Bone Graft Healing Research Articles

Full Arthroscopic Eden-Hybinette Procedure Using 2 Cortical Suture Buttons for the Reconstruction of Anteroinferior Glenoid Defects.

Therapeutic management of recurrent anterior shoulder instability with an anterior glenoid defect and a Hill-Sachs lesion requires a bone graft to restore the width of the glenoid. The Latarjet procedure is the most popular technique but an iliac crest bone graft is preferred when the coracoid process is dysplastic or too short or after failure of Latarjet or Bristow-Latarjet. The purpose of this manuscript is to describe a full arthroscopic Eden-Hybinette-guided technique with 2 cortical suture buttons for bone graft fixation. This procedure allows reconstruction of severe glenoid bone defects and treatment of concomitant capsulolabral lesions and humeral bone loss, while preserving the subscapularis muscle. In addition, the use of 2 cortical buttons for bone graft fixation simplify graft transport and positioning, provides good control of the rotation, improving healing of the iliac crest bone graft to the anterior glenoid rim.

Anterior cruciate ligament reconstruction in a rabbit model using a silk-collagen scaffold modified by hydroxyapatite at both ends: a histological and biomechanical study

BackgroundTo investigate osteointegration at the graft-bone interface and the prevention of osteoarthritis after anterior cruciate ligament (ACL) reconstruction using a silk-collagen scaffold with both ends modified by hydroxyapatite (HA) in a rabbit model.MethodsThe HA/silk-collagen scaffold was fabricated using a degummed, knitted silk scaffold, collagen I matrix, and simulated body fluid (SBF). The HA/silk-collagen scaffold was rolled up to make a graft for replacing the native ACL in the experimental group (HA group), and the silk-collagen scaffold was used in the control (S group). All specimens were harvested at 16 weeks postoperatively to evaluate graft-bone healing and osteoarthritis prevention.ResultsHistological staining revealed the massive formation of more mature bone at the tendon-bone interface, and immunohistochemistry staining revealed more collagen I and osteocalcin deposition in the HA group than in the S group. Higher signals indicating more bone mineral formation were detected in the HA group than in the S group, which was consistent with the results of biomechanical testing. Better osteoarthritis prevention was also observed in the HA group, indicating a more stable knee joint in the HA group than in the S group.ConclusionThe HA/silk-collagen scaffold promotes osteointegration at the tendon-bone interface after ACL reconstruction and has great potential for clinical applications.

Collagen membrane versus platelet rich fibrin membrane in bone graft healing: An experimental study in sheep.

Background and objectives: Guided bone regeneration is a term used to define the use of barri-er membranes to promote complete osteogenesis. The aim of study was to histologically com-pare the effect of platelet rich fibrin membrane and resorbable Collagen membrane on bone substitute healing. Methods: in this experimental study three sheep’s which their weighted between 60-70 kg were used. After intramuscular sedation and local anesthesia, eighteen defects were created about 8 mm in diameter and 5 mm in depth in the lower border of mandible. Six defects on each animal which three in right side and three in left side of the mandible. The defects were filled with Biphasic calcium phosphate bone substitute. The first defect was covered by platelet rich fibrin membrane, the second one covered by Collagen membrane, and third one was left uncovered. The animals were sacrificed at 2, 6, and 12 weeks. Results: The healing of the grafted defects was histologically studied in all groups, and there was non-significant difference between PRF membrane and collagen membrane in healing of bone substitute at 2, 6, and 12 weeks.There was significant deference between PRF membrane and collagen membrane at 6 weekregarding scaffold replacement with mature bone. Conclusion: The use of PRF membrane shows a good outcome as a low cost biological material capable of improving bone healing defects, grafted with bone substitute. Keywords: Platelet rich fibrin membrane, collagen membrane, bone graft, bone healing.

Effects of hyaluronic acid on bone graft healing: An experimental study on sheep.

