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

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 be...

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Autores principales: Robinson, Sean P., Patel, Vikas, Rangarajan, Rajesh, Lee, Brian K., Blout, Collin, Itamura, John M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846684/
https://www.ncbi.nlm.nih.gov/pubmed/33554166
http://dx.doi.org/10.1016/j.jseint.2020.09.018
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author Robinson, Sean P.
Patel, Vikas
Rangarajan, Rajesh
Lee, Brian K.
Blout, Collin
Itamura, John M.
author_facet Robinson, Sean P.
Patel, Vikas
Rangarajan, Rajesh
Lee, Brian K.
Blout, Collin
Itamura, John M.
author_sort Robinson, Sean P.
collection PubMed
description 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.
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spelling pubmed-78466842021-02-04 Distal tibia allograft glenoid reconstruction for shoulder instability: outcomes after lesser tuberosity osteotomy Robinson, Sean P. Patel, Vikas Rangarajan, Rajesh Lee, Brian K. Blout, Collin Itamura, John M. JSES Int Shoulder 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. Elsevier 2020-11-28 /pmc/articles/PMC7846684/ /pubmed/33554166 http://dx.doi.org/10.1016/j.jseint.2020.09.018 Text en © 2020 Published by Elsevier Inc. on behalf of American Shoulder and Elbow Surgeons. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Shoulder
Robinson, Sean P.
Patel, Vikas
Rangarajan, Rajesh
Lee, Brian K.
Blout, Collin
Itamura, John M.
Distal tibia allograft glenoid reconstruction for shoulder instability: outcomes after lesser tuberosity osteotomy
title Distal tibia allograft glenoid reconstruction for shoulder instability: outcomes after lesser tuberosity osteotomy
title_full Distal tibia allograft glenoid reconstruction for shoulder instability: outcomes after lesser tuberosity osteotomy
title_fullStr Distal tibia allograft glenoid reconstruction for shoulder instability: outcomes after lesser tuberosity osteotomy
title_full_unstemmed Distal tibia allograft glenoid reconstruction for shoulder instability: outcomes after lesser tuberosity osteotomy
title_short Distal tibia allograft glenoid reconstruction for shoulder instability: outcomes after lesser tuberosity osteotomy
title_sort distal tibia allograft glenoid reconstruction for shoulder instability: outcomes after lesser tuberosity osteotomy
topic Shoulder
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846684/
https://www.ncbi.nlm.nih.gov/pubmed/33554166
http://dx.doi.org/10.1016/j.jseint.2020.09.018
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