenohumeral instability: 3-year follow-up. Am J Sports Med, 2020, 48(11): 2638-2649.
8. Kraus N, Amphansap T, Gerhardt C, et al. Arthroscopic anatomic glenoid reconstruction using an autologous iliac crest bone grafting technique. J Shoulder Elbow Surg, 2014, 23(11): 1700-1708.
9. Zhao J, Huangfu X, Yang X, et al. Arthroscopic glenoid bone grafting with nonrigid fixation for anterior shoulder instability: 52 patients with 2- to 5-year follow-up. Am J Sports Med, 2014, 42(4): 831-839.
10. Danilkowicz RM, Crook B, Kim J, et al. Patient factors associated with increased risk for complications after the latarjet procedure. Orthop J Sports Med, 2022, 10(2): 23259671211062573. doi: 10.1177/23259671211062573.
11. Hurley ET, Schwartz LB, Mojica ES, et al. Short-term complications of the Latarjet procedure: a systematic review. J Shoulder Elbow Surg, 2021, 30(7): 1693-1699.
12. Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy, 2014, 30(1): 90-98.
13. Pauzenberger L, Dyrna F, Obopilwe E, et al. Biomechanical evaluation of glenoid reconstruction with an implant-free J-bone graft for anterior glenoid bone loss. Am J Sports Med, 2017, 45(12): 2849-2857.
14. Sigrist B, Ferguson S, Boehm E, et al. The biomechanical effect of bone grafting and bone graft remodeling in patients with anterior shoulder instability. Am J Sports Med, 2020, 48(8): 1857-1864.
15. Sugaya H, Moriishi J, Dohi M, et al. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg (Am), 2003, 85(5): 878-884.
16. 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.
17. Zhou P, Shao H, Zhao M, et al. Suspension fixation of iliac bone grafts under arthroscopy is an effective method for the treatment of unstable bony Bankart disease of the shoulder joint in patients with joint relaxation. Knee Surg Sports Traumatol Arthrosc, 2023, 31(5): 1925-1931.
18. 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.
19. 程念南, 潘剑英, 曾春. 关节镜下双袢固定自体髂骨修复合并严重骨缺损的Bankart损伤临床疗效分析. 中华肩肘外科电子杂志, 2021, 9(1): 55-62.
20. 邵振兴, 张淑涵, 蒋艳芳, 等. 关节镜下结合改良线袢固定的 “双嵌入式” 髂骨移植翻修术治疗肩关节复发性前脱位: 初期两年随访结果. 中国运动医学杂志, 2021, 40(7): 509-517.
21. 王东昕, 李盛海, 李靖年, 等. 关节镜下髂骨游离悬吊植骨治疗肩关节复发性脱位. 中国矫形外科杂志, 2021, 29(8): 735-737, 741.
22. Ueda Y, Sugaya H, Takahashi N, et al. Arthroscopic iliac bone grafting for traumatic anterior shoulder instability with significant glenoid bone loss yields low recurrence and good outcome at a minimum of five-year follow-up. Arthroscopy, 2021, 37(8): 2399-2408.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation for recurrent anterior shoulder dislocation with massive glenoid bone defect

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