Background and Objectives: : Alloplastic is one of known materials have been used to treat bony defects in oral and maxillofacial region, but the healing is much more slower than auto graft . So many interpositional graft materials like hyaluronic acid and bone morphogenetic protein have been introduced to such material to induce osteoinductivity of graft material. This study aimed to evaluate the histological effect of Hyaluronic acid on bone graft substitute. Patients and methods: An experimental study carried out on 3 domestic sheep 2-4 years old. They divided into two groups, first group (study group): bone graft substitute mixed with hyaluronic acid introduced to the created cavities in the basal bone of mandible. Second group (control group): bone graft substitute were introduced into created cavities in the basal bone of mandible and the defects in both groups were covered with collagen membrane. The samples then sacrificed in deferent period interval 2 weeks, 6 weeks and 12 weeks and the sample collected and sent for histological examination. Results: all animals survived till the end of study. Both groups were characterized by new bone formation in defects however the bone formation in group 1 significantly preceded. Conclusion: hyaluronic acid induces the onset of of Oral and Maxillofacial department. Keywords: hyaluronic acid, Bone graft, Alloplastic material, guided bone regeneration.

Citric acid, but not tetracycline, improves the microscopic pattern of healing of particulate autogenous bone grafts in critical‐size defects

Bone demineralization has shown to be advantageous in autogenous onlay bone grafts and in pre-osteoblasts cultures, but such procedure has never been evaluated in particulate bone grafts. This study aimed to investigate the role of two demineralizing agents in the repair of the 8-mm critical-size defects in rats' calvaria. Eighty adult male Wistar rats were randomly assigned to one of eight groups as follows: particulate autogenous bone demineralized with citric acid for 15 seconds (CA15), 30 seconds (CA30), or 60 seconds (CA60); particulate autogenous bone demineralized with tetracycline hydrochloride for 15 seconds (TCN15), 30 seconds (TCN30), or 60 seconds (TCN60); blood clot (NC), and non-demineralized autogenous bone (PC). The calvariae were harvested at 30 and 60 postoperative days (n=5) for blinded histological and histometric analysis of the percentage area of newly formed bone within the defects. In the NC and TCN groups, bone formation was limited to the margins of the defects at 30 postoperative days, whereas complete closure was present in all the specimens from CA15 group. Both at 30 and 60 postoperative days, histomorphometry showed significant higher area of newly formed bone in specimens demineralized with CA than in those demineralized with TCN or non-demineralized (P<0.05). TCN appeared to impair bone neoformation, as its use produced similar or inferior results compared to blood clot. Demineralization of particulate bone grafts with CA during 15s enhanced the regeneration of critical-size defects and may be a promising adjuvant in regenerative procedures. TCN seems to be improper for this purpose.

Bony increased-offset–reverse shoulder arthroplasty: 5 to 10 years' follow-up

Glenoid lateralization has been shown to be the most imortant factor in maximizing passive range of motion and shoulder stability while preventing scapular impingement and notching. We aimed to evaluate mid- to long-term functional and radiologicoutcomes after bony increased-offset-reverse shoulder arthroplasty (BIO-RSA) using a Grammont-style (medialized) humeral implant. The study included 143 consecutive shoulders (140 patients; mean age, 72 years)treated with a BIO-RSA for rotator cuff deficiency. A cylinder of autologous cancellous bone graft, harvested from the humeral head, was placed between the reamed glenoid surface and baseplate; fixation was achieved using a long central peg (25 mm) and 4 screws. A large baseplate (29 mm) with a small baseplate sphere (36 mm) was used in 77% of cases, and a Grammont-style (medialized) humeral implant with 155° of inclination was used in all cases. All patients underwent clinical and radiographic assessment at a minimum of 5 years after surgery; in addition, 86 cases (60%) underwent computed tomography scan assessment. At a mean follow-up of 75 months (range, 60-126 months), the survivorship of the BIO-RSAusing revision as an endpoint was 96%. No cases of dislocationor humeral loosening were observed. Overall, 118 patients (83%) were either very satisfied (61%) or satisfied (22%). The adjusted Constant score improved from 40% ± 18% to 93% ± 23%, and the Subjective Shoulder Value improved from 31% ± 15% to 77% ± 18% (P < .001). The humeral bone graft incorporated completely in 96% of cases (137 of 143). Severe inferior scapular notching (grade 3 or 4) occurred in 18% (24 of 136). The risk of postoperative notching correlated to a lower body mass index (P < .05), superior glenosphere inclination (P = .02), and high or flush glenosphere positioning (P = .035). BIO-RSA is a safe and effective technique to lateralize the glenoid, providing consistent bone graft healing, excellent functional outcomes, a low revision rate, and a high rate of patient satisfaction. Thin patients (with a low body mass index) and glenosphere malposition (with persistent superior inclination and/or insufficient lowering of the baseplate and sphere) are associated with higher risk of scapular notching.Our data confirm the importance of implanting the baseplate with a neutral inclination (reverse shoulder arthroplasty angle < 5°) and with sufficient glenosphere inferior overhang (>5 mm) in preventing scapular notching. The use of a less medialized humeral implant (135° or 145° inclined) and smaller (25-mm) baseplate (when using a small, 36-mm sphere) should allow reduction in the incidence of scapular notching.

