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      Autologous Tricortical Iliac Bone Graft for Failed Latarjet Procedures

      brief-report
      , M.D., , M.D., , M.D., , M.D., , M.D., , M.D.
      Arthroscopy Techniques
      Elsevier

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          Abstract

          The high recurrence rates seen in open and arthroscopic Bankart repair in the presence of significant glenoid bone loss, Hill-Sachs lesions, or combined bony deficiencies have led many surgeons to choose bony reconstructions to manage these injuries. Although the Latarjet procedure has proved to be reliable to manage recurrent anterior shoulder instability, there have been concerns of a higher surgical complication rate associated with this procedure. Moreover, some of the complications reported with this procedure such as symptomatic implants, fracture or nonunion of the coracoid graft, and recurrence of instability could need a revision surgery to be solved. The autologous tricortical iliac bone graft is an excellent option for failed bony reconstructions. However, as with any successful surgery, each step requires planning and precise application to limit risks and avoid pitfalls. This Technical Note provides a detailed description of the autologous tricortical iliac bone graft for failed Latarjet procedures.

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          Most cited references31

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          Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review.

          Bone grafting is a commonly performed surgical procedure to augment bone regeneration in a variety of cases in orthopaedic and maxillofacial surgery. Autologous bone graft remains to be the 'gold standard' and the iliac crest to be the most common harvesting site. The intramedullary canal of long bones represents another potential site for large volume of autologous bone graft harvesting and is recently being used as an alternative donor site. However, harvesting of autologous bone graft is associated with morbidity and a number of complications. The aim of this systematic review was to collect and summarise the existing data on reported complications after harvesting autologous bone from the iliac crest (anterior and posterior) and the long bone intramedullary canal using the RIA device. We searched the PubMed Medline and Ovid Medline databases, from January 1990 to October 2010, to retrieve all relevant articles. A total of 92 articles (6682 patients) were included in the analysis. Overall, the complication rate following RIA was 6% (14 complications in 233 patients) and 19.37% after iliac crest bone graft harvesting (1249 complications in 6449 patients). The rate of each of the reported complications was assessed and, when the donor site was properly documented, comparison within the anterior and posterior iliac crest donor sites was performed. Although the difference of the overall morbidity rates between the two harvesting sites was not statistically significant (p=0.71); the rates of certain complications were found to significantly differ when anterior or posterior iliac crest was used. The rates of infection (p=0.016), haematoma formation (p=0.002), fracture (p=0.017), and hyperthrophic scar (p=0.017) were significantly higher when the donor site was the anterior iliac crest compared to the posterior iliac crest; whereas the rates of chronic donor site pain (p=0.004) and sensory disturbances (p=0.003) were significantly lower. The incidence of bone graft harvesting related complications can be reduced further if certain principles are followed depending on the performed harvesting methods; but overall the use of RIA device as harvesting method seems a promising alternative with a low complication rate. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation.

            There is no simple method available to identify patients who will develop recurrent instability after an arthroscopic Bankart procedure and who would be better served by an open operation. We carried out a prospective case-control study of 131 consecutive unselected patients with recurrent anterior shoulder instability who underwent this procedure using suture anchors. At follow-up after a mean of 31.2 months (24 to 52) 19 (14.5%) had recurrent instability. The following risk factors were identified: patient age under 20 years at the time of surgery; involvement in competitive or contact sports or those involving forced overhead activity; shoulder hyperlaxity; a Hill-Sachs lesion present on an anteroposterior radiograph of the shoulder in external rotation and/or loss of the sclerotic inferior glenoid contour. These factors were integrated in a 10-point pre-operative instability severity index score and tested retrospectively on the same population. Patients with a score over 6 points had an unacceptable recurrence risk of 70% (p < 0.001). On this basis we believe that an arthroscopic Bankart repair is contraindicated in these patients, to whom we now suggest a Bristow-Latarjet procedure instead.
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              Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review.

              Various methods of bony stabilization, including modifications of Bristow and Latarjet procedures, are considered gold-standard treatment for recurrent anterior shoulder instability but are associated with unique complications and risk of reoperation. The purpose of this study was to identify the prevalence of these complications. We hypothesized that the Bristow-Latarjet procedure would be a successful technique for treatment of shoulder instability but associated with a risk of recurrent postoperative instability, reoperation, and other complications.
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                Author and article information

                Contributors
                Journal
                Arthrosc Tech
                Arthrosc Tech
                Arthroscopy Techniques
                Elsevier
                2212-6287
                18 February 2019
                March 2019
                18 February 2019
                : 8
                : 3
                : e283-e289
                Affiliations
                [1]Shoulder Unit, Hospital Italiano de Buenos Aires, Buenos Aires City, Argentina
                Author notes
                []Address correspondence to Luciano A. Rossi, M.D., Peron 4190 (C1199ABB), Buenos Aires, Argentina. luciano.rossi@ 123456hospitalitaliano.org.ar
                Article
                S2212-6287(18)30191-9
                10.1016/j.eats.2018.11.002
                6471327
                31019886
                470d812e-89e7-498f-9eb8-40c54273c3d1
                © 2018 by the Arthroscopy Association of North America. Published by Elsevier.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 10 October 2018
                : 2 November 2018
                Categories
                Technical Note

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