Arthroscopic Distal Tibial Allograft Reconstruction With Suture Button Fixation and Capsulolabral Repair for Traumatic Anterior Shoulder Instability Yields High Rates of Graft Union and Improves Clinical Outcomes at 2 Years

Abstract

Purpose: To report the 2-year clinical and radiological outcomes of arthroscopic distal tibial allograft (DTA) reconstruction with labral repair, with or without remplissage for restoring glenoid bone loss in traumatic anterior shoulder instability.

Methods: Between March 2019 and February 2022, patients undergoing arthroscopic DTA reconstruction, performed by 3 fellowship-trained surgeons across 3 centers, were recruited to participate in this study. All patients had some degree of glenoid bone loss and recurrent traumatic anterior shoulder instability. Clinical and radiological outcomes included Western Ontario Stability Index, American Shoulder and Elbow Surgeons, and range of motion preoperatively and at 3, 6, 12, and 24 months postoperatively. Patients underwent computed tomography scanning at 6 months to determine graft union and position.

Results: Thirty-two patients were enrolled into the study (24 males, 8 females). Mean preoperative glenoid bone loss was 19.5% (standard deviation [SD] 6.3%, range 10%-34%). Seven of thirty-two patients underwent a remplissage procedure in addition to the labral repair and distal tibia allograft reconstruction. Compared to baseline, outcome scores improved to 2 years postoperatively (mean Western Ontario Stability Index 37.4% [SD 14.9] to 81.7% [SD 14.1]; mean American Shoulder and Elbow Surgeons score 60 [SD 19] to 92.3 [SD 7.6]). Mean forward elevation returned to normal by 2 years. The mean deficit in external rotation at 2 years was 7° (SD 13°) compared to the contralateral side. Thirty-one patients had computed tomography scans at 6 months to confirm healing and graft position. Partial or full graft healing at 6 months was 94%. In the axial plane, grafts were a mean 12.9° (SD 13.0°) to the native glenoid face and translated a mean 0.8 mm (SD 2.4) medial to the anterior glenoid rim. In the sagittal plane, the graft was positioned 1.6 mm (SD 2.1) superior to the midpoint of the native glenoid defect. One patient experienced an subluxation event postoperatively without further instability. Another required revision to Latarjet procedure. There were no perioperative complications.

Conclusions: Arthroscopic DTA bone block glenoid reconstruction using 2 pairs of suture buttons to treat recurrent traumatic anterior instability with significant bone loss yields improved clinical and acceptable radiological outcomes.

Level of evidence: Level IV, retrospective case series.