Demographics and Distal Tibial Dimensions of Suitable Distal Tibial Allografts for Glenoid Reconstruction

Parada, Stephen A.; Griffith, Matthew; Shaw, K. Aaron; Waterman, Brian R.; Eichinger, Josef K.; Li, Xinning; Provencher, Matthew T.

doi:10.1016/j.arthro.2019.05.019

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…A further analysis found that neither age, height, weight, sex, nor body mass index affected the ability to allow harvest of a standard-size DTA graft. 9 This report means that presumably any distal tibia would be a suitable donor if it were not for the deep concavity of the lateral cortex encountered in 1 of every 7 DTA grafts.…”

Section: Discussionmentioning

confidence: 91%

“…Unfortunately, the age and sex of the donors were not available, although previous studies have shown that the suitability of grafts is independent of these factors. 9 , 10 The DTA grafts were then secured to a polyurethane solid foam block with a density of 20 pounds per cubic foot and with a 2-mm epoxy laminate on 1 side (Sawbones; Pacific Research Laboratories). This model was used to recreate the scenario typical of anterior glenoid bone loss with a cancellous anterior glenoid and an intact posterior glenoid cortex.…”

Section: Methodsmentioning

confidence: 99%

“…The presence of articular cartilage and the similarity of the radius of curvature of the articular surface of the distal tibia to the glenoid makes the DTA graft an attractive alternative to other bony reconstruction procedures. 9 , 10 The graft is typically arranged with the medial cancellous portion of the distal tibia placed into compression against the glenoid, with the lateral cortex of the tibia used to secure fixation ( Figures 1 and 2 ). The lateral aspect of the distal tibia at the articular surface has known anatomic deviations that vary from a straight border to a concave surface.…”

mentioning

confidence: 99%

“…The lateral aspect of the distal tibia at the articular surface has known anatomic deviations that vary from a straight border to a concave surface. 9 , 10 A straight, or nearly straight, lateral border has been found in up to 85% of tibias in imaging studies that used magnetic resonance imaging (MRI). 10 The presence of a straight lateral border allows the surgeon to retain the lateral cortex of the tibia to place screws against during the reconstruction, whereas a concave border requires the cortex to be removed to create a straight border, rendering the graft completely cancellous.…”

mentioning

confidence: 99%

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Anterior Glenoid Reconstruction With Distal Tibial Allograft: Biomechanical Impact of Fixation and Presence of a Retained Lateral Cortex

Parada

Shaw

McGee‐Lawrence

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Glenoid reconstruction with distal tibial allograft (DTA) is a known surgical option for treating recurrent glenohumeral instability with anterior glenoid bone loss; however, biomechanical analysis has yet to determine how graft variability and fixation options alter the torque of screw insertion and load to failure. Hypothesis: It was hypothesized that retention of the lateral cortex of the DTA graft and the presence of a washer with the screw will significantly increase the maximum screw placement torque as well as the load to failure. Study Design: Controlled laboratory study. Methods: Whole, fresh distal tibias were used to harvest 28 DTA grafts, half of which had the lateral cortex removed and half of which had the lateral cortex intact. The grafts were secured to polyurethane solid foam blocks with a 2-mm epoxy laminate to simulate a glenoid with an intact posterior glenoid cortex. Grafts underwent fixation with 4.0-mm cannulated drills, and screws and washers were used for half of each group of grafts while screws alone were used for the other half, creating 4 equal groups of 7 samples each. A digital torque-measuring screwdriver recorded peak torque for screw insertion. Constructs were then tested in compression with a uniaxial materials testing system and loaded in displacement control at 100 mm/min until at least 3 mm of displacement occurred. Ultimate load was defined as the load sustained at clinical failure. Results: The use of a washer significantly improved the ultimate torque that could be applied to the screws (+cortex and +washer = 12.42 N·m [SE, 0.82]; –cortex and +washer = 10.54 N·m [SE, 0.59]) ( P < .0001), whereas the presence of the native bone cortex did not have a significant effect (+cortex and –washer = 7.83 N·m [SE, 0.40]; –cortex and –washer = 8.03 N·m [SE, 0.56]) ( P = .181). Conclusion: In a hybrid construct of fresh cadaveric DTA grafts secured to a foam block glenoid model, the addition of washers was more effective than the retention of the lateral distal tibial cortex for both load to failure and peak torque during screw insertion. Clinical Relevance: This biomechanical study is relevant to the surgeon when choosing a graft and selecting fixation options during glenoid reconstruction with a DTA graft.

