Comparison of reconstructive procedures for glenoid bone loss associated with recurrent anterior shoulder instability

Abstract

Hypothesis: A tibial plafond allograft, iliac crest allograft, and coracoid autograft in a congruent arc Latarjet reconstruction better restore radius of curvature, depth, and surface area for glenoid bone loss in recurrent instability compared with the coracoid autograft in a standard Latarjet reconstruction for anteroinferior glenoid bone loss of the shoulder.

Methods: Three-dimensional shoulder models were generated from bilateral computed tomography scans in 15 patients, who were a mean (standard deviation [SD]) age of 23 (7.7) years, with recurrent anterior shoulder instability and known glenoid bone loss. The surface areas of the glenoid in the involved and contralateral normal shoulder were measured. Virtual surgery was then performed using standard and congruent arc Latarjet reconstruction, tibial plafond, and iliac crest allografts. Grafts were optimally positioned to restore articular congruity and defect fill. Radius of curvature and restoration of glenoid depth were compared with the contralateral glenoid.

Results: Glenoid surface area (11.04% [6.95% SD]) and depth (0.75 [0.57 SD] vs 1.44 [0.65 SD] mm) were significantly reduced (P < .012) in the injured glenoid. The mean (SD) coronal plane radius of curvature of the congruent arc Latarjet reconstruction (60.3 [39.0 SD] mm) more closely matched the radius of curvature of the injured glenoid (67.5 [33.2 SD] mm) compared with the other grafts. Restored glenoid depth was greater in the tibial plafond (1.8 [1.1 SD] mm) and iliac crest (2.0 [0.6 SD] mm) allografts compared with other grafts (P < .002).

Conclusion: Congruent arc Latarjet reconstruction more closely restores native glenoid coronal radius of curvature, whereas tibial plafond and iliac crest allografts more adequately restore depth compared with standard Latarjet reconstruction.

Keywords: Bone loss; Latarjet; allograft; glenoid; instability; shoulder.