Bone Graft Reconstruction Research Articles

Whole Glenoid Reconstruction for Multidirectional Instability of the Shoulder

The surgical results of shoulder multidirectional instability are not satisfactory. To address the structural and biological factors that are related to the low success rate of surgical treatment, we developed a whole glenoid reconstruction technique, which includes mainly 270° glenoid bone grafting and capsule labrum reconstruction, and glenohumeral ligament reconstruction. Our clinical experience indicates that the application of this technique can result in optimal shoulder stability. We consider the introduction of this technique will shed light on the surgical treatment of shoulder multidirectional instability.

Reconstruction of Metacarpal Bone with Giant Cell Tumour by Metatarsal Bone: A Rare Case

Giant cell tumour (GCT) of the metacarpal bone is rare, and it behaves more aggressively with a higher recurrence rate as compared to other long bones. Modalities such as bone curettage with or without bone grafting, ray amputation, or wide resection and reconstruction have been described as surgical management for this condition. Wide resection (en block) is often preferred as it has a lower recurrence rate among the rests. Reconstruction techniques options available include vascularised or non-vascularised fibular graft, iliac crest strut graft with loss of metacarpophalangeal joint function or with metatarsal substitution resulting in a more preserved function of the hand. This case report is about a 15-year-old teenager girl with a giant cell tumor of her left second metacarpal bone, which was confirmed with a plain radiograph and magnetic resonance imaging. This case report focuses the operative technique of the metacarpal reconstruction using the third metatarsal bone. The aim was to preserve hand function and cosmesis while achieving good local control of the disease without compromising the lower limb function. The transfer of osteoarticular ligamentous complex of the third metatarsal bone for the reconstruction of the second metacarpal bone defects is a possible operative procedure that provides good cosmetic and excellent functional outcomes while not compromising the donor’s foot function.

Evaluation and Management of Glenohumeral Instability With Associated Bone Loss: An Expert Consensus Statement Using the Modified Delphi Technique

To establish an international expert consensus, using the modified Delphi technique, on the evaluation and management of glenohumeral instability with associated bone loss. A working group of 6 individuals generated a list of statements related to history and physical examination, imaging and specialized diagnostic tests, bone loss quantification and classification, treatment outcomes and complications, and rehabilitation for the management of glenohumeral instability associated with bone loss to form the basis of an initial survey for rating by a group of experts. The expert group (composed of 22 high-volume glenohumeral instability experts) was surveyed on 3 occasions to establish a consensus on the statements. Items with over 70% agreement and less than 10% disagreement achieved consensus. After a total of 3 rounds, 31 statements achieved consensus. Eighty-six percent of the experts agreed that a history of multiple dislocations and failed soft-tissue surgery should raise suspicion about the possibility of an associated bone deficit. Ninety-five percent of the experts agreed that 3-dimensional (3D) computed tomography (CT) is the most accurate diagnostic method to evaluate and quantify bone loss. Eighty-six percent of the experts agreed that any of the available methods to measure glenoid bone deficiency is adequate; however, 91% of the experts thought that an en face view of the glenoid using 3D CT provides the most accurate method. Ninety-five percent of the experts agreed that Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Ninety percent of the experts agreed that in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed and any of the available options is valid. There was no consensus among experts on how Hill-Sachs injuries should be managed or on how postoperative rehabilitation should be carried out. The essential statements on which the experts reached consensus included the following: A history of multiple dislocations and failed soft-tissue surgery should make surgeons consider the possibility of an associated bone deficit. Three-dimensional CT is the most accurate diagnostic method to evaluate and quantify bone loss. Although any of the available methods to measure glenoid bone deficiency is adequate, an en face view of the glenoid using 3D CT provides the most accurate method. Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Finally, in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed. Level V, consensus statement.

An in vivo comparative evaluation of graft uptake between chin and ramal graft in the reconstruction of atrophic anterior maxillary edentulous ridges for implant placement

Introduction: The goal of modern dentistry is to restore the patient to normal function, esthetics, comfort, speech and health, which can be brought by caries prevention or replacing of missing teeth. Loss of teeth may be devastating for the patient, both functionally and aesthetically. Complex anatomy, functional and aesthetic demands often make reconstruction very challenging as well as the multitude of complications that can arise during or after treatment. Aim and Objectives: To evaluate the amount of bone resorption of mandibular autogenous block bone graft in reconstruction of atrophic anterior alveolar ridges. Materials and Methods: 5 patients underwent harvesting of corticocancellous bone from Mandibular ramus and 5 patients underwent harvesting of corticocancellous bone from Mandibular chin region for Reconstruction of atrophic alveolar ridge. All patients were reviewed for follow-up for 5 months to evaluate the amount of resorption and acceptance of graft. Results: In a follow up period of 5 months the mean graft resorption in ramal graft is 16.8% and mean graft resorption in symphysis graft is 18%. Conclusion: Minimally invasive approach, ease of application, volume of the graft and least postoperative morbidity are observed in ramal graft. The survival of the graft is better in ramal graft than the graft from the chin as the chin graft shows higher resorption rate. Patient compliance is favorable more towards the ramal graft than the chin graft as the immediate postoperative pain is high in symphysis region. Keywords: Graft, Reconstruction, Implant, Ramus, Symphysis.

4‐year follow‐up of staging surgical treatment for ameloblastoma and no‐grafting implantation: A case report

Background: Two-stage surgical protocol for multicystic mandibular provided satisfactory clinical outcomes. The fenestration procedure reduced the range of tumor and curettage in the second stage sustains the shape of mandibular. With or without bone grafting, osteogenesis and bone reconstruction occurred in mandibular bone defect, which provided adequate bone for implant restoration. Aim/Hypothesis: To provide a reference for evaluating the long-term outcomes of spontaneous osteogenesis and implant restoration after staging surgical treatment for multicystic mandibular ameloblastoma. Materials and Methods: A 17-year-old male was diagnosed as multicystic mandibular ameloblastoma and received a two-stage surgical protocol. Radiographic analysis was taken before and after every stage of the treatment. In the first stage, the ameloblastoma was treated by fenestration and decompression technique. Obvious reduction of the lesion extent was observed 9 months later and the curettage of the cyst was presented in the second stage of surgery without bone substitudes grafting. Osteogenesis was discovered in the 6-month and 9-month follow-up of the second stage surgery. Two 4.5x11.0 mm Ankylos implants were placed 14 months after the second stage surgery. The implants were embedded and the healing abutments were attached to the implants 4 months later. Restoration was accomplished 5 months afterwards. The patient was recalled for clinical examination 2 and 4 years post-restoration. Results: Spontaneous osteogenesis was observed 9 months and 14 months after two-stage surgical treatment. Bone-to-implant contact was displayed according to the post-surgical cone-beam CT scan. Normal functioning of the implant restoration was observed in the 2-year and 4-year follow-up. Neither recurrence of the tumor or implant complications was discovered in this case. Conclusions and Clinical Implications: Implant restoration without bone substitudes grafting after staging surgical treatment for ameloblastoma would receive long-term stable outcome in this case. Keywords: Ameloblastoma, staging surgical treatment, implantation, no-grafting

Pediatric Mandibular Central Giant Cell Granuloma: Neoadjuvant Immunotherapy to Minimize Surgical Resection

Central giant cell granuloma (CGCG) is a relatively uncommon benign bony lesion accounting for approximately 7% of all non-neoplastic lesions of the jaw. The clinical behavior of CGCG can vary from a slow-growing, painless lesion to fast-growing and locally destructive. When such a lesion involves the mandible, this can be quite debilitating for the patient, inhibiting oral intake and requiring an extensive resection and bone graft reconstruction. The authors present a case of effectively decreasing the surgical morbidity associated with a large and rapidly growing CGCG of the mandible in a pediatric patient. Neoadjuvant immunotherapy with denosumab (human monoclonal antibody) facilitated treatment of the tumor without the need for a large resection which would have otherwise necessitated a vascularized bony mandibular reconstruction. Consideration of neoadjuvant medical management of CGCG as the primary treatment is advocated.

Virtual surgical planning in fibula flap mandibular reconstruction

: Mandibular reconstruction is one of the workhorse in head and neck reconstructive surgery, with the free fibula flap currently considered the gold standard technique. The last two decades have seen considerable developments and a surge in popularity of virtual surgical planning (VSP) and Computer-aided design and manufacturing (CAD-CAM). Starting with virtual performing of the surgery, the possibilities that this technology offers are enormous. Stereolithographic models, customized bone cut guides and pre-bent reconstruction plates are very useful intraoperative tools. In spite of the high costs of this technology, it is helpful to surgeons in the following ways: (I) During ablative oncological surgery, cleaner bone margins are easily obtained due to bone cut accuracy enhancement; and (II) the efficiency of reconstructive surgery is improved by simplifying the otherwise time-consuming reconstructive steps associated with the traditional free-hand technique. The aim of this article is to describe our experience and to share the tips and pitfalls than we have found along these years with this technology which is producing a paradigm shift in bone graft reconstruction. In conclusion, our recommendation is to use a case-by-case evaluation to select those patients for whom VSP and CAD-CAM will help to obtain the best aesthetical and functional outcomes.

Distal clavicle autograft augmentation for glenoid bone loss in revision shoulder arthroplasty: results and technique

Structural bone graft for reconstruction of glenoid bone stock is often necessary in the setting of revision shoulder arthroplasty. This study introduces a new structural autograft technique using the distal clavicle for treatment of glenoid bone loss in the setting of revision shoulder arthroplasty. This is a retrospective, single-surgeonstudy of patients with significant glenoid bone loss requiring revision shoulder arthroplasty with autologous distal clavicle bone grafting to the glenoid. Twenty patients with failed shoulder arthroplasty who underwent revisions of their glenoid components between 2015 and 2019 were retrospectively identified. Sixteen patients were available with follow-up of greater than 1 year. Patient records and radiographs were reviewed for intraoperative and postoperative complications. Preoperative and postoperative function were evaluated by physical examination and patient-reported outcome surveys. There were no observed intraoperative complications relating to the distal clavicle autograft harvest or placement. There were no iatrogenic nerve injuriesor intraoperative instability. One of the 16 patients developed postoperative loosening and subsequent failure of the glenoid baseplate, requiring revision. One additional patient demonstrated increased elevation of the coracoclavicular interval postoperatively, likely related to the distal clavicle autograft harvest. At a mean follow-up of 25 months, 15 of 16 glenoid implants remained well fixed (93.4%), with no evidence of infection, or impingement demonstrated radiographically or clinically. Average patient age was 69 years at the time of surgery. Forward elevation improved from 76° to 123° at final follow-up (P = .0002). The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score improved from an average of 35.8 to 67.8 at mean follow-up (P = .001). The visual analog scale score improved from an average of 5.9 to 2 at mean follow-up, though not statistically significant (P = .068). There was no significant change in external rotation following surgery (P = .319). Osteolysis and bone loss of the glenoid poses a challenging problem in revision shoulder arthroplasty. Distal clavicle autograft augmentation is a viable and reproducible technique to manage structural glenoid defects.

Osteochondral reconstruction for post-traumatic coronoid deficiency.

This study aimed to evaluate the clinical outcome and graft survival following coronoid reconstruction with osteochondral bone grafts for post-traumatic coronoid deficiency treatment. We hypothesized that coronoid reconstruction using an osteochondral bone graft will provide favorable results in treating post-traumatic coronoid deficiency. A retrospective review was performed on eight patients (mean age = 45.8 years) who underwent osteochondral bone graft reconstruction indicated for post-traumatic coronoid deficiency. The osteochondral bone grafts were obtained from the radial head remnant (four patients), olecranon tip (two patients), and iliac crest (two patients). All the injuries were terrible triad. The mean duration from injury to surgery was 79.3 weeks. The visual analog scale (VAS) for pain, motion arc, and Mayo elbow performance score (MEPS) were used to evaluate the clinical outcome. Radiologic evaluation of graft healing and integrity was performed using computed tomography at 19 months and plain elbow radiography at 24.1 months after reconstruction. The immediate graft height was measured. VAS and MEPS values improved from 4.1 ± 1.2 to 1.1 ± 0.3 and 34.2 ± 16.9 to 85.0 ± 7.1, respectively (p = 0.018, p = 0.018) after reconstruction. The motion arc significantly improved from 84.2° ± 16.1° to 102.1° ± 18.2° at the final follow-up of 39.1 ± 18.8 months (p = 0.048). All the osteochondral grafts survived, with nonunion in two patients (25%). The mean immediate graft height was 15.4 ± 2.6 mm. Among the eight patients, three (37.5%) developed secondary osteoarthritis of the ulnohumeral joint. Coronoid reconstruction with osteochondral bone graft may serve as an option to salvage post-traumatic coronoid deficiency. Sufficient graft height was required for graft survival. Secondary osteoarthritis of the ulnohumeral joint should not be underestimated during follow-up.

Guidelines for management of crush injuries of the hand

Crush injuries of the hand involve damage to multiple structures within the hand, loss of tissue, devascularisation and possibly amputation of digits. They are complex and difficult to classify. Each injury has a unique pattern and requires a unique plan of management. There are no set procedures that can be described, however fundamental principles can be laid down to guide surgical management.Optimum management requires a planned and decisive approach. The surgeon or the team must be well versed with techniques necessary for management of all the structures within the hand, microsurgery and free tissue transfer.The essential components of management are, accurate assessment of the injury and creating a reconstructive plan by structures. The essential components for primary surgery are precise and complete debridement, skeletal stabiliation, vascular repair and if vessels are exposed, soft tissue cover. Secondary surgery should include procedures to enhance the function of the hand or to improve the aesthetics of the hand. These include bone grafting, fusion, tendon and nerve reconstruction, flap de-bulking and toe to hand transfers.The following article is a concise synthesis of the fundamental principles which a hand surgeon must understand while undertaking these challenging procedures.

Combination of Extracorporeally-irradiated Autograft and Vascularized Bone Graft for Reconstruction of Malignant Musculoskeletal Tumor.

Reconstruction after wide resection of a malignant musculoskeletal tumor is challenging. We performed biological reconstruction with an extracorporeally-irradiated autograft in combination with a vascularized bone graft. Fifteen patients who underwent curative resection of malignant musculoskeletal tumor followed by reconstruction with this method were included. Oncological outcomes, survival of the graft, radiological findings and functional outcomes were reviewed. No local recurrences were detected from the irradiated bones, and 93% of the vascularized bone grafts survived. The mean MSTS score was 24.8 in all cases, 22.9 in the osteoarticular cases, and 27 in the intercalary cases. The intercalary tibia cases showed excellent results with a mean MSTS score of 29.3. This method has the advantage of combining the mechanical quality of an irradiated autograft and biological quality of a vascularized bone graft. The best indication of this method is for intercalary defects of the tibia.

Rehabilitation after partial mandibulectomy - Clinical Report

Purposes: The rehabilitation of oral function impairments secondary to acquired defects following segmental mandibulectomy continues to be a major challenge. The success in rehabilitating patients who had undergone tumour resection depends upon the nature and extent of the surgical defect, treatment plan, type of prothesis and patient co-operation. Removable dentures supported by remaining teeth and/or gum are often unstable and rarely satisfactory. However, given the recent advances in maxillofacial prosthetics and reconstructive surgery, it is possible to restore most individuals to nearly normal anatomy and function with immediate vascularized bone graft reconstruction followed by rehabilitation with removable or fixed implant-supported prosthesis. Case report: This case report emphasises the truly multidisciplinary approach, as it describes the prosthodontic rehabilitation of a patient with history of a segmental mandibulectomy that involved the use of a vascularized bone graft, to reconstruct the mandible, and an implant-supported fixed partial denture to restore oral function. ​Conclusions: Prosthetic rehabilitation with dental implants and fixed implant-supported prosthesis is a valid tool advocated by several authors as they provide stability with enhanced masticatory efficiency as well as aesthetics, hence providing the best dental rehabilitation with a stabilized or immobilized prothesis.

Recurrence of Mandibular Ameloblastoma on Autogenous Bone Graft: A Case Report

Presented is a case of a 62-year-old female who underwent segmental resection with iliac bone graft reconstruction for recurrent ameloblastoma. Another recurrence was noted 14 years later, this time with involvement of the osseous graft. A search of recurrences on bone grafts showed limited reports in literature. The authors explore possible reasons for this unusual occurrence and present current treatment recommendations in ameloblastoma management. Key words: ameloblastoma, head and neck surgery, oromandibular reconstruction, recurrence

Arthroscopic Bone Block Cerclage: A Fixation Method for Glenoid Bone Loss Reconstruction Without Metal Implants

Large glenoid bone loss defects are associated with higher failure rates after arthroscopic Bankart repair in cases of glenohumeral anterior instability, further necessitating bone graft reconstruction. Because most techniques use strong initial fixation using metal devices, bone graft resorption considered to be closely related to the presence of metal components is a potential shortcoming of these techniques. We describe an arthroscopic technique for anatomical reconstruction of the glenoid that uses a tricortical iliac crest with a metal-free fixation method using 2 ultra-high-strength sutures (FiberTape Cerclage System; Arthrex, Naples, FL), which provide substantial stability to the graft, and finishing with a capsulolabral reconstruction.

Efficacy of structural bone graft for reconstruction of acetabulum in total hip arthroplasty in patients with developmental dysplasia of hips and severe acetabular defect

Efficacy of structural bone graft for reconstruction of acetabulum in total hip arthroplasty in patients with developmental dysplasia of hips and severe acetabular defect

Nonvascularized Iliac Bone Reconstruction for the Mandible Without Maxillofacial Skin Scarring

There are many methods to reconstruct the mandible, but they are often accompanied by trauma, which can lead to scarring of the maxillofacial skin. The purpose of this study was to show the utility of a minimally invasive method for reconstruction of the mandible with nonvascularized iliac bone grafts without a skin scar, as well as to evaluate the success rate and complications. This was a retrospective case series. We retrospectively analyzed patients who underwent transoral resection of benign mandibular pathologies, followed by nonvascularized iliac bone graft reconstruction. The primary outcome variable was the success rate of the bone grafts. Secondary outcome variables were postoperative complications at the grafted bone recipient and donor sites, the long-term absorptivity of grafted bone, and the type of mandibular defect. We computed descriptive statistics or performed the χ2 test for each variable. Overall, 54 patients were included in the study, including 21 male and 33 female patients, with an age range of 10 to 65years. The complete survival rate was 87.0% (47 of 54 patients), and the partial survival rate was 98.1% (53 of 54).The average bone absorption rate 3years after surgery was 1.8 to 30.7%. We propose a new classification method for mandibular defects based on the extent of the tumor, location of the osteotomy, and degree of surgical difficulty. Intraoral nonvascularized iliac bone grafting is a highly successful minimally invasive method for mandibular reconstruction. It is also one of the best methods for mandibular reconstruction in patients with benign mandibular tumors without soft tissue involvement.

The incidence and risk factor of deep venous thrombosis after arthroscopically assisted anterior cruciate ligament reconstruction

PurposeTo retrospectively analyze the incidence and risk factors of deep venous thrombosis (DVT) detected by ultrasonography after arthroscopically assisted Anterior Cruciate Ligament Reconstruction (ACLR). MethodsWe retrospectively reviewed medical records of arthroscopically assisted ACLR surgery performed at our institution between 2012 and 2015. Revision ACLR, bone patella tendon bone (BTB) graft reconstruction, and concomitant multiple ligament reconstructions were excluded. We performed a standardized double-bundle reconstruction procedure using hamstrings graft for ACLR. All patients routinely received DVT screening by using venous ultrasonography on postoperative day 7 from 2012 to 2013, and postoperative days 7 and 14 from 2014 to 2015. The prevalence of DVT was calculated and clinical factors such as age, gender, Body Mass Index (BMI), operative time, and duration of tourniquet application were evaluated in relation to the risk factor of DVT. ResultsTwo hundred and fifty-six patients (129 men and 127 women) with a mean age of 28.9 were enrolled. Sixteen patients (6.6%) were detected with DVT on postoperative day 7. Among 146 patients who received venous ultrasonography on both postoperative days 7 and 14, DVT were detected in five additional patients on postoperative day 14. In a total of 21 patients who were diagnosed with DVT, two were proximal, the remaining 19 were distal, and no patient had progressed to pulmonary embolism (PE). In terms of predisposing factors for developing DVT on postoperative day 7, only age ≥30 showed a statistically significant higher risk of DVT (P = 0.03). ConclusionIncidence of DVT after ACLR detected by ultrasonography on postoperative day 7 was 6.6%. Patients aged ≥30 years have a potentially higher risk for developing DVT. Great care for DVT should be taken if prolonged immobilization is applied after ACLR surgery. Level of evidenceLevel Ⅳ

Nonvascularized Bone Grafts for Reconstruction of Segmental Mandibular Defects: Is Length of Graft a Factor of Success?

