Glenoid Reconstruction For Recurrent Post-Traumatic Anterior Shoulder Dislocation
Authors:
Thomas J. Gill MD, Massachusetts General Hospital, Boston, MA
Neil Pathare, Massachusetts General Hospital, Boston, MA
Peter J. Millett MD, Brigham & Women's HospitalDepartment of Orthopaedics, Boston, MA
James O'Holleran MD, Harvard/Children's HospitalDept. of Ortho. Surgery, Jamaica Plain, MA
Jon J.P. Warner MD, Massachusetts
General Hospital Orthopaedic Dept., Boston, MA
Objective: The purpose of this study is to present an experience treating recurrent anterior shoulder instability in the setting of large osseous defects of the glenoid with anatomical reconstruction of the glenoid deficiency using tri-cortical iliac crest bone graft combined with capsular shift.Methods: From 1999-2001 the senior author performed 262 instability surgeries. Of these, twelve patients were identified who had significant glenoid bone loss which precluded either arthroscopic or open capsulorrhaphy. This was based on preoperative CT-examination demonstrating loss of glenoid depth. There were 10 males and 2 females with an average age of 35 years (range 20-80 yo). Eight of these patients had an average of 1.7 previous surgeries (range 0-2) which had failed. Surgical reconstruction consisted of intra-articular placement of a tricortical iliac crest autograft placed in a manner to reestablish the normal glenoid concavity and held in place with 2-3 cannulated 4.0mm AO screws. In all cases the capsule was repaired directly to the edge of the graft. Postoperative assessment was performed using the ASES rating system as well as plain radiographs, and postoperative CT scans taken after 6 months.Results: At a minimum follow-up of 24 months (range 24-61) the mean ASES score was 78 (range 45-100) and no patient complained of recurrent instability. Only 2 patients had mild pain with overhead activity and two professional hockey players returned to full competition. Average motion loss compared to the contralateral side was 7 flexion (range 0-30), 14 external rotation in abduction (range 0-45) and one intervertebral level (range 0-2) internal rotation. Plain radiographs and CT scans showed no evidence of arthritis and union of all bone grafts. All patients stated they would do the procedure again based on their experience.Conclusions: Anatomical reconstruction of glenoid insufficiency in the setting of recurrent instability is an effective method of treatment with a high level of patient satisfaction. It offers an alternative to the Bristow or Laterjet procedures.References: Acknowledgements:
