Iliac Crest Allograft for Glenoid Deficiency in Recurrent Shoulder Instability in Athletes (SS-15)

Abstract

IntroductionPerforming a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>25% of glenoid diameter). We hypothesized that restoring a near-normal glenoid structure would prevent further dislocations and that osseous union would be achievedMethodsAll athletes with recurrent anterior shoulder instability and a large glenoid defect who underwent open anterior shoulder stabilization and glenoid reconstruction with iliac crest allograft were prospectively followed over a three year period. Pre-operatively, a detailed history and physical exam was obtained along with radiographs, a CT scan, and magnetic resonance imaging of the affected shoulder. All patients also complete the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) evaluation forms pre- and post-operatively. A CT scan was again obtained 6 months post-operatively to assess osseous union of the graft, and the patient again when through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI) forms.ResultsNine patients (all male) were followed for an average of 16 months (4 – 36 months) and had a mean age of 24.4 years. All patients exhibited a negative apprehension/relocation test and full shoulder strength at final follow-up. Eight of nine patients had achieved osseous union at six months (88.9%). ASES scores improved from 64.3 to 96.7, and SST scores improved from 66.7 to 100. Average post-operative WOSI scores were 94%.ConclusionThe use of iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency. IntroductionPerforming a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>25% of glenoid diameter). We hypothesized that restoring a near-normal glenoid structure would prevent further dislocations and that osseous union would be achieved Performing a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>25% of glenoid diameter). We hypothesized that restoring a near-normal glenoid structure would prevent further dislocations and that osseous union would be achieved MethodsAll athletes with recurrent anterior shoulder instability and a large glenoid defect who underwent open anterior shoulder stabilization and glenoid reconstruction with iliac crest allograft were prospectively followed over a three year period. Pre-operatively, a detailed history and physical exam was obtained along with radiographs, a CT scan, and magnetic resonance imaging of the affected shoulder. All patients also complete the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) evaluation forms pre- and post-operatively. A CT scan was again obtained 6 months post-operatively to assess osseous union of the graft, and the patient again when through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI) forms. All athletes with recurrent anterior shoulder instability and a large glenoid defect who underwent open anterior shoulder stabilization and glenoid reconstruction with iliac crest allograft were prospectively followed over a three year period. Pre-operatively, a detailed history and physical exam was obtained along with radiographs, a CT scan, and magnetic resonance imaging of the affected shoulder. All patients also complete the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) evaluation forms pre- and post-operatively. A CT scan was again obtained 6 months post-operatively to assess osseous union of the graft, and the patient again when through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI) forms. ResultsNine patients (all male) were followed for an average of 16 months (4 – 36 months) and had a mean age of 24.4 years. All patients exhibited a negative apprehension/relocation test and full shoulder strength at final follow-up. Eight of nine patients had achieved osseous union at six months (88.9%). ASES scores improved from 64.3 to 96.7, and SST scores improved from 66.7 to 100. Average post-operative WOSI scores were 94%. Nine patients (all male) were followed for an average of 16 months (4 – 36 months) and had a mean age of 24.4 years. All patients exhibited a negative apprehension/relocation test and full shoulder strength at final follow-up. Eight of nine patients had achieved osseous union at six months (88.9%). ASES scores improved from 64.3 to 96.7, and SST scores improved from 66.7 to 100. Average post-operative WOSI scores were 94%. ConclusionThe use of iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency. The use of iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency.