2021 ISAKOS Biennial Congress ePoster
Arthroscopic Guided Bone Block Procedure Using Cortical Round-Button In Recurrent Anterior Shoulder Instability: A Prospective Study
Sabri Dlimi, MD, Porto Viro, Rovigo ITALY
Paolo Piovan, Este ITALY
Andrea Fiocchi, MD, Ferrara, Ferrara ITALY
Alberto Marzolla, MD, Porto Viro, Rovigo ITALY
Ali Ghorbankhani, MD, Nottingham, Nottingham UNITED KINGDOM
Oreste Arduin, MD, rovigo, Rovigo ITALY
Gianluigi Carloni, MD, Forli ITALY
Antonello Lazzaro, MD, Pescara, Pescara ITALY
Casa di cura Madonna della Salute , Porto Viro, Rovigo, ITALY
FDA Status Not Applicable
Summary
Arthroscopic Latarjet and Bone Block procedure are effective, reproducible treatment with an excellent final outcome in patients affected by shoulder instability. The Round-Button system with dedicated guide was found to be a reliable fixation system, allows graft healing and avoids hardware related complications.
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Abstract
Aim
We hypothesized that a specific guide can improve the positioning of the graft and bicortical buttons’ fixation can decrease screws related complications’ rate.
Background
Glenoid bone-loss is a challenging problem in setting of recurrent anterior shoulder instability (AGHI).Arthroscopic Latarjet, Iliac Crest Bone Graft And Xenograft are commonly utilized in patients with glenoid bone-loss >13 % or with significant risk factors for recurrence; both provided excellent functional results but high revision rates for screws related problems.
Methods
Patients affected by AGHI with bone loss from 2016-2020 were prospectively enrolled.
Preoperative X-ray, arthro-MRI and CT were performed.
Clinical exam in the pre and post-operative follow-up included ROM, Apprehension-test, ROWE-score and Subjective Shoulder Value (SSV).
Two differents surgical techniques were performed: 1) Arthroscopic latarjet according to Boileau using 2 Round-button and 2) Iliac crest bone block or equine Xenograft with Subscapularis Augmentation (ASA) procedure according to Taverna-Russo-Maiotti using 5 Round-Button.
A failure was defined by (compared to healthy shoulder):
a) apprehension or recurrence, b) ROM reduction (except ER1-2)>25%, c) reduction of ER1-2>50% d) non-integration of the graft e) Hardware Cortical Button faillure
Results
The study involved 30 patients (M:F;20 :10), The median age was 30 years (IQR 25-36).
After a median follow-up time of 30 months (IQR 14-40), 28 patients (95%) had a significant improvement of the post-operative median Rowe-Score from 52 to 92°(p<0.001). We observed also a significant improvement of the SSV from 40 to 87%(p<0.001)
We didn’t observe any significant difference in ROM, except in ER. The mean deficit of RE1 was 10°(±5°) and 6°(±5°) in the ER2 compared to healthy shoulder.
Onefailure case (3%) was observed: one patient had recurrence of dislocation with non-integration of the Bone Block (xenograft).
We observed, at the the CT-scan, an optimal placement of our graft in the 28 patients ( 90%) , flush and in the half sub-equatorial part of the glenoide.
We registered no infections, no vascular-nerve injuries and no hardware related complications (migration, breakage, torsion, bending and pull-out).
Conclusions
Arthroscopic Latarjet and Bone Block combined with ASA procedure are effective, reproducible treatment with an excellent final outcome in patients affected by shoulder instability.
The Round-Button system with dedicated guide was found to be a reliable fixation system in all cases, ensuring excellent positioning, solid compression and stability of the graft.
This system allows graft healing and avoids hardware related complications.