A Synthetic Graft With Multilayered Co-Electrospinning Nanoscaffolds for Bridging Massive Rotator Cuff Tear in a Rat Model

Background: Graft bridging is used in massive rotator cuff tear (MRCT); however, the integration of graft-tendon and graft-bone is still a challenge. Hypothesis: A co-electrospinning nanoscaffold of polycaprolactone (PCL) with an “enthesis-mimicking” (EM) structure could bridge MRCT, facilitate tendon regeneration, and improve graft-bone healing. Study Design: Controlled laboratory study. Methods: First, we analyzed the cytocompatibility of the electrospinning nanoscaffolds, including aligned PCL (aPCL), nonaligned PCL (nPCL), aPCL–collagen I, nPCL–collagen II, and nPCL-nanohydroxyapatite (nHA). Second, for the EM condition, nPCL–collagen II and nPCL-nHA were electrospun layer by layer at one end of the aPCL–collagen I; for the control condition, the nPCL was electrospun on the aPCL. In 40 mature male rats, resection of both the supraspinatus and infraspinatus tendons was performed to create MRCT, and the animals were divided randomly into EM and control groups. In both groups, one end of the layered structure was fixed on the footprint of the rotator cuff, whereas the other end of the layered structure was sutured with the tendon stump. The animals were euthanized for harvesting of tissues for histologic and biomechanical analysis at 4 weeks or 8 weeks postoperatively. Results: All scaffolds showed good cytocompatibility in vitro. The graft-tendon tissue in the EM group had more regularly arranged cells, denser tissue, a significantly higher tendon maturing score, and more birefringence compared with the control group at 8 weeks after operation. Newly formed fibrocartilage could be observed at the graft-bone interface in both groups by 8 weeks, but the EM group had a higher graft-bone healing score and significantly more newly formed fibrocartilage than the control group. An enthesis-like structure with transitional layers was observed in the EM group at 8 weeks. Biomechanically, the values for maximum failure load and stiffness of the tendon-graft-bone complex were significantly higher in the EM group than in the control group at 8 weeks. Conclusion: The co-electrospinning nanoscaffold of aPCL–collagen I could be used as a bridging graft to improve early graft-tendon healing for MRCT in a rat model and enhance early enthesis reconstruction in combination with a multilayered structure of nPCL–collagen II and nPCL-nHA. Clinical Relevance: We constructed a graft to bridge MRCT, enhance graft-tendon healing and graft-bone healing, and reconstruct the enthesis structure.

Efficacy of Platelet-Rich Plasma in Enhancing the Osteogenic Potential of Bone Graft in Oral and Maxillofacial Region.

Platelet-rich plasma (PRP) has been a breakthrough in the stimulation and acceleration of bone and soft tissue healing. It represents a relatively new biotechnology that is part of the growing interest in tissue engineering and cellular therapy. A prospective study was carried out in 50 patients. The cases were selected randomly in the age group of 8-50years who needed bone grafts for alveolar cleft defects and surgical defects following removal of osteolytic jaw lesions. They were divided into study group with autologous PRP and control group without PRP. Bone density was calculated as per Hounsfield scale preoperatively and post-operatively for both the groups. There was significant difference in the Hounsfield units at 06months and 12months post-operatively in both the groups showing good amount of bone regeneration. The preoperative volume of the defect and the post-operative volume of the regenerated bone were statistically analysed. The mean V2 was 0.7652cc for the study group, whereas for control group, it was 0.4840cc. The volume ratio for study group was 0.9070 and for control group was 0.6740. This showed greater bone regeneration in the study group. The results were statistically significant for both the groups. PRP is a new application of tissue engineering and a developing area of interest for clinicians and researchers. It is a storage vehicle for growth factors, especially PDGF and TGF-b, both of which influence bone regeneration, and also eliminates the concerns about immunogenic reactions and disease transmission. PRP does enhance the healing of bone grafts in the maxillofacial region as shown by the increase in the density of bone.

