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Fresh Distal Tibial Allograft: An Updated Graft Preparation Technique for Anterior Shoulder Instability.

ABSTRACT: Fresh distal tibia allograft (DTA) has been gaining popularity among surgeons as an anatomic reconstruction option for the treatment of significant glenoid bone loss. Fresh DTA results in a clinically stable joint with excellent clinical outcomes and minimal graft resorption, and it has similar outcomes as the Latarjet procedure. Proper graft preparation and fixation are critical to ensuring optimal outcomes. The purpose of this Technical Note is, therefore, to describe our updated technique for DTA preparation that highlights precise cutting anatomy, sizing options, and use of orthobiologics to optimize distal tibia graft union to the native glenoid surface.

SUBMITTER: Liles JL

PROVIDER: S-EPMC9244476 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Fresh Distal Tibial Allograft: An Updated Graft Preparation Technique for Anterior Shoulder Instability.

Liles Jordan L JL Ganokroj Phob P Peebles Annalise M AM Mologne Mitchell S MS Provencher Capt Matthew T CMT

Arthroscopy techniques 20220517 6

Fresh distal tibia allograft (DTA) has been gaining popularity among surgeons as an anatomic reconstruction option for the treatment of significant glenoid bone loss. Fresh DTA results in a clinically stable joint with excellent clinical outcomes and minimal graft resorption, and it has similar outcomes as the Latarjet procedure. Proper graft preparation and fixation are critical to ensuring optimal outcomes. The purpose of this Technical Note is, therefore, to describe our updated technique for ...[more]

PMID: 35782838

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Project description:BackgroundThe results of arthroscopic anterior labral repair have demonstrated high failure rates in patients with significant glenoid bone loss. Several reconstruction procedures using a bone graft have been developed to overcome bone loss.PurposeThe primary objective of this study was to generate a safety profile for arthroscopic anatomic glenoid reconstruction using a distal tibial allograft. The secondary objective was to evaluate the radiological outcomes of patients who underwent this procedure.Study designCase series; Level of evidence, 4.MethodsThis retrospective review included the medical charts and diagnostic images of 42 consecutive patients who underwent arthroscopic shoulder stabilization by means of capsule-labral reattachment and bony augmentation with a distal tibial allograft. The safety profile was measured by detecting intraoperative or postoperative complications, including neurovascular (nerves and blood vessels) injuries, bleeding, infections, and dislocations. A radiological evaluation was conducted by assessing computed tomography (CT) scans obtained preoperatively and at approximately 6 months postoperatively.ResultsA total of 42 patients (29 male, 13 female) with a mean age of 26.73 ± 9.01 years were included. An excellent safety profile was observed, with no intraoperative complications, neurovascular injuries, adverse events, bleeding, or infections. CT bone scans were obtained for 31 patients, and the mean follow-up for CT scanning (to measure resorption and union) was 6.31 ± 1.20 months (range, 6-7.5 months). There were no cases of nonunion or partial union. Thirteen patients (42%) had no resorption, whereas 13 (42%) and 5 (16%) patents had <50% and ≥50% resorption, respectively.ConclusionArthroscopic shoulder stabilization with distal tibial allograft reconstruction is a safe operative procedure with a minimal risk to neurovascular structures. Most patients had a healed allograft, but 16% of patients had ≥50% resorption on CT at 6 months. Studies with a longer follow-up are recommended for better assessment of the safety profile.

Project description:BackgroundDistal tibia allograft reconstruction of the glenoid in shoulder instability has garnered significant attention over the last decade. Prior studies demonstrate significant improvement in all reported patient outcomes albeit the approach is through a subscapularis split. There have not been prior studies evaluating outcomes after lesser tuberosity osteotomy which provides excellent exposure to the anterior glenoid.We hypothesize there is significant improvement in functional outcomes and no deleterious effects after lesser tuberosity osteotomy for distal tibia allograft reconstruction of the glenoid for shoulder instability.MethodsA retrospective review was performed from 2016 of 2019 of patients undergoing distal tibia allograft reconstruction of the glenoid through a lesser tuberosity osteotomy. Patients were indicated if they had recurrent anterior shoulder instability with >20% glenoid bone loss and evidence of an off-track lesion. Clinical, imaging, and operative data were evaluated. Objective follow-up data evaluated at minimum 2 years included radiographs, range of motion, DASH, SANE, VAS, SST, ASES, and Constant scores.ResultsA total of 12 patients were available with average follow-up 28 months, average age 26 years old, and average glenoid bone loss of 33%. The patients demonstrated significant improvement in their clinical outcomes at final follow-up: DASH 42.9-8.9 (P = .004), SANE 32.2-85 (P = .00005), VAS 4.6-1.1 (P = .003), SST 7-11.4 (P = .01), ASES 50.2-90.5 (P = .001), and Constant 37.6-86.2 (P = .01). Range of motion at final follow-up was forward flexion to 161.4° (135-170°), external rotation 49.5° (40-65°), and internal rotation to T12-L1 (T7-L2) vertebral body.ConclusionThe present study demonstrates the effectiveness of a lesser tuberosity osteotomy in exposure of the glenoid for reconstruction with a distal tibia allograft. The functional integrity of the subscapularis is maintained and the patient-reported outcomes are comparable with current literature.

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Fresh Distal Tibial Allograft: An Updated Graft Preparation Technique for Anterior Shoulder Instability.

Publications

Fresh Distal Tibial Allograft: An Updated Graft Preparation Technique for Anterior Shoulder Instability.

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