Philipp Moroder1, Martina Blocher2, Alexander Auffarth2, Thomas Hoffelner2, Wolfgang Hitzl3, Mark Tauber4, Herbert Resch2. 1. Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria. Electronic address: philipp.moroder@pmu.ac.at. 2. Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria. 3. Research Office for Biostatistics, Paracelsus Medical University, Salzburg, Austria. 4. Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria; Department of Shoulder and Elbow Surgery, ATOS Clinic, Munich, Germany.
Abstract
BACKGROUND: The presence of a significant bony defect in anterior shoulder instability cases warrants glenoid reconstruction surgery typically by means of an autograft. Some surgeons use the same graft techniques even in the absence of a significant bony defect, thus augmenting the glenoid surface. The goal of this study is to investigate the clinical and computed tomography-radiologic outcome after glenoid augmentation surgery. METHODS: Between 2006 and 2011, 11 patients with recurrent anterior shoulder instability and glenoid bone loss of 5% or less were treated with an iliac crest autograft. Of the patients, 9 were available for follow-up at a mean of 34.6 months (range, 12 to 80 months), including apprehension testing, Western Ontario Shoulder Instability Index, Rowe score, Simple Shoulder Value, and 3-dimensional computed tomography examination. RESULTS: The mean Rowe score achieved was 85.0 points (range, 51 to 100 points); Simple Shoulder Value, 80.5 points (range, 30 to 100 points); and Western Ontario Shoulder Instability Index, 373.5 points (range, 61 to 878 points). Two patients reported a recurrence of instability, and one featured a positive apprehension test. The mean glenoid surface area was 96.5% (95% confidence interval [CI], 95.5% to 97.4%) preoperatively, increased after graft implantation to 119.5% (95% CI, 105.6% to 133.3%), and decreased to 102.8% (95% CI, 98.6% to 107.1%) at follow-up, concordant to an intact glenoid surface area. From preoperatively to follow-up, the mean increase in glenoid surface area was 6.4% (95% CI, 2.1% to 10.6%; P = .008); in concavity diameter, 2.0 mm (95% CI, -0.9 to 4.9 mm; P = .168); in concavity depth, 0.9 mm (95% CI, 0.3 to 1.5 mm; P = .005); and in concavity retroversion, 2.4° (95% CI, -1.2° to 6.1°; P = .178). CONCLUSION: Because of anatomic bony remodeling processes, glenoid augmentation surgery seems to be subject to extensive graft osteolysis and, consequently, unsatisfactory clinical outcome in terms of stability in some cases.
BACKGROUND: The presence of a significant bony defect in anterior shoulder instability cases warrants glenoid reconstruction surgery typically by means of an autograft. Some surgeons use the same graft techniques even in the absence of a significant bony defect, thus augmenting the glenoid surface. The goal of this study is to investigate the clinical and computed tomography-radiologic outcome after glenoid augmentation surgery. METHODS: Between 2006 and 2011, 11 patients with recurrent anterior shoulder instability and glenoid bone loss of 5% or less were treated with an iliac crest autograft. Of the patients, 9 were available for follow-up at a mean of 34.6 months (range, 12 to 80 months), including apprehension testing, Western Ontario Shoulder Instability Index, Rowe score, Simple Shoulder Value, and 3-dimensional computed tomography examination. RESULTS: The mean Rowe score achieved was 85.0 points (range, 51 to 100 points); Simple Shoulder Value, 80.5 points (range, 30 to 100 points); and Western Ontario Shoulder Instability Index, 373.5 points (range, 61 to 878 points). Two patients reported a recurrence of instability, and one featured a positive apprehension test. The mean glenoid surface area was 96.5% (95% confidence interval [CI], 95.5% to 97.4%) preoperatively, increased after graft implantation to 119.5% (95% CI, 105.6% to 133.3%), and decreased to 102.8% (95% CI, 98.6% to 107.1%) at follow-up, concordant to an intact glenoid surface area. From preoperatively to follow-up, the mean increase in glenoid surface area was 6.4% (95% CI, 2.1% to 10.6%; P = .008); in concavity diameter, 2.0 mm (95% CI, -0.9 to 4.9 mm; P = .168); in concavity depth, 0.9 mm (95% CI, 0.3 to 1.5 mm; P = .005); and in concavity retroversion, 2.4° (95% CI, -1.2° to 6.1°; P = .178). CONCLUSION: Because of anatomic bony remodeling processes, glenoid augmentation surgery seems to be subject to extensive graft osteolysis and, consequently, unsatisfactory clinical outcome in terms of stability in some cases.
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