Biomineralizaion of hydroxyapatite on polyethylene terephthalate artificial ligaments promotes graft-bone healing after anterior cruciate ligament reconstruction: An in vitro and in vivo study.

The purpose of the present study is to modify the polyethylene terephthalate ligament with hydroxyapatite via biomineralization and to investigate its effect on graft-bone healing. After biomineralization of hydroxyapatite, the surface characterization of polyethylene terephthalate ligament was examined by scanning electron microscopy, Fourier transform infrared spectroscopy, X-ray diffraction, and water contact angle measurements. The compatibility and osteoinduction, along with the underlying signaling pathway involved of hydroxyapatite-polyethylene terephthalate ligament, were evaluated in vitro. Moreover, a rabbit anterior cruciate ligament reconstruction model was established, and the polyethylene terephthalate or hydroxyapatite-polyethylene terephthalate artificial ligament was implanted into the knee. The micro-computed tomography analysis, histological, and immunohistochemical examination as well as biomechanical test were performed to investigate the effect of hydroxyapatite coating in vivo. The results of scanning electron microscopy, Fourier transform infrared spectroscopy, and X-ray diffraction showed that the hydroxyapatite was successfully deposited on the polyethylene terephthalate ligament. Water contact angle of the hydroxyapatite-polyethylene terephthalate group was significantly smaller than that of the polyethylene terephthalate group. The in vitro study showed that hydroxyapatite coating significantly improved adhesion and proliferation of MC3T3-E1 cells. The osteogenic differentiation of cells was also enhanced through the activation of ERK1/2 pathway. The micro-computed tomography, histological, and immunohistochemical results showed that biomineralization of hydroxyapatite significantly promoted new bone and fibrocartilage tissue formation at 12 weeks postoperatively. Moreover, the failure load and stiffness in the hydroxyapatite-polyethylene terephthalate group were higher than that in the polyethylene terephthalate group. Therefore, biomineralizaion of hydroxyapatite enhances the biocompatibility and osseointegration of the polyethylene terephthalate artificial ligament, thus promoting graft-bone healing for anterior cruciate ligament reconstruction through the activation of ERK1/2 pathway.

Therapeutic Effects of Revascularisation on the Healing of Free Bone Grafts in Dogs.

IntroductionThe therapeutic effect of subcutaneous embedding and revascularisation on the repair of canine bone defects caused by open fracture was examined.Material and MethodsA total of 12 adult beagle dogs were randomly split into a control group (group C) and a test group (group T). A section of the radius was removed from each dog under general anaesthesia and the deficit supported by an orthopaedic implant. Group T had the section surgically implanted next to the blood vessel–rich saphenous vein and Group C had it cryopreserved at −80°C. After eight weeks, the bone was surgically implanted back into the matching radial deficit. Bone healing was evaluated by gross morphological and X-ray examinations, post-mortem histology, and successive blood measurements of key bone biochemical markers.ResultsAt 12 weeks, the bone healing boundary was disappearing more quickly in group T dogs than in their group C counterparts. X-ray and histological examinations showed that the cortical repair of group T subjects was complete and the bony plate arrangement was more regular than that in group C. The levels of bone biochemical markers also proved that the healing state of group T was better.ConclusionThe results showed that the degree of healing, osteoclast activity, and bone formation status of group T were better than those of group C, proving that the vascularised bone graft had a significantly shorter healing time than the cryopreserved bone graft.

