Comparison of Glenohumeral Contact Pressures and Contact Areas After Posterior Glenoid Reconstruction With an Iliac Crest Bone Graft or Distal Tibial Osteochondral Allograft

Abstract

This study supports posterior glenoid reconstruction with fresh DTA as a viable alternative solution, with the potential advantage of improving joint congruity via an anatomic reconstruction, resulting in a cartilaginous, congruent articulation with the humeral head. Further studies are required to determine potential clinical effects of the glenohumeral joint contact mechanics reported here.

Graft Transfer Technique in Arthroscopic Posterior Glenoid Reconstruction With Distal Tibia Allograft

“…Numerous techniques have been described for treatment including both iliac crest bone graft and allograft distal tibia. 1 , 4 , 6 , 7 Although both iliac crest and distal tibia allograft have been shown to restore glenohumeral contact pressures, 9 we prefer distal tibia allograft because of its congruity to the articular surface, 4 lack of graft harvest morbidity, and retained cartilaginous surface for articulation with the native humeral head in a patient cohort that is at risk for progressive osteoarthritic development. 7 Certainly, there remains the minimal risk of disease transmission with use of any allograft tissue, which is a concern and must be discussed with the patient.…”

“… 2 , 3 , 4 Although technically demanding, allograft distal tibia augmentation has been shown to restore glenohumeral contact pressure, comparable to both an intact glenoid and an iliac crest graft, but providing the advantage of an anatomic and congruent joint surface. 9 It has the additional benefit over iliac crest graft of providing a cartilaginous surface while also avoiding the morbidity associated with autograft harvest.…”

Shoulder instability: State of the Art

“…In addition to coracoid transfer and iliac crest bone grafting procedures for addressing critical glenoid bone loss, several authors have advocated for the use of a distal tibial allograft, citing its excellent articular conformity with the native glenoid ROC 97 98. Additionally, the use of allograft to address large HS lesions has been described 99.…”

Anterior instability

“…While cadaveric studies show the potential of this procedure to be as effective as iliac crest autograft augmentation, the authors believe that this technique represents a salvage option pending the results of more robust clinical trials (Millett et al, 2012;Frank et al, 2014). The use of the distal tibial allograft in glenoid augmentation was first shown to be feasible in a cohort of three patients .…”