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Indication d’une butée arthroscopique en cas de perte de substance glénoïdienne antérieure: revue systématique et résultats radiologiques - 15/07/21

Arthroscopic bone block stabilisation procedures for glenoid bone loss in anterior glenohumeral instability: A systematic review of clinical and radiological outcomes

Doi : 10.1016/j.rcot.2021.04.026 
Muaaz Tahir a, , Shahbaz Malik b, Robert Jordan a, Madara Kronberga a, Peter D’Alessandro c, Adnan Saithna d
a Trauma and orthopaedic surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK 
b Worcestershire Acute Hospitals NHS Trust, Worcester, UK 
c Orthopaedic Research Foundation of Western Australia, Perth, Australia 
d Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA 

Auteur correspondant. Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UKQueen Elizabeth Hospital Birmingham, Mindelsohn WayBirmingham B15 2THUK
En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Thursday 15 July 2021
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Abstract

Introduction

Recurrent shoulder instability is frequently associated with glenohumeral bone loss. Recently there has been a surge of interest in arthroscopically performed bone block procedures. The aim of this systematic review was to determine the clinical and radiological outcomes of arthroscopic glenoid bone block stabilisation for recurrent anterior dislocation.

Methods

This systematic review was performed in accordance with PRISMA guidelines. The search strategy was applied to MEDLINE and Embase databases on 20th July 2020. Studies reporting either clinical or radiological outcomes following arthroscopic bone block stabilisation for recurrent anterior dislocation were included. Primary outcomes were function and instability scores. Secondary outcomes included recurrent instability, graft union and resorption rates, return to activity/sports, and complications. Pooled analysis was performed when an outcome was uniformly reported by more than one study. Critical appraisal of studies was conducted using the Methodological Index for Non-Randomized Studies (MINORS) tool.

Results

Application of the search strategy resulted in the inclusion of 15 eligible studies; 12 used iliac crest bone graft while 3 used distal tibial allograft. The overall population comprised 265 patients (mean age range, 25.5–37.5 years; 79% of participants were men). All post-operative outcome scores were significantly improved, and the overall rate of recurrent instability was low (weighted mean 6.6%, range 0–18.2%) at mean follow up of 30.4 months. The Rowe score was the most frequently reported outcome measure, improving on average by 53.9 points at final follow-up, exceeding the minimal clinically important difference (MCID) threshold. Graft union rates ranged between 92–100% in 8 out of 10 studies at mean follow up range 6–78.7 months but two reported lower rates ranging from 58.3–84% for autografts and 37.5% for allografts. Graft resorption rates averaged between 10–16% for autografts and 32% for allografts. Hardware-related complications occurred in 2% with the most frequent being screw breakage or symptomatic mechanical irritation.

Conclusion

Arthroscopic bone block stabilisation is associated with high rates of graft union, significant improvements in the WOSI, Rowe, Constant and SSV scores (exceeding MCID thresholds where known), and a low rate of complications, including re-dislocation in the short to mid-term. Graft union rates were high, but the long-term implications of graft resorption (which occurs more frequently with allograft) are unknown. Longer follow-up of these patients and future experimental studies are required to further examine the effects of graft type and fixation methods.

Level of Evidence

IV; systematic review.

El texto completo de este artículo está disponible en PDF.

Keywords : Shoulder instability, Glenoid defect, Autograft, Allograft, Arthroscopic bone block procedure



 Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus.


© 2021  Publicado por Elsevier Masson SAS.
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