Bardwell Abigail, Scott Parker, Langhans Mark T, Barlow Jonathan D, Camp Christopher L
Mayo Clinic, Rochester, Minnesota, USA.
Video J Sports Med. 2024 Mar 12;4(2):26350254231213388. doi: 10.1177/26350254231213388. eCollection 2024 Mar-Apr.
Managing patients with recurrent anterior shoulder instability and glenoid bony deficiency remains a challenge. Multiple graft options, including iliac crest, distal clavicle, coracoid, and distal tibia allograft have been used. There is a growing body of evidence that supports distal tibia allograft for glenoid restoration in patients with shoulder instability due to its ability to restore the articular surface as well as the glenoid depth and curvature.
Surgical indications for anterior glenoid reconstruction with distal tibia allograft combined with open capsular shift include patients with recurrent shoulder instability and glenoid bone loss.
A deltopectoral interval is utilized and the subscapularis is split in lines with its fibers. The subscapularis and capsule are split together in a horizontal fashion and tagged together. Any prior hardware is then removed utilizing appropriate removal sets, a burr, and a broken screw set if necessary. The anterior glenoid is then prepared and the defect is measured. Bone marrow aspirate is then harvested from the proximal humerus using a vortex needle. The distal tibia allograft is then cut to size and prepared utilizing pulsed lavage, pressurized sterile carbon dioxide, and the bone marrow aspirate. The allograft is then fixed with solid stainless steel 3.5-mm cortical screws with washers. The medial, glenoid based capsular repair it completed by placing 1.8-mm knotless FiberTak anchor at the bottom of the distal tibia allograft. A free needle is utilized to place a horizontal mattress stitch from the anchor to the inferior capsule, which is then loaded onto a shuttling suture, to repair it to the anterior inferior glenoid. A knotless anchor is then placed right off the chondral margin of the humeral head, and this is used to repair both the capsule and subscapularis in the correct position by passing through both inferior and superior leaflets. This is then loaded onto the knotless anchor and reduced, which shifts the subscapularis and capsule laterally. The remainder of the subscapularis split is then closed. Patients are then placed in a sling with an abduction pillow with no shoulder range of motion for 6 weeks. They can then progress their therapy with a goal of returning to sport at 6 months.
Several large systemic reviews have shown that return to sport rates after anterior glenoid reconstruction range between 80% and 90%, with returning to the same level of play in the 70% range.
Anterior glenoid reconstruction utilizing distal tibia allograft combined with an open capsular shift is a durable surgical option for patients presenting with shoulder instability and glenoid bone loss.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
对于复发性前肩不稳合并肩胛盂骨缺损的患者，治疗仍然是一项挑战。已经使用了多种移植选择，包括髂嵴、锁骨远端、喙突和胫骨远端同种异体骨。越来越多的证据支持在肩不稳患者中使用胫骨远端同种异体骨进行肩胛盂重建，因为它能够恢复关节面以及肩胛盂的深度和曲率。
胫骨远端同种异体骨联合开放关节囊移位进行前肩胛盂重建的手术适应证包括复发性肩不稳和肩胛盂骨丢失的患者。
采用胸大肌三角肌间隙入路，沿肩胛下肌纤维方向劈开。肩胛下肌和关节囊一起水平劈开并标记在一起。如有必要，使用合适的取出器械、磨钻和断钉取出器械去除先前的内固定物。然后准备前肩胛盂并测量缺损。接着使用涡旋针从肱骨近端采集骨髓抽吸物。将胫骨远端同种异体骨切割成合适尺寸，并用脉冲冲洗、加压无菌二氧化碳和骨髓抽吸物进行处理。然后用带垫圈的3.5毫米实心不锈钢皮质螺钉固定同种异体骨。通过在胫骨远端同种异体骨底部放置1.8毫米无结FiberTak锚钉来完成基于肩胛盂内侧的关节囊修复。使用游离针从锚钉至下关节囊放置水平褥式缝线，然后将其加载到穿梭缝线上，以将其修复至前下肩胛盂。然后在肱骨头软骨边缘外侧放置一个无结锚钉，通过穿过下叶和上叶将其用于在正确位置修复关节囊和肩胛下肌。然后将其加载到无结锚钉上并复位，使肩胛下肌和关节囊向外移位。然后关闭肩胛下肌劈开的其余部分。患者随后用外展枕悬吊6周，期间肩部无活动范围。然后他们可以逐步进行康复治疗，目标是在6个月时恢复运动。
几项大型系统评价表明，前肩胛盂重建后的运动恢复率在80%至90%之间，其中70%的患者恢复到相同的运动水平。
对于出现肩不稳和肩胛盂骨丢失的患者，利用胫骨远端同种异体骨联合开放关节囊移位进行前肩胛盂重建是一种可靠的手术选择。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可识别，作者在提交本稿件以供发表时已包含患者的豁免声明或其他书面批准形式。
