Brian R Waterman1, Philip J Chandler2, Edward Teague3, Matthew T Provencher4, John M Tokish5, Mark P Pallis2. 1. Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, U.S.A.. Electronic address: brian.r.waterman@gmail.com. 2. Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, U.S.A. 3. Department of Mathematics, United States Military Academy, West Point, New York, U.S.A. 4. Massachusetts General Hospital, Boston, Massachusetts, U.S.A. 5. Tripler Army Medical Center, Honolulu, Hawaii, U.S.A.
Abstract
PURPOSE: To describe the short-term clinical outcomes of glenoid bone block augmentation in a high-demand population, as well as to describe its clinical success and complications at greater than 2 years' follow-up in an at-risk military population. METHODS: All patients undergoing anterior capsulorrhaphy with coracoid process transfer or anterior bone block augmentation (Current Procedural Terminology code 23662 or 23460) for shoulder instability between 2006 and 2012 were isolated from the Military Health System Management Analysis and Reporting Tool. Demographic and occupational parameters were identified, and multiple surgical factors and clinical outcomes were extracted from the medical record and US Defense Manpower Data Center. RESULTS: A total of 64 service members (65 shoulders) underwent anterior bone block procedures, including coracoid transfer (n = 59, 90.8%), distal tibial allograft (n = 3, 4.6%), and autologous or allograft iliac crest bone graft (n = 3, 4.6%). This group was predominately comprised of men (n = 59), and the mean age was 25.9 years (range, 19 to 45 years). A total of 19 perioperative complications, including 8 neurologic injuries, 6 infections, and 4 hardware failures, occurred in 16 patients (25%). At a mean 2.4-year follow-up, 21 patients (32.8%) reported persistent shoulder pain and 15 patients (23.4%) disclosed subjective apprehension or recurrent instability. Secondary surgical procedures were performed in 12 patients (18.8%), including 4 revisions (6.3%). Ultimately, 20 patients (31.3%) underwent a medical discharge for persistent shoulder disability. Univariate analysis showed that the presence of a perioperative complication (P = .049) and tobacco use (P = .038) were associated with increased risk of subsequent surgical failure. CONCLUSIONS: Anterior glenoid bone block procedures for shoulder instability with concomitant bone loss enable a return to high-demand physical function. The short-term complication profile (25%), recurrence rate (23%), and persistence of shoulder pain (33%) should be emphasized during preoperative counseling, particularly in an active military population and revision setting. Although moderately successful in the military, anterior bone block procedures for complex shoulder instability can be associated with significant short-term complications and morbidity. LEVEL OF EVIDENCE: Level IV, therapeutic case series. Published by Elsevier Inc.
PURPOSE: To describe the short-term clinical outcomes of glenoid bone block augmentation in a high-demand population, as well as to describe its clinical success and complications at greater than 2 years' follow-up in an at-risk military population. METHODS: All patients undergoing anterior capsulorrhaphy with coracoid process transfer or anterior bone block augmentation (Current Procedural Terminology code 23662 or 23460) for shoulder instability between 2006 and 2012 were isolated from the Military Health System Management Analysis and Reporting Tool. Demographic and occupational parameters were identified, and multiple surgical factors and clinical outcomes were extracted from the medical record and US Defense Manpower Data Center. RESULTS: A total of 64 service members (65 shoulders) underwent anterior bone block procedures, including coracoid transfer (n = 59, 90.8%), distal tibial allograft (n = 3, 4.6%), and autologous or allograft iliac crest bone graft (n = 3, 4.6%). This group was predominately comprised of men (n = 59), and the mean age was 25.9 years (range, 19 to 45 years). A total of 19 perioperative complications, including 8 neurologic injuries, 6 infections, and 4 hardware failures, occurred in 16 patients (25%). At a mean 2.4-year follow-up, 21 patients (32.8%) reported persistent shoulder pain and 15 patients (23.4%) disclosed subjective apprehension or recurrent instability. Secondary surgical procedures were performed in 12 patients (18.8%), including 4 revisions (6.3%). Ultimately, 20 patients (31.3%) underwent a medical discharge for persistent shoulder disability. Univariate analysis showed that the presence of a perioperative complication (P = .049) and tobacco use (P = .038) were associated with increased risk of subsequent surgical failure. CONCLUSIONS:Anterior glenoid bone block procedures for shoulder instability with concomitant bone loss enable a return to high-demand physical function. The short-term complication profile (25%), recurrence rate (23%), and persistence of shoulder pain (33%) should be emphasized during preoperative counseling, particularly in an active military population and revision setting. Although moderately successful in the military, anterior bone block procedures for complex shoulder instability can be associated with significant short-term complications and morbidity. LEVEL OF EVIDENCE: Level IV, therapeutic case series. Published by Elsevier Inc.
Authors: Anthony Sanchez; Marcio B Ferrari; Ramesses A Akamefula; Rachel M Frank; George Sanchez; Matthew T Provencher Journal: Arthrosc Tech Date: 2017-04-17