Summary

Patients with dislocated anterior glenoid fractures were treated with a novel all-arthroscopic button-suture-technique without relevant complications and with excellent clinical results in 16 patients after a minimum follow-up of 6 months

Abstract

Background

Surgical treatment of anterior glenoid fractures remains challenging. Open techniques are associated with high complication rates. Existing arthroscopic methods (utilizing screws or suture anchors) have several pitfalls and limitations. A novel arthroscopic technique uses a glenoid guide to drill from posterior and to introduce an Endobutton-suture-construct from anterior (Wafaisade et al., Arthroscopy Techniques, 2019). The aim of this study was to evaluate the clinical and radiological results of this novel technique.

Methods

23 patients with anterior glenoid fractures were treated with the new technique from March 2017 until December 2017. For the follow-up demographic data, active shoulder function, several shoulder scores and radiographs were evaluated. Mean values with standard deviations were calculated. Ethical approval was obtained from the local ethics committee.

Results

Surgery was performed 12.4 ± 11.0 days after the injury. 61% of the patients showed relevant concomitant intraarticular injury. All 23 patients showed bony healing about 104 days (35 - 259) days following surgery, without any secondary dislocation.

Overall, 16 patients were available for clinical follow-up (14 male, 2 female) at 15.8 (8.6 to 33.9) months after surgery. At this time the Constant Score was 85.9 ± 9.6 , Rowe Score (/100) 90.0 ±12.3, Melbourne Instability Shoulder Score (/100) 86.6 ±15,5, Western Ontario Shoulder Instability Index (%) 81.6 ±15.7, Subjective Shoulder Value (%) 84.4 ± 17.0. Active abduction was 171.9° ±20.7°, and active flexion 175.6° ± 13.2°.
Relevant complications (recurrent instability, infection, wound healing disorders, neuro-vascular injury, heterotopic ossifications, non-union, implant dislocation, hardware impingement) did not occur in any patient.

Conclusion

Anterior glenoid fractures were treated safely, reproducibly and effectively with the novel arthroscopic Endobutton-suture-technique with excellent mid-term results. Standard portals can be used and, in particular, access through the subscapularis muscle, which endangers the neurovascular structures, can be avoided. However, long-term results are still necessary, especially with respect to development of posttraumatic osteoarthritis.