ZnO-assisted coating of tetracalcium phosphate/ gelatin on the polyethylene terephthalate woven nets by atomic layer deposition

Abstract A new kind of coating consisting of zinc oxide (ZnO)/tetracalcium phosphate (TTCP)/gelatin (Gel) on the PET woven nets is prepared chemically by the method of atomic layer deposition (ALD) and hydrothermal method. The prepared materials are confirmed by XRD and SEM. XRD results show that ZnO and TTCP are well coated on the surface of PET woven nets and ALD-assisted ZnO leads to a surprising coating adhesion of about 8 MPa. Furthermore, SEM results indicate the diameter and morphology of ZnO, TTCP and Gel of PET woven nets. And the water contact angles of PET’s surface are decreased with ZnO, TTCP and Gel of PET woven nets. Moreover, the confocal imaging of NIH3T3 cells shows that the obtained product could promote the cells proliferation, which indicates that the good biocompatibility of the prepared PET/ZnO/TTCP/ Gel woven builds a foundation for their future application. The results aim to obtain an efficient method to modify PET for fabricating an ideal artificial implant meeting the clinical needs, and imply a positive effect in promoting the compatibility of PET for enhancing graft-bone healing after implantation.

Tissue Engineering and Regenerative Medicine Therapies for Cell Senescence in Bone and Cartilage.

The bone repair and substitute have been developed for decades with the bone defect repair applied successfully in clinical. However, implant complications may occur in more challenging situations, bone cell senescence and osteoporosis (OP). Due to certain microenvironment conditions, including hormonal, nutritional, and aging factors, the bone cell responses are regulated to alteration and end into cell senescence and OP. Thus, the bone tissue regeneration is limited with site morbidity increased, leading to bone graft failure. In such pathological state, bone grafts and substitutes are companied with OP therapies to improve bone tissue engineering and to enhance bone graft healing. Those substitutes with OP therapeutic-based applications have been becoming a growing field of interest in bone repair. Bone grafts, such as scaffolds with antiosteoporotic drugs releasing and implants with surface therapeutic modified, are studied to significantly increase low bone density as well as improve impaired bone regeneration. In this review, we discuss a thorough understanding in bone remodeling process, bone cell senescence, and mechanisms of OA and OP. Based on the understanding, the review concentrates on the treatments to the OP and the bone grafts applied in the bone senescence model and provides a future direction in clinical trial. Impact Statement This review discusses the tissue engineering and regenerative medicine therapies for aging-related bone diseases, which have been highly concerned in aging society. These therapies can improve the efficacy of bone tissue regeneration, enhance the quality of bone repair, and provide new insights in the field of bone clinical treatments and aging regeneration.

Positive Effect of Injectable Platelet Rich Fibrin (i-PRF) on Vital Bone Formation in Graft Reconstruction of the Mandible: A Histologic and Histomorphometric Study

In this clinical case series, relative centrifugation force (RCF) and centrifugation time (CT) were reduced to produce the liquid form of platelet rich fibrin (i-PRF). The goal of this study is to histologically evaluate if the liquid form of PRF has a positive effect on vital bone formation in the grafted mandible using mineralized freeze-dried allogeneic bone. Materials and Methods: Forty-two patients completed immediate bone grafting after a non-restorable endodontically treated molar tooth was extracted in preparation for future implant surgery. Each bone graft was augmented with i-PRF. To process i-PRF, relative centrifugation force (RCF) was reduced from 2,700 RPM to 700 RPM (60g). Centrifugation time was reduced from 12 minutes to 3 minutes. After an average bone graft healing time of 8 to 12 weeks, bone core samples were obtained at the time of implant surgery for histological and histomorphometric analysis. Results: Forty-two bone cores were harvested at the time of implant surgery for histological and histomorphometric analysis. The liquid form of PRF resulted in greater percentages of vital bone formation (average 87.4 %) compared to the existing published literature. Conclusion: i-PRF resulted in greater percentages of new vital bone formation compared to the published literature. This could be due to the continuous slow release and delivery of growth factors in i-PRF. Further clinical use of iPRF is needed to evaluate the full potential of bone regeneration.

