The J-Bone Graft for Anatomical Glenoid Reconstruction in Recurrent Posttraumatic Anterior Shoulder Dislocation

Auffarth, Alexander; Schauer, Josef; Matis, Nicholas; Kofler, Barbara; Hitzl, Wolfgang; Resch, Herbert

doi:10.1177/0363546507309672

Cited by 159 publications

(185 citation statements)

References 36 publications

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“…Studies have reported good outcomes in the use of iliac crest bone autograft in patients. However these studies are limited by small population groups and limited followup period [67][68][69] . The use of a distal clavicle arthroscopic autograft has also been reported [70] .…”

Section: Glenoid Bone Lossmentioning

confidence: 99%

Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

Ramhamadany

Modi

2016

WJO

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The management of recurrent anterior gleno-humeral joint instability is challenging in the presence of bone loss. It is often seen in young athletic patients and dislocations related to epileptic seizures and may involve glenoid bone deficiency, humeral bone deficiency or combined bipolar lesions. It is critical to accurately identify and assess the amount and position of bone loss in order to select the most appropriate treatment and reduce the risk of recurrent instability after surgery. The current literature suggests that coracoid and iliac crest bone block transfers are reliable for treating glenoid defects. The treatment of humeral defects is more controversial, however, although good early results have been reported after arthroscopic Remplissage for small defects. Larger humeral defects may require complex reconstruction or partial resurfacing. There is currently very limited evidence to support treatment strategies when dealing with bipolar lesions. The aim of this review is to summarise the current evidence regarding the best imaging modalities and treatment strategies in managing this complex problem relating particularly to contact athletes and dislocations related to epileptic seizures.

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Section: Glenoid Bone Lossmentioning

confidence: 99%

Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

Ramhamadany

Modi

2016

WJO

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“…1,2,10 There are only a few published all-arthroscopic iliac crest graft augmentation techniques, including those of Taverna et al 11 using metal screws and, more recently, EndoButton devices (Smith & Nephew); Scheibel et al 12 with the use of bioabsorbable screws; and Anderl et al 13 with implant-free, Jebone graft reconstruction. 14 We consider our proposed technique to have several advantages (Table 2). Possible risks include malpositioning of the graft; therefore, correct placement of the glenoid guide is important.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Iliac Crest Bone Block for Reconstruction of the Glenoid: A Fixation Technique Using an Adjustable-Length Loop Cortical Suspensory Fixation Device

Kalogrianitis

Tsouparopoulos

2016

Arthroscopy Techniques

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Recurrent anterior shoulder instability with significant bone loss represents a surgical challenge. Anterior bone block procedures including variations of the Latarjet coracoid transfer have been used in this setting. Bone graft resorption with prominence of the metalwork is a serious concern, whereas the relative contribution of the dynamic sling effect of a Latarjet procedure is still controversial. We describe an arthroscopic technique for anatomic reconstruction of anterior glenoid bone defects using autologous iliac crest graft. This technique allows accurate placement of the bone block; fixation with 2 knotless TightRope devices (Arthrex, Naples, FL), avoiding the use of screws; and a final labral repair. R ecurrent anterior shoulder instability is associated with bone loss in 90% of cases. With significant bone loss, primary arthroscopic Bankart repair carries a high risk of failure in more than 70% of cases. Although not clearly defined yet, biomechanical studies suggest that critical glenoid bone loss is around 20%. Most of the defects, though, are bipolar lesions and can be managed with glenoid-based surgery. On the glenoid side, the workhorse has been the Latarjet procedure and its variations. Other options include the use of tricortical iliac crest graft or distal tibial allograft. The arthroscopic Latarjet procedure has been gaining increasing popularity recently, whereas only a few arthroscopic techniques have been described for iliac crest bone graft. 1,2We describe an arthroscopic technique for reconstruction of the anterior glenoid with iliac crest graft. We use a specific posterior glenoid guide (Arthrex, Naples, FL) for accurate graft positioning, and the bone block is introduced through the rotator interval and secured in place with 2 knotless TightRope-RT devices (Arthrex), which are adjustable-length loop devices tensioned between cortical buttons (Arthrex) with a suture tensioner (Arthrex). This knotless fixation method eliminates the use of screws and their potential problems (Video 1, Table 1). Indications and Preoperative PlanningWe consider arthroscopic reconstruction of the glenoid with iliac crest bone graft in cases with glenoid bone loss greater than 20%, in cases with glenoid bone loss between 10% and 20% in younger patients (aged <20 years) involved in competitive or contact sports, and in bipolar lesions involving the glenoid and humeral head. Patients usually undergo magnetic resonance arthrography and routinely undergo threedimensional computed tomography of the shoulder with digital subtraction of the humeral head to provide an en face sagittal view of the glenoid. The percentage of glenoid bone loss can be calculated by modeling the inferior aspect of the intact glenoid as a true circle. Iliac Crest Graft HarvestingThe tricortical iliac crest graft is harvested from the ipsilateral side with the technique described by Warner et al. 2 The dimensions of the block are usually 2 cm in length Â 1 cm in height Â 1 cm in width, although the size can be customized dependin...

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“…In the more recent series, with well-fixed transplants, the recurrence rate is very low [13][14][15]17] Arthritis is seen more often, although mostly mild; reports are not always clear on the prevalence of preoperative arthritis and further deterioration. Development of arthritis is possibly prevented when, after fixing the graft the capsule is reattached on the rim of the native glenoid, thus, placing the bone block extra-articularly [15].…”

Section: Complicationsmentioning

confidence: 96%

“…The technique shows a wide variation: the graft is either fixed by impaction in the scapular neck, the so-called J graft [13]. In most of the other studies the graft is fixed with screws.…”

Section: Glenoid Reconstruction With Autologous Bonementioning

confidence: 99%

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Reconstruction of glenoid bone defects in shoulder instability with autologous bone

Willems¹

2014

Curr Rev Musculoskelet Med

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Bone defects, both at glenoid and at the humeral side are a frequent sequel of anterior shoulder instability. Although the transfer of the coracoid process (Latarjet, Bristow procedures) has gained popularity in treating the glenoid defect, equal results can be achieved with the use of a bone graft, for which mainly a graft of the iliac crest is used. Recently, arthroscopic procedures have been developed, leaving the subscapularis muscle largely intact.

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The J-Bone Graft for Anatomical Glenoid Reconstruction in Recurrent Posttraumatic Anterior Shoulder Dislocation

Cited by 159 publications

References 36 publications

Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

Arthroscopic Iliac Crest Bone Block for Reconstruction of the Glenoid: A Fixation Technique Using an Adjustable-Length Loop Cortical Suspensory Fixation Device

Reconstruction of glenoid bone defects in shoulder instability with autologous bone

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