Clinical outcomes of an all-arthroscopic glenoid reconstruction using iliac crest bone graft with a double cannulated screw fixation technique

Abstract

IntroductionSignificant glenoid bone loss contributes to recurrent anterior shoulder instability. Reconstruction using an iliac crest bone graft provides an anatomic restoration of the glenohumeral arc. We present a case series of an all-arthroscopic glenoid bone reconstruction using iliac crest bone graft (ICBG) with a double cannulated screw fixation technique. Materials and methodsThis is a retrospective study from 2012 to 2017. Patient selection was based on Instability Severity Index Score (ISIS) of greater than 3 points and the presence of glenoid bone defect of more than 20% surface area. The ICBG was harvested from the ipsilateral hip and delivered arthroscopically to the deficient glenoid. The bone graft was then fixed with two cannulated screws. All patients were evaluated at 0, 6, 12 and 24 months for range of motion, isometric strength, pain score, and functional outcome scores: Constant-Murley Score (CMSO), Oxford Shoulder Score (OSS), and UCLA Shoulder Score. Results7 patients (6 males, 1 female) with the mean age of 40.2 years and mean glenoid bone loss of 41.8% were included. At 24 months, the mean active flexion improved from 119 to 143° (p = 0.128) and active abduction improved from 112 to 138° (p = 0.063). Isometric strength increased from 14.7 to 17.6lbs (p = 0.345). All functional scores showed significant improvement (p < 0.05), where CMSO increased from 66.9 to 81.4; OSS 17.4 to 31.4, and UCLA score 23.5 to 32.1. Pain score improved from 4 to 0.5. Bone graft incorporation was confirmed for all the cases and none had recurrent instability. One patient required screw removal for screw cutout. ConclusionOur mid-term results for an all-arthroscopic glenoid reconstruction using ICBG demonstrated good clinical result with minimal complications.