Use of allograft to reconstruct anterior bony glenoid defect in chronic glenohumeral instability: a systematic review
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ARTHROSCOPY AND SPORTS MEDICINE
Use of allograft to reconstruct anterior bony glenoid defect in chronic glenohumeral instability: a systematic review Guillaume Villatte1,2 · Antoine Martins1 · Roger Erivan1,2 · Bruno Pereira3 · Stéphane Descamps1,2 · Stéphane Boisgard1,2 Received: 16 June 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Bone-block procedures are well-established in anterior chronic shoulder instability treatment. Autograft with the coracoid process (Bristow-Latarjet procedures) and iliac crest (Eden-Hybbinette) are the most frequent source of bone but the use of allograft is also possible. The objective of this review is to assess clinical and radiographic outcomes after bony allograft reconstruction in anterior glenohumeral instability. Material and methods Medline, Cochrane, Embase databases were searched for studies reporting on bone allograft reconstruction in anterior glenohumeral instability with glenoid defect. We conducted a systematic review of studies with all levels of evidence reporting on clinical or radiological outcomes or both. Level of evidence: IV. Results Ten studies met the inclusion criteria for the review; 283 shoulders were included with a mean age of 26 years (17–63) and mean follow-up of 34 months (4–168). Glenoid reconstruction was performed using bone from different source: femoral head (1 study), distal tibia allograft (5 studies), and iliac crest (4 studies). Allografts were fresh in 4 studies, demineralized in 2 studies, and freeze-dried after sterilization in 1 study. All scores performed in the different studies increased between pre-operative and post-operative evaluations (mean + 36.8 points for the ASES). Global rate of recurrence was 3.9% (11 patients) (0–11%), comprising 6 cases of dislocation (2.1%) and 5 subluxations (1.8%). Allograft healing occurred in 93.5% of cases. Conclusions This systematic review data suggest that allograft reconstructions in anterior glenohumeral instability could be a viable alternative to similar reconstructions with autografts and provide close clinical/radiological outcomes, at short and mid-term follow-up. Prospective randomized studies are needed to confirm these results. Keywords Shoulder instability · Dislocation · Anterior glenoid defect · Bone-block procedure · Allograft
Introduction Chronic anterior glenohumeral instability is a frequent problem in the daily practice of shoulder surgery. Most patients with recurrent shoulder dislocation exhibit bony lesions [1,
2], especially on the glenoid rim. The percentage of bone loss that should be considered significant is not precisely known [3], but glenoid lesions are considered as a major risk factor for recurrence, even after a “soft tissue” reconstruction procedure [4–6].
* Guillaume Villatte [email protected]
Stéphane Boisgard sboisgard@chu‑clermontferrand.fr
Antoine Martins [email protected]
1
Service d’Orthopédie‑Traumatologie, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont‑Ferr
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