Outcomes are comparable using free bone block autografts versus allografts for the management of anterior shoulder instability with glenoid bone loss: a systematic review and meta-analysis of “The Non-Latarjet”

Abstract

Purpose Glenoid augmentation using free bone blocks for anterior shoulder instability has been proposed as an alternative to or bail-out for the Latarjet procedure. The purpose of this investigation was to systematically review and compare outcomes of patients undergoing glenoid augmentation using free bone block autografts versus allografts. Methods A systematic review using PubMed, MEDLINE, Embase, and the Cochrane Library databases was performed in line with the PRISMA statement. Studies reporting outcomes of patients treated with free bone block procedures for anterior shoulder instability with minimum 2-year follow-up were included. Random efects modelling was used to compare patientreported outcomes, return to sports, recurrent instability, non-instability related complications, and development of arthritis between free bone block autografts and allografts. Results Eighteen studies comprising of 623 patients met the inclusion criteria for this investigation. There were six studies reporting on the use of allografts (of these, two used distal tibial, three iliac crest, and one femoral head allograft) in 173 patients and twelve studies utilizing autografts (of these, ten used iliac crest and two used free coracoid autograft) in 450 patients. Mean age was 28.7 ± 4.1 years for the allograft group and 27.8 ± 3.8 years for the autograft group (n.s). Mean follow-up was 98 months in autograft studies and 50.8 months for allograft studies (range 24-444 months, n.s). Overall mean increase in Rowe score was 56.2 with comparable increases between autografts and allografts (n.s). Pooled recurrent instability rates were 3% (95% CI, 1-7%; I 2 = 77%) and did not difer between the groups (n.s). Arthritic progression was evident in 11% of autografts (95% CI, 2-27%; I 2 = 90%) and 1% (95% CI, 0-8%; I 2 = 63%) of allografts (n.s). The overall incidence of non-instability related complications was 5% (95% CI, 2-10%; I 2 = 81%) and was similar between the groups (n.s). Pooled return to sports rate was 88% (95% CI, 76-96%; I 2 = 76%). Conclusion Glenoid augmentation using free bone block autograft or allograft in the setting of recurrent anterior shoulder instability with glenoid bone loss is efective and safe. Outcomes and complication incidence using autografts and allografts were comparable. Due to the high degree of heterogeneity in the data and outcomes reported in available studies, which consist primarily of retrospective case series, future prospective trials investigating long-term outcomes using free bone block autograft versus allograft for anterior shoulder instability with glenoid bone loss are warranted. Level of evidence IV.

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

“…Glenoid bone grafting is primarily used as a salvage procedure or in patients with more severe glenoid bone loss. 9,56 However, a recent randomized controlled trial by Moroder et al 57 found that iliac crest bone graft transfer resulted in similar clinical results as the Latarjet procedure. Additionally, glenoid bone grafting may have several potential advantages over the Latarjet procedure, including its ability to accommodate a greater degree of glenoid bone loss and reduced risk of convulsion-related graft failure in patients with epilepsy.…”

“…7,8 Alternatively, glenoid bone grafting by means of a free graft transfer may be used to reconstruct the anterior aspect of the glenoid. 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.…”

Open Stabilization Procedures of the Shoulder in the Athlete: Indications, Techniques, and Outcomes

“… 102 One systematic review by Gilat et al showed that autograft vs. allograft bone grafting had similar efficacy and safety. 103 …”

“…102 One systematic review by Gilat et al showed that autograft vs. allograft bone grafting had similar efficacy and safety. 103 Indications for bone grafting for anterior shoulder instability: 99 1. Isolated anterior glenoid bone loss between 20-25% 2.…”

Arthroscopic Bankart versus open Latarjet as a primary operative treatment for traumatic anteroinferior instability in young males: a randomised controlled trial with 2-year follow-up

“… 14 Another potential treatment for treating shoulder instability is block bone procedures, which have been reported to be especially successful in the presence of glenoid bone deficiency. 15 In recent years, Latarjet, a coracoid bone block procedure, has gained growing popularity. This procedure involves a non-anatomical transfer of the coracoid process and cojoined tendon to the glenoid neck.…”