Comparaison des allogreffes distales du tibia et des butées de type de Latarjet dans l’instabilité antérieure : étude prospective

Abstract

Introduction Recently, the use of fresh distal tibia allograft (DTA) for glenoid reconstruction in anterior shoulder instability has been described with encouraging short-term outcomes. However, the outcomes of patients undergoing DTA have not been compared to patients undergoing the Latarjet procedure, which has been considered the standard for shoulder stabilization for clinically significant anterior glenoid bone loss. The purpose of this study was to determine clinical outcomes for patients undergoing DTA compared to a matched cohort of patients undergoing Latarjet. Methods A review of prospectively collected data of patients with minimum 15% anterior glenoid bone loss, minimum follow-up of 2 years, and who underwent shoulder stabilization with either DTA or Latarjet was conducted. Consecutive patients undergoing DTA were matched by age, BMI, and number of previous ipsilateral shoulder surgeries to patients undergoing Latarjet. Patients were evaluated preoperatively and at minimum 2 years postoperatively with American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Western Ontario Shoulder Instability Index (WOSI) outcomes assessments. Complications, reoperations and episodes of recurrent instability were also analyzed. Statistical analysis was performed with Student t-tests, with P > 0.05 considered significant. Results A total of 60 patients (30 Latarjet, 30 DTA) with an average age of 24.3 ± 6.9 years were analyzed at an average 46 ± 17 months (range, 24–87) following surgery. Twenty-two patients (73%) in each group underwent prior ipsilateral shoulder surgery (range, 1–3 surgeries). There were no statistical differences in age, BMI, or number of prior surgeries between the groups, signifying adequate matching ( P > 0.05 for all). Both groups had significant improvements in all preoperative to postoperative outcome scores ( P > 0.05). When comparing final outcomes of Latarjet versus DTA, Latarjet patients had significantly higher ASES scores (93 ± 8 vs. 87 ± 13, P = 0.03); no significant differences were found in postoperative WOSI or SANE scores. In the Latarjet group, 2 patients underwent reoperation (6.7%), including 1 patient who redislocated after a traumatic motocross accident and 1 patient who underwent arthroscopic debridement for anterolateral shoulder pain. In the DTA group, 1 patient (3.3%) underwent reoperation including DTA revision for asymptomatic hardware failure. There were no cases of neurovascular injuries or other complications in either cohort. Discussion and conclusion At an average follow-up of nearly 4 years, fresh DTA reconstruction for recurrent anterior shoulder instability results in a clinically stable joint with equivalent clinical outcomes and recurrence rates compared to Latarjet. Longer-term studies are needed to determine if these results are maintained over time.