title: Arthroscopic Implant-Free Bone Grafting for Shoulder Instability With Glenoid Bone Loss: Clinical and Radiological Outcome at a Minimum 2-Year Follow-up.
abstract: Posttraumatic anteroinferior shoulder dislocations with concomitant glenoid bone loss show high recurrence rates. The open J-bone graft technique for implant-less anatomic restoration of bony glenoid structure has previously been described, whereas results of arthroscopic techniques are currently not available.
  
  
  
  To evaluate clinical and radiological outcome after arthroscopic anatomic reconstruction of the glenoid for recurrent anteroinferior glenohumeral instability.
  
  
  
  Case series; Level of evidence, 4.
  
  
  
  Fifteen shoulders of 14 patients with recurrent anteroinferior shoulder instability were prospectively followed after glenoid reconstruction with a modified arthroscopic, implant-free J-bone graft. Preoperatively, the instability severity index score was documented. Patients were followed for a minimum of 2 years using the Rowe score and the Constant score. Subjective outcome was assessed using a visual analog scale (VAS) for pain and the subjective shoulder value for sports (SSVS); satisfaction with procedure outcome was also rated. Range of motion was recorded. Incidence of recurrent instability, defined as dislocation, subluxation, or persistent apprehensiveness, was documented. Pre- and postoperative (1 day and 3, 12, and 24 months) computed tomographic images were used to evaluate glenoid bone loss, reconstruction of the glenoid, and graft remodeling.
  
  
  
  All preoperative scores (Rowe score: 57.6 ± 14.4; Constant score: 70.9 ± 8.9; VAS: 4.4 ± 2.6; SSVS: 31.4% ± 19.5%) were significantly (P ≤ .02) improved at final follow-up (Rowe score: 98.6 ± 1.5; Constant score: 96.3 ± 3.9; VAS: 0.2 ± 0.6; SSVS: 95.6% ± 3.8%). The preoperative glenoid area (82.1% ± 4.5%) was significantly increased immediately after surgery to 99.2% ± 6.6% (P < .001). After a physiological remodeling process, the glenoid area remained significantly increased at the latest follow-up (89.5 ± 3.2%, P < .001). J-bone grafting successfully restored glenoid concavity by significantly increasing concavity extent and depth from preoperative (19.8 ± 2.1 and 0.9 ± 0.6 mm, respectively) to postoperative (24.0 ± 2.1 and 2.1 ± 0.8 mm, respectively) (P < .001). There were no recurrent instabilities. One traumatic graft fracture occurred during the follow-up period.
  
  
  
  The arthroscopic J-bone graft technique permits minimally invasive reconstruction of anteroinferior glenoid defects and provided excellent early clinical outcome without recurrent instability in posttraumatic shoulder dislocations. A physiological remodeling process leads to restoration of a more natural glenoid anatomy.
authors: Department of Orthopedic Surgery, St Vincent Hospital, Vienna, Austria.
authors: Werner
authors: W
authors: Anderl
authors: Department of Orthopedic Surgery, St Vincent Hospital, Vienna, Austria.
authors: Leo
authors: L
authors: Pauzenberger
authors: Department of Orthopedic Surgery, St Vincent Hospital, Vienna, Austria.
authors: Brenda
authors: B
authors: Laky
authors: Department of Orthopedic Surgery, St Vincent Hospital, Vienna, Austria.
authors: Bernhard
authors: B
authors: Kriegleder
authors: Department of Orthopedic Surgery, St Vincent Hospital, Vienna, Austria philipp.heuberer@bhs.at.
authors: Philipp R
authors: PR
authors: Heuberer
mesh_terms: D000328:Adult; D001182:Arthroscopy; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D061165:Glenoid Cavity / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012785:Shoulder Joint / Q000601:surgery*; D055815:Young Adult
keywords: J-bone graft; arthroscopic bone grafting; glenoid bone loss; glenoid defect; implant-less