Effects of hyaluronic acid on bone graft healing: An experimental study on sheep

Background and objectives: Alloplastic is one of known materials have been used to treat bony defects in oral and maxillofacial region, but the healing is much more slower than auto graft . So many interpositional graft materials like hyaluronic acid and bone morphogenetic protein have been introduced to such material to induce osteoinductivity of graft material. The aim was to evaluate the histological effect of Hyaluronic acid on bone graft substitute. Materials and methods: An experimental study carried out on 3 domestic sheep 2-4 years old. They divided into two groups, first group (study group): bone graft substitute mixed with hyaluronic acid introduced to the created cavities in the basal bone of mandible. Second group (control group): bone graft substitute were introduced into created cavities in the basal bone of mandible and the defects in both groups were covered with collagen membrane. The samples then sacrificed in deferent period interval 2 weeks, 6 weeks and 12 weeks and the sample collected and sent for histological examination. Results: All animals survived till the end of study. Both groups were characterized by new bone formation in defects however the bone formation in group 1 significantly preceded. Conclusions: Hyaluronic acid induces the onset of new bone formation when mixed with alloplastic material. Conclusions: Hyaluronic acid induces the onset of new bone formation when mixed with alloplastic material.

Three dimensionally printed surgical guides for removing fixation screws from onlay bone grafts in flapless implant surgeries

The present technique report describes a digital workflow for flapless implant surgery after onlay block bone graft healing in the esthetic area. Virtual removal of block fixation screws and optimal single-tooth implant position and digital crown waxing were planned from cone beam computed tomography (CBCT) and intraoral scans. Two different surgical guides were digitally designed and 3D-printed to allow for flapless implant surgery. The first surgical guide was used to remove all 3 fixation screws from a healed onlay block graft, whereas the second guide was used to determine the implant position and direction. The present methodology may be considered a time-efficient flapless approach for placing implants in sites with block grafts.

Non-rigid fixation of the glenoid bone block for patients with recurrent anterior instability and major glenoid bone loss: A systematic review.

New types of glenoid bone block fixation, involving suture buttons, suture anchors or even implant-free impaction of the graft, have been recently introduced. In contrast to screws which allow for a rigid fixation of the bone block, these alternative procedures provide a non-rigid type of fixation. Two reviewers independently conducted the search in a systematic way (according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms "Latarjet" OR "Eden-Hybbinette" OR "bone block" AND "anterior" AND "shoulder" AND "instability." Eight out of the 325 initial studies were finally chosen according to our inclusion-exclusion criteria. In total, 750 patients were included in this review. The overall anterior instability recurrence rate for patients treated with non-rigid fixation was 2.6%, while the overall rate of non-union or graft osteolysis was 5.4%. Regardless of the graft type, bone block non-rigid fixation showed satisfactory clinical and functional outcomes for the treatment of anterior shoulder instability with substantial glenoid bone deficiency. Furthermore, non-rigid fixation resulted in adequate bone graft healing and osseous incorporation. Lastly, given the relative lack of data, further prospective controlled studies are required to assess bone block non-rigid fixation procedures in comparison with the traditional rigid (with screws) fixation techniques. Systematic review, IV.

Histological evaluation of the healing process of autografted mandibular bone defects in rats under treatment with zoledronate

ObjectiveThis study aims to evaluate the healing process of autografted mandibular bone defects in rats treated with zoledronate (ZOL). Subjects and methodsA total of 180 Wistar rats were divided into four groups: group L received intravenous infusion of two doses of 0.06 mg/kg ZOL, nine weeks apart; group H received 0.06 mg/kg ZOL, while groups C and NC received normal saline at three-week intervals for nine weeks. Three weeks following the last infusion, a unilateral mandibular bone defect (5 mm) was created. Except in the NC group, all defects were repaired with autologous iliac bone graft. Fifteen animals from each group were sacrificed on postoperative Day 20, Day 40, and Day 60. Graft healing was scored using a histological grading system (ranging from 1 to 6). ResultsHistological evaluations performed on postoperative Day 60 showed that the mandibular defects were mainly repaired with fibrous tissue in the NC and H groups (93.00% ± 7.51% and 82.67% ± 13.08%, respectively) and with bone in the C and L groups (75.33% ± 14.20% and 92.67% ± 8.84%, respectively). The percentage of fibrous tissue and bone as well as the healing score of the NC and H groups were significantly different (P = 0.001) from those of the C and L groups. However, these were not different between neither the NC and H groups nor the C and L groups. ConclusionBased on the results of the present study the hypothesis can be established that there also might be a dose-dependent effect of ZOL on the healing of bone grafts in humans. This hypothesis has to be verified or rejected in clinical trials.

