33 - Anterior instability—bone augmentation surgery: Primary and revision outcomes

Abstract

In the setting of anterior shoulder instability, bone lesions of the humeral head (Hill-Sachs lesions) and glenoid bone loss (GBL) are common. In the acute phase, glenoid fractures are frequently observed following anterior shoulder dislocation, and fragment fixation is key to avoid attritional glenoid bone loss. Young age (<20 years), elite level athletics, contact sports, repeated overhead activity, and shoulder hyperlaxity have been identified as risk factors for inferior clinical results and recurrence of instability events. Historically, bone augmentation procedures have been considered for GBL of 20% to 25%. However, inferior results have been shown following GBL as low as 13.5%. It is paramount that the clinician considers glenoid and humeral bone defects together, and three-dimensional computed tomography reconstructions are recommended to evaluate the glenoid track in the setting of glenoid bone loss. The most common bone augmentation procedures are coracoid bone block transfer (Latarjet), distal tibia allograft, and iliac bone crest autograft. These procedures can be considered in both primary and revision cases. Latarjet is the most frequently used method; however, in the setting of a failed Latarjet or extensive GBL, a distal tibia allograft has shown excellent outcomes with the additional benefit of a cartilage-covered graft. Alternatively, a distal clavicle autograft offers a cost-effective cartilage-covered graft option. Iliac crest autograft with the J-graft method has shown similar clinical results compared to Latarjet, but high donor site morbidity has been reported without the benefit of a cartilage restoration.