Arthroscopic Autologous Scapular Spine Bone Graft Combined With Bankart Repair for Anterior Shoulder Instability With Subcritical (10%-15%) Glenoid Bone Loss

Abstract

The purpose of our study is to prove that the autologous scapular spine bone graft is an alternative for the treatment of anterior shoulder instability and the clinical and radiological results are promising. Method: From July 2016 to August 2018, patients who were diagnosed as having anterior shoulder instability with subcritical (10%-15%) glenoid bone loss were treated by arthroscopic repair with autologous scapular spine bone graft. The inclusion criteria were (1) anterior shoulder instability underwent arthroscopic autologous scapular spine bone graft; (2) glenoid bone loss was within 10% to 15% (measured by Sugaya's method); (3) three complete sets of computed tomography (CT) scans (preoperative, 1 week after surgery, and 1 year after surgery) available; and (4) clinical follow-up time was at least 2 years. The exclusion criteria were (1) concomitant rotator cuff tear; (2) concomitant remplissage or SLAP repair;(3) previous surgery of the affected shoulder; (4) open surgery; and (5) incomplete radiological or clinical follow-up. The preoperative and postoperative Constant-Murley score, dietary approaches to stop hypertension (DASH) score, visual analog scale (VAS) score, and range of motion (ROM) were recorded. CT scans with 3-dimensional reconstruction were obtained at the first week after operation and at 1 year after operation; the graft resorption rate was consequently calculated. Results: Twenty-seven patients were qualified and enrolled in the study. No severe complication was recorded during follow-up. No redislocation or subluxation was found, and the apprehension tests were all negative. At the last follow-up, the mean Constant-Murley score was 89.74 AE 3.71, the mean DASH score was 9.77 AE 5.31, the mean VAS score was 0.74 AE 0.64, which are all improved significantly compared with preoperative scores (P ¼ .00,.00,.00, respectively). At the last follow-up, the ROM including anterior flexion, external rotation by side, and the internal rotation were well restored without significant difference compared with the contralateral shoulder (P ¼.48, .08, .47, respectively). At 1 year after operation, the resorption rate of the bone graft was 19.4%. Conclusion:This study found that anterior shoulder instability with subcritical (10%-15%) glenoid bone loss treated with arthroscopic autologous scapular spine bone graft with suture anchor fixation is safe and could achieve satisfactory result at short-term follow-up. Level of Evidence: Therapeutic case series.

Morphometric and Biomechanical Comparison of the Scapular Spine and Coracoid Graft in Anterior Shoulder Instability

“…The authors also pointed out the importance of future clinical and biomechanical studies to verify the characteristics of scapular spines. Another study treated subcritical glenoid bone loss with arthroscopic autologous scapular spine grafts, 52 and the Constant-Murley score improved significantly at the 1-year follow-up without any serious complications or redislocation episodes. As a result, the comparison of biomechanical strength of the scapular spine graft may validate this as an option.…”

“…37,46 Successful clinical outcomes of scapular spine grafts in glenoid reconstruction have been reported in both open and arthroscopic surgery. 16,26,44,52,55 However, few studies have focused on biomechanical and morphometric characteristics. Investigation of scapular spine biomechanics is necessary to help determine the safety and strength of screw placement.…”

“…A number of free bone block grafting strategies have been described in recent decades. 15,27,30,37,38,40,48,52 Given the satisfactory outcomes and low rates of recurrent instability, the use of bone blocks has increased. 13 Commonly used allogenic grafts include distal tibial, iliac crest, and femoral head grafts; however, additional costs, decreased healing potential, and the risk of disease transmission are matters of concern.…”

Editorial Commentary: Surgical Treatment of Shoulder Instability With Subcritical Glenoid Bone Loss Requires Innovation: Bankart May Risk Significant Recurrence and Latarjet May Risk Significant Complications

“…The new technique introduced by Xiang, Yang, Chen, Hu, Zhang, Li, and Jiang in their study, "Arthroscopic Autologous Scapular Spine Bone Graft Combined With Bankart Repair for Anterior Shoulder Instability With Subcritical (10%-15%) Glenoid Bone Loss," 6 offers innovation in the setting of a patient group that many of us as shoulder surgeons deal with each day. This single-surgeon, retrospective case series of 27 patients offers short-term (2-year) follow-up of a well-detailed technique that involves harvest of a 2-cm segment of scapular spine, which is then stabilized with suture anchors along the anterior glenoid.…”

Arthroscopic Bone Block Cerclage Technique Using a Tricortical Scapular Spine Autograft for Glenoid Reconstruction in Patients With Anterior Shoulder Instability

“… 11 Satisfactory results with an autologous scapular spine bone graft were achieved at short-term follow-up in patients with anterior shoulder instability and subcritical bone loss. 16 The purpose of this Technical Note is to describe an arthroscopic bone block cerclage technique 17 that uses a tricortical scapular spine autograft for reconstruction of the glenoid in patients with anterior shoulder instability and glenoid bone loss.…”