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Section: Discussionmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Anterior Glenoid Reconstruction With Distal Tibial Allograft: Biomechanical Impact of Fixation and Presence of a Retained Lateral Cortex

Parada

Shaw

McGee‐Lawrence

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…9 While proponents of using autograft sources, such as iliac crest cite theoretically improved healing rates and a lower cost over allograft, distal tibial allograft has, thus, far proven to reliably match the congruity of the glenoid arc and has demonstrated excellent union rates. [10][11][12][13][14] Humeral-sided bone loss resulting in an "off-track" and/or engaging Hill-Sachs lesion is commonly treated either indirectly with one of the above procedures, or directly by means of a remplissage. 15 The remplissage procedure, first described by Dr. Eugene Wolf in 2008, acts to fill the lesion and render it extra-articular through tenodesis of the infraspinatus and posterior capsule into the defect.…”

Section: Introductionmentioning

confidence: 99%

Anterior Shoulder Instability Part II—Latarjet, Remplissage, and Glenoid Bone-Grafting—An International Consensus Statement

Hurley

Matache

Wong

et al. 2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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High resorption rates following glenoid augmentation procedures do not seem to lead to higher recurrence rates or worse clinical outcomes: a systematic review and meta-analysis

Rutgers

Verweij

Schuit

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeBone augmentation techniques show a relatively high complication rate, which might be due to graft non‐union and resorption. It is unclear which augmentation techniques demonstrate the highest amount of non‐union and resorption and whether this leads to worse clinical or functional outcomes. Therefore, the aim of this review was (i) to compare non‐union and resorption rates between surgical approaches, procedures, graft types, donor sites and fixation methods regarding clinical and functional outcomes and (ii) determine whether high non‐union or resorption rates lead to less favorable clinical or functional outcomes. MethodsThe Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statements were followed. PubMed, EMBASE (Ovid) and Cochrane Library were searched on December 15th 2021 for studies examining bone graft non‐union or resorption using radiograph or CT following glenoid augmentation to treat anterior shoulder dislocation. ResultsThe search resulted in 103 inclusions, comprising 5,128 glenoid augmentations. When comparing pooled proportions of bony union, graft fracture rate, hardware failure rate, recurrence rate, return to sports and Rowe score, most results were similar between approaches, procedures, graft types, donor sites and fixation methods. High resorption rates were seen for allograft augmentation (74.3; 95% CI: 39.8–92.7) compared to autograft augmentation (15.5; 95% CI 10.1–23.2), but this was not associated with higher recurrence rates or worse clinical outcomes. Meta‐analyses (8 studies; 494 patients) demonstrated no difference in incomplete and complete non‐union rates between arthroscopic and open procedures; however, both analyses showed substantial heterogeneity. Higher partial resorption rates were observed on CT (48.0; 95% CI 43.3–52.7) compared to radiograph (14.1; 95% CI 10.9–18.1). Three studies comprising 267 shoulders demonstrated a higher rate of non‐union and recurrence in smokers, whereas one study comprising 38 shoulders did not. ConclusionNon‐union and resorption rates were similar among procedures, grafts and fixation methods. Higher resorption rates were observed in allografts, but this was not associated with higher recurrence rates or worse clinical outcomes. Pooling data demonstrated substantial heterogeneity and definitions varied among studies, warranting more standardized measuring. Level of evidenceIV.

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Demographics and Distal Tibial Dimensions of Suitable Distal Tibial Allografts for Glenoid Reconstruction

Cited by 9 publications

References 21 publications

Anterior Glenoid Reconstruction With Distal Tibial Allograft: Biomechanical Impact of Fixation and Presence of a Retained Lateral Cortex

Anterior Glenoid Reconstruction With Distal Tibial Allograft: Biomechanical Impact of Fixation and Presence of a Retained Lateral Cortex

Anterior Shoulder Instability Part II—Latarjet, Remplissage, and Glenoid Bone-Grafting—An International Consensus Statement

High resorption rates following glenoid augmentation procedures do not seem to lead to higher recurrence rates or worse clinical outcomes: a systematic review and meta-analysis

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