The Hawkins Foundation, Greenville, South Carolina, USA.
Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Łódź, Poland.
Am J Sports Med. 2018 Apr;46(5):1046-1052. doi: 10.1177/0363546517749915. Epub 2018 Jan 30.
Bone loss in shoulder instability is a well-recognized cause of failure after stabilization surgery. Many approaches have been described to address glenoid bone loss, including coracoid transfer. This transfer can be technically difficult and has been associated with high complication rates. An ideal alternative to coracoid transfer would be an autologous source of fresh osteochondral graft with enough surface area to replace significant glenoid bone loss. The distal clavicle potentially provides such a graft source that is readily available and low-cost.
To evaluate distal clavicular autograft reconstruction for instability-related glenoid bone loss, specifically comparing the width of the clavicular autograft with the width of an ipsilateral coracoid graft as prepared for a Latarjet procedure. Further, we sought to compare the articular cartilage thickness of the distal clavicle graft with that of the native glenoid.
Controlled laboratory study.
Twenty-seven fresh-frozen cadaver specimens were dissected, and an open distal clavicle excision was performed. The coracoid process in each specimen was prepared as has been described for a classic Latarjet coracoid transfer. In each specimen, the distal clavicle graft was compared with the coracoid graft for size and potential of glenoid articular radius of restoration. The distal clavicle graft was also compared with the native glenoid for cartilage thickness.
In all specimens, the distal clavicle grafts provided a greater radius of glenoid restoration than the coracoid grafts ( P < .0001). On average, the clavicular graft was able to reconstruct 44% of the glenoid diameter, compared with 33% for the coracoid graft ( P < .0001). The articular cartilage of the glenoid was significantly thicker (1.4 mm thicker, P < .0001) than that of the distal clavicular autograft (average ± SD, 3.5 ± 0.6 mm vs 2.1 ± 0.8 mm, respectively). When specimens with osteoarthritis were excluded, this difference decreased to 0.97 mm when compared with the clavicular cartilage ( P = .0026).
The distal clavicle autograft can restore a significantly greater glenoid bone deficit than the Latarjet procedure and has the additional benefit of restoring articular cartilage to the glenoid. The articular cartilage thickness of the distal clavicle is within 1.4 mm of that of the native glenoid.
The distal clavicular autograft may be a suitable option for reconstruction of instability-related glenoid bone loss. This graft provides a structural osteochondral autograft with a broader radius of reconstruction than that of a coracoid graft, is locally available, has minimal donor site morbidity, is anatomic, and provides articular cartilage.
肩部不稳定导致的骨丢失是稳定手术后失败的一个公认原因。已经描述了许多方法来解决肩胛盂骨丢失的问题，包括喙突转移。这种转移技术难度大，并发症发生率高。喙突转移的理想替代方法是使用具有足够表面积的自体新鲜骨软骨移植物来替代大量的肩胛盂骨丢失。锁骨远端可能是一种提供这种移植物来源的方法，因为它很容易获得并且成本低廉。
评估与不稳定相关的肩胛盂骨丢失的锁骨远端自体骨重建，特别是比较锁骨远端自体骨的宽度与为 Latarjet 手术准备的同侧喙突移植物的宽度。此外，我们还试图比较锁骨远端移植物的关节软骨厚度与正常肩胛盂的关节软骨厚度。
对照实验室研究。
对 27 个新鲜冷冻的尸体标本进行解剖，并进行开放性锁骨远端切除。每个标本中的喙突过程均按经典 Latarjet 喙突转移的方法进行准备。在每个标本中，比较锁骨远端移植物与喙突移植物的大小和恢复肩胛盂关节半径的潜力。还比较了锁骨远端移植物与正常肩胛盂的软骨厚度。
在所有标本中，锁骨远端移植物提供的恢复肩胛盂半径均大于喙突移植物（P <.0001）。平均而言，锁骨远端移植物能够重建 44%的肩胛盂直径，而喙突移植物为 33%（P <.0001）。肩胛盂的关节软骨明显更厚（厚 1.4 毫米，P <.0001），而锁骨远端自体骨的关节软骨厚度分别为 2.1 ± 0.8 毫米（P <.0001）。当排除骨关节炎标本时，与锁骨软骨相比，这一差异减小到 0.97 毫米（P =.0026）。
锁骨远端自体骨可明显恢复比 Latarjet 手术更大的肩胛盂骨缺损，并具有恢复肩胛盂关节软骨的额外益处。锁骨远端的关节软骨厚度与正常肩胛盂的关节软骨厚度相差 1.4 毫米。
锁骨远端自体骨可能是不稳定相关肩胛盂骨丢失重建的合适选择。这种移植物提供了一种结构性的骨软骨自体移植物，其重建半径比喙突移植物更宽，局部可用，供区并发症少，具有解剖学特征，并提供关节软骨。
