Arthroscopic Anatomic Glenoid Reconstruction: Analysis of the Learning Curve

Abstract

Background:Anatomic glenoid reconstruction involves the use of distal tibial allograft for bony augmentation of the glenoid surface. An all-arthroscopic approach was recently described to avoid damage to the subscapularis tendon and preserve the capsule and labrum.Purpose:To explore and compare change in surgical time between 2 proposed methods used for the treatment of anterior shoulder instability—arthroscopic anatomic glenoid reconstruction (AAGR) and arthroscopic Latarjet (AL)—over successive procedures. We also compared graft positioning on the anterior glenoid surface between the 2 methods.Study Design:Cohort study; Level of evidence, 3.Methods:This was a single-surgeon retrospective review of 54 cases of surgically treated recurrent anterior shoulder instability: 27 had AAGR with distal tibial allograft, while the other 27 had AL. AAGR with the distal tibial allograft was the primary choice for the treatment of anterior shoulder instability; however, AL was performed when tibial allograft was not available from the bone bank. Thus, there was an overlapping period for those 2 procedures. Procedure start and end times were recorded, and duration was calculated. Postoperative 3-dimensional computed tomography scans were reviewed, and graft position was judged to be in the lower third (desired position), middle third, or upper third of the anterior glenoid surface. To assess learning, these data were organized in chronological order of surgery, and each surgical cohort was divided into 3 chronological clusters of 9 patients each. Learning was assessed through change in operative time over successive clusters, change in variability of operative time among clusters, and change in graft positioning among clusters. Statistical analysis comprised a 2-tailed independent-sample t test and the Levene test for equality of variance.Results:Our study found that AAGR was significantly faster to perform than AL in the early (P = .001), middle (P = .001), and late (P = .05) clusters of each cohort. Duration of surgery did not significantly improve across clusters within each cohort (P = .15-.79). There were no significant changes in the variability of surgical time in the AAGR group (P = .09) or the AL group (P = .13). Desired positioning of the bone graft on the anterior glenoid surface (lower third) was identified more commonly in the AAGR cohort.Conclusion:AAGR is faster to learn and perform than AL for the treatment of recurrent anterior shoulder instability with significant glenoid bone loss. The current study found higher rates of desired graft positioning for AAGR clusters.

Arthroscopic anatomic glenoid reconstruction demonstrates its safety with short-term to medium-term results for anteroinferior shoulder instability: a systematic review

“…There were two studies that described a technique and presented cadaveric findings 39 40. There were eight studies that present results using one of the previously described techniques 16 17 19–22 26. This means that there are 19 described techniques.…”

“…Clinical studies reported outcomes including patient satisfaction, functional scores, range of motion (ROM), radiographic findings and recurrence of instability. There are 12 studies that report outcomes 15–17 19–27. These outcomes are presented in tables 3 and 4.…”

“…There is high cross-over in these patient populations. As such, patients from the smaller series16 17 are assumed to be included in the largest series19 to avoid duplicate reporting. The two smaller series are included in tables 3 and 4, but the only inclusion in the text of this review is in the radiographic section specifically comparing the outcome of AAGR and AL 17…”

“…Risk of bias assessment was performed to identify factors that could influence the interpretation of the results. The Risk Of Bias In Non-randomised Studies—of Interventions (ROBINS-I) tool14 was used to assess the three case–control studies 15–17. The Institute of Health Economics (IHE) Quality Appraisal of Case Series Studies Checklist18 was used to assess the nine case series 19–27…”

Arthroscopic Anatomic Glenoid Reconstruction in the Setting of a Failed Latarjet Using Distal Tibial Allograft

“…14 Arthroscopic anatomic glenoid reconstruction using distal tibial allograft is a newly described surgical technique with a relatively fast learning curve and high rates of desired graft position compared with the arthroscopic Latarjet procedure. 13 This technique has been originally described by Wong and Urquhart in 2015. 11 The arthroscopic procedure allows us to place the graft at the desired location and flush with the adjacent glenoid fossa.…”