Postsurgical glenohumeral anchor arthropathy treated with a fresh distal tibia allograft to the glenoid and a fresh allograft to the humeral head

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The treatment of recurrent glenohumeral instability, especially with a concomitant bony lesion, remains challenging. This is especially true in the case of posterior instability given its less common incidence. Moreover, the presence of an engaging reverse Hill-Sachs lesion in combination with posterior instability will result in the need for a more aggressive treatment option. In comparison with a Hill-Sachs lesion, a reverse Hill-Sachs lesion features greater chondral deficiency that must be addressed during treatment. We propose the talus allograft as a potential allograft for treatment of an engaging reverse Hill-Sachs lesion. The superior articular surface of the talus may be used to reconstruct the articular surface of the humeral head. In this technical note, we describe our preferred primary technique for treatment of an engaging reverse Hill-Sachs lesion with recurrent glenohumeral instability through use of a fresh osteochondral talus allograft, as well as discuss the advantages and disadvantages of this allograft option.

mentioning

confidence: 99%

Anatomic Humeral Head Reconstruction With Fresh Osteochondral Talus Allograft for Recurrent Glenohumeral Instability With Reverse Hill-Sachs Lesion

Provencher

Sánchez

Schantz

et al. 2017

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“…DTA has also been successfully applied in a posterior glenoid deficiency reconstruction by Millett et al 16 in 2 cases with a follow-up of 2 years. Yet another potential use for this versatile procedure, first described in a case report by Provencher et al, 17 may be in the treatment of postsurgical glenohumeral anchor arthropathy. DTA was used successfully in combination with a fresh humeral allograft to focal sites of humeral head damage.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Glenoid Reconstruction Using Fresh Osteochondral Distal Tibia Allograft After Failed Latarjet Procedure

Sanchez

Ferrari

Akamefula

et al. 2017

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In the treatment of recurrent anterior glenohumeral instability, the Latarjet procedure has been shown to fail. This results in a need for viable revisional procedures for patients who present with this challenging pathology. We report our preferred technique for anatomical glenoid reconstruction using a fresh osteochondral distal tibia allograft after a failed Latarjet procedure. This bony augmentation technique employs a readily available dense, weight-bearing osseous tissue source that has excellent conformity, as well as the added benefit of a cartilaginous surface to correct chondral deficiencies. Given its effectiveness in the Latarjet revision setting and low complication rate, the distal tibia allograft is a reasonable treatment option.

“…Previous methods of DTA preparation have called for using a 0.5-inch sagittal saw to cut the graft while an assistant holds it in place with 2 towel clamps. 13,21 Alternatively, a bone vice can be used to securely hold the distal tibia. To accommodate any slope changes of the glenoid, the allograft is cut at various angles, typically 5 to 15 .…”

Section: Figmentioning

confidence: 99%

“…Usually between 8 and 11 mm of tibial bone is used with the graft specifically cut to dimensions meant to conform on a case specific basis to the particular glenoid deformity and native anatomy. 13,21 The superior-and inferior-most aspects of the allograft are rounded to the shape of a glenoid, the aim being to establish a smooth graft-to-native Inappropriate fixation of the graft can jeopardize the procedure.…”

Section: Figmentioning

confidence: 99%

“…Recent studies have shown that DTA reconstruction was able to restore shoulder function and stability in patients with recurrent posterior instability and substantial bone loss. 19,20 Provencher et al 21 used the DTA to treat a focal chondral defect of the glenoid. Additional values of the procedure include potential prevention of morbidity after coracoid transfer and avoiding nonanatomic placement of the conjoined Fig 5.…”

mentioning

confidence: 99%

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Use of a Cutting Instrument for Fresh Osteochondral Distal Tibia Allograft Preparation: Treatment of Glenoid Bone Loss

Ferrari

Sanchez

Sánchez

et al. 2017

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Glenoid bone loss presents a major risk for glenohumeral instability that has been well recognized as a cause of instability recurrence after attempted Bankart repair, and although most surgeons consider the Latarjet procedure as the gold standard, failures can occur with this technique as well and the search for alternative grafts to address glenoid bone loss is a major topic of ongoing research in the field. Of these techniques, the distal tibia allograft (DTA) has been shown to provide an excellent option to restore glenoid biomechanics, due to its congruency with the humeral head, dense bony quality, and the facility of harvest. The correct preparation of the DTA is essential to provide the most anatomic reconstruction possible and to avoid damage to the graft. The purpose of this Technical Note is to present our technique for cutting the DTA in detail, using a special workstation to optimize this procedure.