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Anatomical glenoid reconstruction via a J-bone graft for recurrent posttraumatic anterior shoulder dislocation

Anatomische Glenoidrekonstruktion mit J-Span-Plastik nach wiederkehrender posttraumatischer vorderer Schulterluxation

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Abstract

Objective

To reconstruct the anatomical glenoid shape in cases of osseous glenoid rim defects after recurrent posttraumatic anterior shoulder dislocation to restore stability without severely compromising the range of motion.

Indications

Osseous glenoid defects after recurrent posttraumatic anterior shoulder dislocation. Suitable for primary stabilization as well as for revision surgery in cases previously operated on.

Contraindications

Recurrent anterior shoulder dislocations without glenoid rim defects. Hyperlax shoulders with multidirectional instability. Patients over 60 years of age due to compromised bone quality. Teenage patients due to incomplete apophyseal fusion at the iliac crest.

Surgical technique

The subscapularis tendon and capsule are split. The humeral head is retracted laterally, and the glenoid defect is prepared and abraded with a rasp. A bicortical iliac crest bone block including crest and outer cortex is harvested and molded in a J-shaped manner. To incorporate the graft, a crevice on the glenoid rim is produced using a chisel. The keel is fitted into the preformed crevice with a spiked impactor. The graft’s surface is contoured using a high-speed burr.

Results

A total of 47 shoulders were followed-up after an average of 90 months (range 25–152 months). The mean Rowe scores were 94.3 for the affected shoulder and 96.8 for the uninjured shoulder. The Constant scores reached 93.5 and 95 points, respectively. Loss of external rotation was 4.4°. In addition, 24 shoulders were followed-up by computed tomography (CT). There were no recurrences, with the exception of one traumatic graft fracture. Of 19 patients with arthropathy at follow-up, 11 already had arthropathy prior to the procedure.

Zusammenfassung

Operationsziel

Rekonstruktion der anatomischen Glenoidform bei knöchernem Defekt nach wiederkehrender traumatischer vorderer Schulterluxation zur Wiederherstellung der Schultergelenksstabilität – ohne den Bewegungsumfang wesentlich zu beeinträchtigen.

Indikationen

Knöcherner Glenoiddefekt nach wiederkehrender posttraumatischer vorderer Schulterluxation als Erst- oder Revisionseingriff.

Kontraindikationen

Wiederkehrende vordere Schulterluxationen ohne knöchernen Glenoiddefekt. Multidirektionale Instabilitäten. Patienten über 60 Jahre. Offene Apophysenfuge am Beckenkamm.

Operationstechnik

Die Subskapularissehne und die Gelenkskapsel werden gespalten. Der Humeruskopf wird zur Seite gehalten und der Glenoiddefekt dargestellt. Ein bikortikaler Beckenkammspan mit kranialer und lateraler Kortikalis wird entnommen und in Form des Buchstaben J modelliert. Um den Span zu verankern, wird mit dem Meißel eine Osteotomie am Skapulahals vorgenommen. Der Keil des Spans wird mit einem gezahnten Stößel eingeschlagen. Die Oberfläche des Spans wird mit der Olivenfräse an das umgebende Knorpelniveau angeglichen.

Ergebnisse

Siebenundvierzig Schultern wurden nach durchschnittlich 90 (25–152) Monaten untersucht. Der durchschnittliche Rowe-Score lag bei 94,3 für die operierte und 96,8 für die unverletzte Schulter. Der Constant-Score lag im Vergleich bei 93,5 bzw. 95 Punkten. Die Einschränkung der Außenrotation lag bei durchschnittlich 4,4°. Vierundzwanzig Schultern wurden mit Computertomographie nachuntersucht. Es gab keine Reluxationen, jedoch eine traumatische Spanfraktur. Von den 19 Patienten mit Arthrosezeichen bei Nachuntersuchung lagen diese schon in 11 Fällen präoperativ vor.

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Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Traumatology and Sportsinjuries, Paracelsus Medical University, Muellner- Hauptstr. 48, 5020, Salzburg, Austria

    A. Auffarth & H. Resch

  2. Department of Traumatology and Sportsinjuries, Innsbruck Medical University, Innsbruck, Austria

    F. Kralinger

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  1. A. Auffarth
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  2. F. Kralinger
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  3. H. Resch
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Correspondence to A. Auffarth.

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Auffarth, A., Kralinger, F. & Resch, H. Anatomical glenoid reconstruction via a J-bone graft for recurrent posttraumatic anterior shoulder dislocation. Oper Orthop Traumatol 23, 453–461 (2011). https://doi.org/10.1007/s00064-011-0055-5

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