An arthroscopic bone block procedure is effective in restoring stability, allowing return to sports in cases of glenohumeral instability with glenoid bone deficiency

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 26; no. 12; pp. 3780 - 3787
• Main Authors: Taverna, Ettore, Garavaglia, Guido, Perfetti, Carlo, Ufenast, Henri, Sconfienza, Luca Maria, Guarrella, Vincenzo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-12-2018; Springer Nature B.V
• Subjects: Adolescent; Adult; Arthroscopy - methods; Athletes; Athletic Injuries - surgery; Bone grafts; Bone healing; Bone loss; Bone Remodeling; Computed tomography; Dislocations; Female; Fixation; Grafting; Humans; Knee; Male; Medicine; Medicine & Public Health; Orthopedics; Patients; Range of Motion, Articular; Retrospective Studies; Return to Sport; Shoulder; Shoulder Dislocation - rehabilitation; Shoulder Dislocation - surgery; Shoulder Joint - diagnostic imaging; Shoulder Joint - surgery; Skin & tissue grafts; Stability; Substitute bone; Surgery; Tomography, X-Ray Computed; Treatment Outcome; Young Adult; Shoulder instability; Arthroscopic bone block; Button fixation; Eden-Hybinette; Artroscopically assisted; Latarjet; Glenoid guide; Glenoid bone loss
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-018-4921-7

Purpose
A group of patients affected by bone loss in the context of recurrent anterior shoulder instability were treated arthroscopically with a modified Eden-Hybinette technique since 2005. The last modification was made in 2013, consisting of fixation using a pair of specifically designed double round Endobuttons, which secure the bone graft to the glenoid rim placed through a guide. This report describes patients operated on after this last modification. No reports have described the results of this technique, and the purpose of this study was to assess early clinical and radiological results of an arthroscopic bone block procedure with double round Endobutton fixation. We hypothesized that this technique would restore shoulder stability in patients with anteroinferior glenohumeral instability with glenoid bone deficit, with excellent clinical and radiological results.
Methods
The clinical and radiological efficacy of this procedure was retrospectively evaluated in 26 patients with an average follow-up of 29.6 months (range 24–33 months).
Results
At minimum 2-year follow-up, we had no recurrent anterior dislocations, excellent clinical results [average Walch-Duplay score 93.2, (SD 7.8); average Rowe score, 96.4 (SD 6.5); average SSV, 87.4 (SD 12.1); satisfaction rate, 88.5%; average loss of external rotation, 4.4° (SD 8.7°)] optimal graft positioning, and a healing rate of 92.3% on computed tomography scan.
Conclusions
Arthroscopic bone block grafting combined with a standard Bankart repair restored shoulder stability in patients with anteroinferior glenohumeral instability with glenoid bone deficit, with excellent clinical and radiological results. This procedure did not substantially limit external rotation, allowing a high rate of return to sports even among competitive, overhead, and “at risk” athletes.