' '
Deutsch | English    

Forschungsdatenbank PMU-SQQUID

Clinical and Radiological Long-term Results After Implant-Free, Autologous, Iliac Crest Bone Graft Procedure for the Treatment of Anterior Shoulder Instability.
Moroder, P; Plachel, F; Becker, J; Schulz, E; Abdic, S; Haas, M; Resch, H; Auffarth, A;
Am J Sports Med. 2018; 46(12): 2975-2980.
Originalarbeiten (Zeitschrift)

PMU-Autor/inn/en

Auffarth, MSc Alexander
Becker Johannes
Moroder Philipp
Plachel Fabian
Resch Herbert

Abstract

BACKGROUND
The implant-free, autologous, iliac crest bone graft procedure (J-bone graft) for the treatment of anterior shoulder instability shows low rates of recurrent dislocations and moderate progression of instability arthropathy in the midterm follow-up.
To analyze the clinical and radiological long-term results of the J-bone graft procedure.
Case series; Level of evidence, 4.
A total of 46 patients (47 shoulders) with anterior shoulder instability and a relevant bony glenoid defect who received a J-bone graft between 1993 and 2000 and who were previously subjected to a midterm follow-up (mean, 8 years) were included. In total, 34 patients and 35 shoulders (74%) were clinically and radiologically assessed after a mean follow-up of 18 years (range, 15-23 years). Patients were assessed in terms of pain, bilateral active range of motion, and strength; in addition, the Western Ontario Shoulder Instability Index (WOSI), the Rowe Score, and the Subjective Shoulder Value (SSV) were obtained. Both an apprehension test and a relocation test were performed. Radiological imaging included bilateral radiographs (true anteroposterior and axillary view) to determine the grade of instability arthropathy.
At final follow-up, a mean WOSI score of 295 (range, 0-1765), Rowe Score of 94 (range, 55-100), SSV of 90% (range, 20%-100%), and pain level of 0.5 (range, 0-4) were noted. Slight differences were detected in active range of motion between the affected and the contralateral side: flexion 178° vs 179° ( P = .325), abduction 177° vs 179° ( P = .225), external rotation 63° vs 67° ( P = .048), high external rotation 77° vs 82° ( P = .007), internal rotation 8.8 vs 9.4 points ( P = .017), and high internal rotation 70° vs 74° ( P = .026). No significant strength deficit of the affected side was noticed. In 1 patient, a traumatic redislocation with fracture of the bone graft was observed 6 weeks after index surgery. No further recurrences were found during the follow-up period. Negative apprehension and relocation tests were confirmed in 77% of the shoulders, while 23% were positive. At final follow-up, 9 shoulders showed no signs of instability arthropathy (26%), mild arthropathy was revealed in 22 shoulders (63%), moderate arthropathy was noted in 3 shoulders (9%), and signs of severe arthropathy were found in 1 shoulder (3%) (collective instability arthropathy score, 0.9). The collective instability arthropathy score on the contralateral side was 0.4 ± 0.8 with no instability arthropathy in 24 shoulders (69%), mild arthropathy in 8 shoulders (23%), moderate signs of arthropathy in 2 shoulders (6%), and severe arthropathy in 1 shoulder (3%) at the time of follow-up examination (collective instability arthropathy score, 0.4). The overall difference between affected shoulders and contralateral shoulders was significant ( P = .005).
The J-bone graft procedure for the treatment of recurrent anterior shoulder instability shows excellent results regarding stability and function after a mean follow-up period of 18 years. However, the development of instability arthropathy of the affected shoulder is not prevented by this procedure.


Find related publications in this database (Keywords)

anterior shoulder instability
significant bony glenoid defect
J-bone graft procedure
instability arthropathy
long-term follow-up