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. 2020 Nov 28;5(1):60-65.
doi: 10.1016/j.jseint.2020.09.018. eCollection 2021 Jan.

Distal tibia allograft glenoid reconstruction for shoulder instability: outcomes after lesser tuberosity osteotomy

Sean P Robinson  1 , Vikas Patel  1 , Rajesh Rangarajan  1 , Brian K Lee  1 , Collin Blout  1 , John M Itamura  1
Affiliations

Distal tibia allograft glenoid reconstruction for shoulder instability: outcomes after lesser tuberosity osteotomy

Sean P Robinson et al. JSES Int. .

Abstract

Background: Distal tibia allograft reconstruction of the glenoid in shoulder instability has garnered significant attention over the last decade. Prior studies demonstrate significant improvement in all reported patient outcomes albeit the approach is through a subscapularis split. There have not been prior studies evaluating outcomes after lesser tuberosity osteotomy which provides excellent exposure to the anterior glenoid.We hypothesize there is significant improvement in functional outcomes and no deleterious effects after lesser tuberosity osteotomy for distal tibia allograft reconstruction of the glenoid for shoulder instability.

Methods: A retrospective review was performed from 2016 of 2019 of patients undergoing distal tibia allograft reconstruction of the glenoid through a lesser tuberosity osteotomy. Patients were indicated if they had recurrent anterior shoulder instability with >20% glenoid bone loss and evidence of an off-track lesion. Clinical, imaging, and operative data were evaluated. Objective follow-up data evaluated at minimum 2 years included radiographs, range of motion, DASH, SANE, VAS, SST, ASES, and Constant scores.

Results: A total of 12 patients were available with average follow-up 28 months, average age 26 years old, and average glenoid bone loss of 33%. The patients demonstrated significant improvement in their clinical outcomes at final follow-up: DASH 42.9-8.9 (P = .004), SANE 32.2-85 (P = .00005), VAS 4.6-1.1 (P = .003), SST 7-11.4 (P = .01), ASES 50.2-90.5 (P = .001), and Constant 37.6-86.2 (P = .01). Range of motion at final follow-up was forward flexion to 161.4° (135-170°), external rotation 49.5° (40-65°), and internal rotation to T12-L1 (T7-L2) vertebral body.

Conclusion: The present study demonstrates the effectiveness of a lesser tuberosity osteotomy in exposure of the glenoid for reconstruction with a distal tibia allograft. The functional integrity of the subscapularis is maintained and the patient-reported outcomes are comparable with current literature.

Keywords: Distal tibia allograft; glenoid bone loss; lesser tuberosity osteotomy; shoulder instability.

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Figures

Figure 1
Figure 1
(A) The anterolateral portion of the distal tibia allograft is measured and cut followed by (B) placement along the anterior glenoid and secured in place. (C) Allograft is secured with final implants. (D) Lesser tuberosity osteotomy repair in double row technique.
Figure 2
Figure 2
Patient-reported outcomes. Significant improvement from preoperative vs 12-month follow-up and preoperative vs final follow-up. No significant difference from 12-month follow-up to final follow-up. Significance P < .05.
Figure 3
Figure 3
Plain axillary radiographs of a patient demonstrating osteotomy and allograft healing from (A) 1 month postoperatively, (B) 2 months postoperatively, (C) 4 months postoperatively, (D) 7 months postoperatively, and (E) 3 years postoperatively.
See this image and copyright information in PMC

References

    1. Bernhardson A.S., Peebles L.A., Murphy C.P., Sanchez A., LaPrade R.F., Provencher M.T. Management of The Failed Latarjet Procedure: Outcomes of Revision Surgery With Fresh Distal Tibial Allograft. Ortho J Sports Med. 2019;7(suppl5) doi: 10.1177/2325967119s00315. - DOI - PubMed
    1. Bhatia S., Van Thiel G.S., Gupta D., Ghodadra N., Cole B.J., Bach B.R., Shewman E. Comparison of Glenohumeral Contact Pressures and Contact Areas after Glenoid Reconstruction with Latarjet or Distal Tibial Osteochondral Allografts. Am J Sports Med. 2013;41:1900–1908. doi: 10.1177/0363546513490646. - DOI - PubMed
    1. Buckley T., Miller R., Nicandri G., Lewis R., Voloshin I. Analysis of Subscapularis Integrity and Function after Lesser Tuberosity Osteotomy versus Subscapularis Tenotomy in Total Shoulder Arthroplasty Using Ultrasound and Validated Clinical Outcome Measures. J Shoulder Elbow Surg. 2014;23:1309–1317. doi: 10.1016/j.jse.2013.12.009. - DOI - PubMed
    1. Buraimoh M.A., Okoroha K.R., Oravec D.J., Peltz C.D., Yeni Y.N., Muh S.J. A Biomechanical Comparison of Subscapularis Repair Techniques in Total Shoulder Arthroplasty: Lesser Tuberosity Osteotomy versus Subscapularis Peel. JSES Open Access. 2018;2:8–12. doi: 10.1016/j.jses.2017.11.008. - DOI - PMC - PubMed
    1. Burkhart S.S., DeBeer J.F., Tehrany A.M., Parten P.M. Quantifying Glenoid Bone Loss Arthroscopically in Shoulder Instability. Arthroscopy. 2002;18:488–491. doi: 10.1053/jars.2002.32212. - DOI - PubMed

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