2017 ISAKOS Biennial Congress ePoster #2005

 

Arthroscopic Anatomic Glenoid Reconstruction: Analysis of the Learning Curve

Iustin Moga, MD, Halifax, Nova Scotia CANADA
Ivan Wong, MD, FRCSC, MACM, Dip. Sports Med, Halifax, NS CANADA
George A. Konstantinidis, MD, PhD, Darwin, NT AUSTRALIA

Dalhousie University, Halifax, Nova Scotia, CANADA

FDA Status Not Applicable

Summary

Our retrospective study of Arthroscopic Anatomic Glenoid Reconstruction, a novel treatment technique for recurrent anterior shoulder instability, finds that this procedure is easier to learn than Arthroscopic Latarjet, and achieves similar outcomes.

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Abstract

Introduction

The arthroscopic Anatomic Glenoid Reconstruction has been recently described. This technique involves the use of distal tibial bone graft to recreate anterior glenoid bone surface in patients with glenoid bone loss and shoulder instability. An additional medial portal is used for graft placement, and this is established using an inside-out technique. This approach avoids damage to the subscapularis muscle, and the capsule and labrum are also preserved. By comparison, the Arthroscopic Latarjet technique requires more portals and splitting of the subscapularis tendon, as well as excision of the capsule and labrum. This innovative technique has a good safety profile and good early clinical results, and is less technically complex than the Arthroscopic Latarjet.

Purpose

The purpose of this study is to investigate the learning curve for the Arthroscopic Anatomic Glenoid Reconstruction technique and to compare it with the learning curve of the Arthroscopic Bristow-Latarjet technique with respect to surgical time, outcome scores, and complication rates.

Methods

Fifty-seven cases of surgically treated patients with recurrent anterior shoulder instability were reviewed. All operations were carried out with the patient in a lateral decubitus position. Twenty-nine patients were managed with the Arthroscopic Latarjet procedure using coracoid bone graft, and 28 were treated with Arthroscopic Anatomic Glenoid Reconstruction using distal tibial bone graft. Procedure start and stop times were recorded and procedure durations calculated. Additional data, including demographic information, intraoperative and postoperative complications, and postoperative Western Ontario Instability Index scores were collected for each participant.

Results

In the case of Arthroscopic Latarjet, the first 14 cases took an average 184 minutes to perform, with the remaining cases in the cohort averaging 116 minutes each in duration. For Arthroscopic Anatomical Glenoid Reconstruction, the first 14 cases took an average of 90 minutes, with the remaining cases averaging 84 minutes each. The complication rates were low and the postoperative outcomes satisfactory for both techniques.

Conclusion

These results suggest that Arthroscopic Anatomic Glenoid Reconstruction is faster to perform compared to the Arthroscopic Latarjet. Further investigations into the safety and efficacy of this procedure will help determine whether it is a better choice for surgeons looking to learn the skill of boney augmentation for recurrent anterior instability.