Joel Locher1, Umile Giuseppe Longo2, Francesco Pirato2, Roman Susdorf1, Heath B Henninger3, Thomas Suter4. 1. Department of Orthopaedic Surgery, Kantonsspital Baselland, 4101, Bruderholz, Switzerland. 2. Department of Orthopaedic and Trauma Surgery , Campus Biomedico University , Rome, Italy. 3. Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City , USA. 4. Department of Orthopaedic Surgery, Kantonsspital Baselland, 4101, Bruderholz, Switzerland. suter.thomas@gmx.net.
Abstract
INTRODUCTION: The purpose of this study was to determine if "off-track" Hill-Sachs lesions in patients with dynamic anteroinferior instability were transformed into "on-track" lesions using iliac bone autografts with screw fixation. The secondary purpose was to observe if postoperative bony remodeling would occur over time, resulting in recurrent "off-track" Hill-Sachs lesions with corresponding instability. MATERIALS AND METHODS: We retrospectively reviewed clinical and CT records of 8 patients with an "off-track" Hill-Sachs lesion who underwent open anatomical glenoid reconstruction with an iliac crest bone autograft. Hill-Sachs lesions, glenoid track widths, and glenoid surface areas were measured on a preoperative and two postoperative (6 weeks, ≥ 2 years) 3D-CT models to determine graft resorption over time. All patients were available for postoperative clinical and CT final follow-up 3 years (2-4 years) postoperatively. RESULTS: In all patients, the Hill-Sachs lesions were "on-track" 6 weeks postoperatively and remained "on-track" at final-follow-up. Compared to preoperative values, the glenoid track width and glenoid surface area both were higher 6 weeks postoperatively (p < 0.001 and p = 0.023, respectively) and at final follow-up (p < 0.001 and p = 0.023, respectively). Whereas the glenoid track width between 6 weeks and final follow-up showed no decrease (p = 0.234), glenoid surface area tended to decrease (p = 0.055). The median SSV was 93 points (85-95 points), the Rowe score 90 points (80-100 points) and the WOSI 1980 points (1783-2067 points) at final follow-up. No recurrent dislocations or subluxations were observed. CONCLUSIONS: An open anatomical glenoid reconstruction with an iliac crest bone autograft technique using screw fixation effectively transformed "off-track" Hill-Sachs lesions to "on-track" lesions, resulting in good short-term clinical outcomes. Whereas glenoid surface area tended to be reduced by bony remodeling processes over time, the glenoid track width did not decrease at final follow-up and consequently no recurrence of "off-track" lesions occurred. LEVEL OF EVIDENCE: Case series; Level of evidence, IV.
INTRODUCTION: The purpose of this study was to determine if "off-track" Hill-Sachs lesions in patients with dynamic anteroinferior instability were transformed into "on-track" lesions using iliac bone autografts with screw fixation. The secondary purpose was to observe if postoperative bony remodeling would occur over time, resulting in recurrent "off-track" Hill-Sachs lesions with corresponding instability. MATERIALS AND METHODS: We retrospectively reviewed clinical and CT records of 8 patients with an "off-track" Hill-Sachs lesion who underwent open anatomical glenoid reconstruction with an iliac crest bone autograft. Hill-Sachs lesions, glenoid track widths, and glenoid surface areas were measured on a preoperative and two postoperative (6 weeks, ≥ 2 years) 3D-CT models to determine graft resorption over time. All patients were available for postoperative clinical and CT final follow-up 3 years (2-4 years) postoperatively. RESULTS: In all patients, the Hill-Sachs lesions were "on-track" 6 weeks postoperatively and remained "on-track" at final-follow-up. Compared to preoperative values, the glenoid track width and glenoid surface area both were higher 6 weeks postoperatively (p < 0.001 and p = 0.023, respectively) and at final follow-up (p < 0.001 and p = 0.023, respectively). Whereas the glenoid track width between 6 weeks and final follow-up showed no decrease (p = 0.234), glenoid surface area tended to decrease (p = 0.055). The median SSV was 93 points (85-95 points), the Rowe score 90 points (80-100 points) and the WOSI 1980 points (1783-2067 points) at final follow-up. No recurrent dislocations or subluxations were observed. CONCLUSIONS: An open anatomical glenoid reconstruction with an iliac crest bone autograft technique using screw fixation effectively transformed "off-track" Hill-Sachs lesions to "on-track" lesions, resulting in good short-term clinical outcomes. Whereas glenoid surface area tended to be reduced by bony remodeling processes over time, the glenoid track width did not decrease at final follow-up and consequently no recurrence of "off-track" lesions occurred. LEVEL OF EVIDENCE: Case series; Level of evidence, IV.
Authors: Philipp Moroder; Corinna Hirzinger; Stefan Lederer; Nicholas Matis; Wolfgang Hitzl; Mark Tauber; Herbert Resch; Alexander Auffarth Journal: Am J Sports Med Date: 2012-05-10 Impact factor: 6.202
Authors: Joel Locher; Frauke Wilken; Knut Beitzel; Stefan Buchmann; Umile Giuseppe Longo; Vincenzo Denaro; Andreas B Imhoff Journal: Arthroscopy Date: 2016-05-07 Impact factor: 4.772
Authors: Johannes E Plath; Daniel J H Henderson; Julien Coquay; Klaus Dück; David Haeni; Laurent Lafosse Journal: Am J Sports Med Date: 2017-09-27 Impact factor: 6.202
Authors: Philipp Moroder; Wolfgang Hitzl; Mark Tauber; Thomas Hoffelner; Herbert Resch; Alexander Auffarth Journal: J Shoulder Elbow Surg Date: 2013-05-08 Impact factor: 3.019
Authors: Favian Su; Marcin Kowalczuk; Stephenson Ikpe; Hannah Lee; Soheil Sabzevari; Albert Lin Journal: J Bone Joint Surg Am Date: 2018-08-01 Impact factor: 5.284
Authors: Philipp Moroder; Eva Schulz; Guido Wierer; Alexander Auffarth; Peter Habermeyer; Herbert Resch; Mark Tauber Journal: J Shoulder Elbow Surg Date: 2019-05-23 Impact factor: 3.019