The purpose of this study was to evaluate a long-debated question in the field of whether the success of reconstructing mandibular defects with nonvascularized bone grafts (NVBGs) is dependent on the length of the graft. The inclusion criteria were patients who had received NVBGs, such as anterior or posterior iliac crest and costochondral grafts, to reconstruct segmental defects of the mandible between 2008 and 2017 at the Department of Oral and Maxillofacial Surgery at Case Western Reserve University. Patients with a history of irradiation of the head and neck and patients with inadequate follow-up were excluded from this study. Data such as defect length, patient age, comorbidities, length of follow-up, location of defect, etiology of defect, and postoperative course were collected. Success was judged by radiographic and clinical evidence of bone continuity and stability at a minimum of 4months postoperatively. Failures were considered loss of all or part of the graft, resulting in a residual continuity defect requiring further bone grafting. We identified 61 potential cases, of which 29 met the inclusion and exclusion criteria. The mean age of the patients at the time of grafting was 55years (range, 17 to 81years), with a mean follow-up length of 18months. The length of defects ranged from 2 to 22cm. The grafts were 6cm or less in length in 7 defects and greater than 6cm in length in 22 defects. All cases were grafted at a minimum of 6months after resection, and bone morphogenetic protein was used in 25 cases (86%).Failure occurred in 1 patient in the group with grafts of 6cm or less and 2 patients in the group with grafts greater than 6cm, corresponding to success rates of 86% and 91%, respectively. Eight patients experienced minor complications such as wound dehiscence or infection, which resolved with local measures and antibiotics. The results of our study show that NVBGs are a viable, safe, and effective treatment option for segmental mandibular defects over 6cm in length in non-irradiated patients.

Reconstruction plate-related complications in mandibular continuity defects.

The purpose of this study was to evaluate the complications associated with the use of reconstruction plates with or without non-vascularized bone graft in reconstruction of mandibular segmental defects caused by trauma and tumor resection and to analyze various factors that are associated with the development of complications. A retrospective observational study was conducted, and the investigated variables included the age and gender of the patients, etiology of the defect, the site of the defect, the size of the defect, whether bone graft was used or not, type of plate used, and whether the reconstruction was immediate or delayed. The outcome variables were the postoperative complications and the success rate. Fifty-one patients were enrolled in this study; the etiology of mandibular defect was trauma in 39 patients (76.5%) and resection of benign or malignant tumors in 12 patients (23.5%). The complication rate was (58.8%) and the success rate was (94.1%); the only factor that significantly increased the incidence of postoperative complications was the size of the defect. Reconstruction plates demonstrated a high success rate despite the high complication rate. Segmental defects caused by trauma were smaller than those created after tumor resection and the only factor that increased complication rate was the size of the defect; other factors did not affect the complication rate.

Current review of surgical management options for extremity bone sarcomas.

Modern surgical management of extremity bone sarcomas is governed by limb-sparing surgery combined with adjuvant and neoadjuvant chemotherapy.All the resection and reconstruction techniques have to achieve oncologic excision margins, with survival rates and functional results superior to amputation.The main reconstruction techniques of bone defects resulted after resection are: modular endoprosthetic reconstruction; bone graft reconstruction; bone transport; resection arthrodesis; and rotationplasty.Oncologic resection and modular endoprosthetic reconstruction are the generally approved surgical options adopted for the majority of cases in major specialized bone sarcoma centres.Good basic principles, efficient multidisciplinary approach and sustained research in the field can provide a better future for the challenge posed by extremity bone sarcoma treatment.Cite this article: EFORT Open Rev 2019;4:174-182. DOI: 10.1302/2058-5241.4.180048