Risk factors in bone augmentation procedures.

Bone augmentation is an extremely common procedure in implant dentistry today because of significant advancements with reactive biomaterials, a better understanding of the mechanism of action that is found with growth factors contained in platelets, and improvements in surgical techniques. The expectation is for the surgeon to place the dental implant in the position that best serves the requirements of the prosthetic restorations. With the increasing demands that patients have for ideal prosthetic results, surgeons are expected to predictably augment both hard and soft tissues to provide the anticipated esthetic and functional outcomes. Bone grafting can be performed before, during, and after the implant placement; however, these augmentation procedures come with increased cost, the risk of complications such as infection or failure, and lengthening of the total treatment time. In addition, a plethora of grafting materials are available commercially, where they are often inadequately studied, or there is minimal information regarding their predictability or long-term success, or ability to support dental implants. It is clear that although the surgical field has seen major progress since early implant surgical techniques in the 1980s, major challenges still exist with hard tissue augmentation procedures. This review will discuss these challenges that are increased and often specific to bone graft healing, and which are becoming more common as implant site development often requires bone augmentation to improve volume or contour deficiencies. The risk factors that patients may present with that will affect outcomes with bone augmentation procedures are identified, and recommendations for the prevention of complications or managing complications once they have occurred are provided.

All-arthroscopic, guided Eden-Hybbinette procedure using suture-button fixation for revision of failed Latarjet

To report the results of a guided arthroscopic Eden-Hybbinette procedure, using suture button for iliac crest bone graftfixation, in a series of patients with a prior failed Latarjet and persistent glenoid bone loss. Seven consecutive patients (5 males, 2 females, mean age: 30.7 years [range, 17-47 years]) with recurrent anterior dislocations and glenoid deficiency greater than 20% underwent the all-arthroscopic revision procedure. The iliac crest bone graft and suture-button device (Bone-Link) were shuttled through the rotator interval. Specific drill guides were used and a suture tensioning device allowed bone graft compression. Previous broken screw shafts (3 patients) were left in situ. Graft placement and healing was assessed postoperatively with computed tomographyimaging. No neurologic injury or hardware problems occurred, and no patient required further surgery. On computed tomography scan, optimal positioning (flush and under the equator) and healing of the bone graft was observed in all patients. At a mean follow-up of 21 months (range, 12-39 months), all but one patient were satisfied and had a stable shoulder; 5 returned to sports. The Constant score increased from 32 to 81 points, and the subjective shoulder value from 31% to 87% (P < .001). The Walch-Duplay and Rowe scores averaged 85.7 (range, 65-100) points and 86.4 (range, 70-100) points, respectively. Recurrence of anterior shoulder instability after a failed Latarjet procedure can be successfully treated by an all-arthroscopic Eden-Hybbinette procedure. Suture-button fixation is reliable and permits optimal positioning and predictable healing of the new bone graft; in addition, it is an appropriate fixation option in the setting of retained broken hardware.

Double-row fixation of the transferred coracoid process: a rescue technique for intraoperative coracoid fracture during the Latarjet procedure

The Latarjet procedure is the preferred method to treat recurrent anterior shoulder instability with glenoid deficiency. An iatrogenic fracture of the transferred coracoid process is one possible intraoperative complication. We propose a rescue technique using double-row suture bridge fixation. Double-loaded 4.5-mm suture anchors were placed medially in the scapular neck. These sutures were then brought over the top of the coracoid fragment, placed around the bony fragment, and fixated to the glenoid face with knotless suture anchors. Radiologic evidence of bone graft healing was observed in the desired position. We present a salvage procedure that will assist surgeons if an intraoperative fracture of the coracoid bone graft occurs during fixation when performing the Latarjet procedure.