Summary
This study assessed the healing of critical soft tissue structures after Arthroscopic Anatomic Glenoid Reconstruction (AAGR) with Distal Tibial Allograft (DTA), finding that most patients demonstrated excellent healing of the capsule, labrum, and rotator interval at an average follow-up of three years.
Abstract
Introduction
Arthroscopic Anatomic Glenoid Reconstruction (AAGR) with Distal Tibial Allograft (DTA) is a procedure aimed to restore glenoid bone loss and re-establish glenohumeral stability in patients with recurrent anterior shoulder dislocation. While AAGR with DTA has excellent clinical and radiographic outcomes, there are no previous studies evaluating healing of critical soft tissue structures. The aim of this study is to assess healing of the capsule, labrum, and rotator interval in patients undergoing revision shoulder arthroscopy following an index AAGR with DTA.
Methods
A retrospective, single-center case series was conducted from 2012 to 2021 This retrospective analysis involved the review of prospectively collected arthroscopic videos from patients who underwent revision shoulder arthroscopy after an initial AAGR with DTA. All initial and revisions surgeries were performed by a single surgeon at a single center. Patients with multi-directional instability, medical comorbidities impeding healing or missing arthroscopic videos were excluded. Patient demographics including age, gender, time between index and revision surgery, complications and indication for revision arthroscopy were collected. Revision arthroscopic videos were examined for healing status of capsule, labrum, and rotator interval. Healing was qualitatively evaluated based on inspection and dynamic examination of each structure, and the findings were categorized as Complete, Partial, or None.
Results
Our series included 9 patients, with mean age of 40 years (range 21- 63), and mean interval between index AAGR and revision surgery of 3 years (range 1- 6 years). Complications after index procedure included symptomatic hardware (8 patients, 89%), stiffness (3 patients, 33%) and subjective instability (1 patient, 11%). There were no frank dislocations, infection, fractures or neurovascular deficits. Hardware removal was the most common indication for revision surgery (8 patients, 89%). Revision arthroscopy demonstrated complete healing of the rotator interval in 8 (89%), complete healing of the labrum in 8 (88%) and complete healing of the capsule in 7 (78%) patients. Two patients accounted for partial healing of soft tissue structures. The first patient showed partial healing of the rotator interval as well as a capsular defect associated with suture anchor pullout. The second patient demonstrated an antero-inferior defect of the capsule and labrum with exposure of the inferior screw head; however, this patient did not receive a Bankart repair during the index procedure.
Conclusions
At a mean follow-up of 3 years, patients receiving AAGR with DTA demonstrated excellent healing of labrum, capsule, and the rotator interval. AAGR with DTA is a promising boney procedure for treatment of anterior shoulder instability.