Iliac Crest Bone Grafting for the Management of Anterior Shoulder Instability in Patients with Glenoid Bone Loss: a Systematic Review of Contemporary Literature

Michael-Alexander Malahias,Efstathios Chronopoulos,Emmanouil Antonogiannakis,Vasileios Raoulis,Emmanouil Brilakis,Dimitrios Chytas

doi:10.1186/s40798-020-0240-x

Abstract

BackgroundA number of clinical trials have been published assessing the role of iliac crest bone grafting for the management of recurrent anterior instability with glenoid bone loss in contemporary practice. We therefore performed a systematic review of contemporary literature to examine the effect of iliac crest bone grafting on postoperative outcomes of these patients. Our hypothesis is that contemporary iliac crest bone block techniques are associated with low reoperation and complication rates combined with satisfactory functional results.MethodsThe US National Library of Medicine (PubMed/MEDLINE), the Cochrane Database of Systematic Reviews, and EMBASE were searched between January 2008 and December 2019 for relevant publications.ResultsFollowing the application of the inclusion-exclusion criteria, nine articles were found eligible for our analysis. In total, 261 patients (mean age range, 25.5–37.5 years; mean follow-up range, 20.6–42 months) were included in the studies of the current review. The mean modified Coleman score was 48.6 (range 37–65), indicating an overall low-to-moderate methodological quality. In the short term, the overall all-cause reoperation rate was 6.1%, while the rate of recurrent instability was 4.8%. The graft non-union rate was 2.2%, while the rate of osteolysis, graft fracture, and infection was 0.4%, 0.9%, and 1.7%, respectively. Finally, hardware-related complications, such as screw breakage or symptomatic mechanical irritation around the screw insertion, occurred in 3.9% of the patients.ConclusionsIliac crest bone block techniques in contemporary practice are safe and effective in the short-term (< 4 years) follow-up for the management of anterior shoulder instability with substantial glenoid bone deficiency. However, further studies of higher quality and longer follow-up are required to establish the therapeutic value of these techniques as well as to clarify whether there are differences in the outcomes of arthroscopic and open iliac crest bone block procedures.

Highlights

A number of clinical trials have been published assessing the role of iliac crest bone grafting for the management of recurrent anterior instability with glenoid bone loss in contemporary practice
We aimed to answer the following questions: (1) what are the clinical and functional outcomes of the iliac crest bone block technique for the treatment of anterior shoulder instability with glenoid bone loss in contemporary practice? (2) Do contemporary iliac crest bone block techniques result in adequate bone graft healing, union, and osseous incorporation? (3) Do arthroscopic iliac crest bone block techniques result in similar clinical and radiographic outcomes compared to the respective open techniques? Our hypothesis is that contemporary iliac crest bone block techniques are associated with low reoperation and complication rates combined with satisfactory functional results
The literature search identified 76 abstracts that were examined to determine the efficacy of the iliac crest bone block technique for the management of glenoid bone loss in patients with anterior shoulder instability (Fig. 1)

Summary

Introduction

A number of clinical trials have been published assessing the role of iliac crest bone grafting for the management of recurrent anterior instability with glenoid bone loss in contemporary practice. Our hypothesis is that contemporary iliac crest bone block techniques are associated with low reoperation and complication rates combined with satisfactory functional results. In cases with substantial anterior-inferior glenoid osseous defects, isolated soft tissue repair techniques have been shown inadequate in restoring shoulder stability, since they have been related to high postoperative recurrence rates of up to 40% [3–7]. While the Latarjet procedure has proved to be reliable to manage recurrent anterior shoulder instability with large glenoid bone defects, there have been concerns of a high surgical complication rate associated with this procedure [12–14]. A large recent review reported an overall complication rate in the open Latarjet procedure of 15%, with a 7% rate of unplanned reoperations [15]

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